J Nutr Health Aging.

2020;24(9):948-950
© Serdi and Springer-Verlag International SAS, part of Springer Nature

EFFECT OF THE COVID-19 EPIDEMIC ON PHYSICAL ACTIVITY

IN COMMUNITY-DWELLING OLDER ADULTS IN JAPAN:
A CROSS-SECTIONAL ONLINE SURVEY
M. YAMADA1, Y. KIMURA2, D. ISHIYAMA2, Y. OTOBE2, M. SUZUKI2, S. KOYAMA2, T. KIKUCHI2,
H. KUSUMI2, H. ARAI3
1. Faculty of Human Sciences, University of Tsukuba, Tokyo, Japan; 2. Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tokyo, Japan; 3. National Center for
Geriatrics and Gerontology, Aichi, Japan. Corresponding author: Minoru Yamada, PT, PhD, Faculty of Human Sciences, University of Tsukuba, 3-29-1 Otsuka, Bunkyo-ku, Tokyo 112-
0012, Japan, Tel: +81-3-3942-6863, Fax: +81-3-3942-6895, E-mail address: m-yamada@human.tsukuba.ac.jp

Abstract: Objectives: The objective of this study was to investigate changes in physical activity (PA) between
January (before the COVID-19 epidemic) and April (during the COVID-19 epidemic) 2020 in community-
dwelling older adults in Japan. Design: Cross-sectional online survey. Setting and Subjects: From April 23 to
27, 2020, an online survey was completed by 1,600 community-dwelling older adults in Japan. Methods: We
assessed the frailty status using the Kihon checklist, and other demographics and asked questions regarding PA
at two time points: January and April 2020. We defined the total PA time (minutes) per week based on activity
frequency and time. Results: The study participants’ mean age, proportion of women, and prevalence of frailty
were 74.0±5.6 years, 50% (n=800), and 24.3% (n=388), respectively. We found a significant decrease in total
PA time in April 2020 (median [interquartile range (IQR)], 180 [0 to 420]) when compared to January 2020
(median [IQR], 245 [90 to 480]) (P<0.001). We also performed a subgroup analysis according to the frailty
category; total PA time significantly decreased in April 2020 when compared to January 2020 for all frailty
categories (P<0.001). Conclusion: In conclusion, due to the COVID-19 epidemic, the total PA time in April
2020 significantly decreased compared to that in January 2020 in older adults. This finding may lead to a higher
incidence of disability in the near future in older people.

Key words: COVID-19, physical activity, older adults.

Introduction that the PA in April has drastically decreased compared to that

in January in older adults, especially for frail older adults.
The Coronavirus disease 2019 (COVID-19) is creating a
serious impact that causes a high morbidity and mortality rate Methods
worldwide. The World Health Organization (WHO) declared
COVID-19 a pandemic in March 2020, and the Japanese Participants
government declared a state of emergency on April 7, 2020. From April 23 to 27, 2020, an online survey was completed
In particular, older adults may be at high risk for severe illness by 1,600 community-dwelling older adults in Japan. The
from COVID-19, and several academic societies have proposed inclusion criteria included adults who were 65 to 84 years old
recommendations on COVID-19 for older adults. Many older without COVID-19 and were residents of Tokyo, Kanagawa,
adults, especially frail older adults, are more vulnerable to Chiba, Saitama, Aichi, Osaka, Hyogo, and Fukuoka prefectures,
adverse health outcomes, such as falls and disabilities (1, 2). which are urban areas. This study was conducted in accordance
Physical activity or exercise, such as walking, plays an with the guidelines proposed by the Declaration of Helsinki,
important role in preventing several adverse health outcomes and the study protocol was reviewed and approved by
for older adults (3, 4). However, the amount of physical activity the Ethics Committee of the Faculty of Human Sciences,
(PA) for older adults may notably decrease due to the COVID- University of Tsukuba.
19 epidemic. In March 2011, the north-eastern part of Japan
was rocked by a huge earthquake and tsunami. This disaster PA measurement
not only led to a large number of deaths, but also to a higher We assessed PA using a questionnaire based on the Short
incidence of disability after a few months in disaster areas (5). Version of the International Physical Activity Questionnaire
One of the possible reasons is a decline in PA after a disaster, (6), which consists of three dimensional activity items: activity
similarly, the COVID-19 epidemic may cause lower PA and a intensity level (light, moderate, and vigorous intensity), activity
high incidence of disability. frequency per week, and activity time per day. We investigated
The objective of this study, therefore, was to investigate PA at 2-time points: January 2020 (before the COVID-19
the change in PA between January (before the COVID-19 epidemic) and April 2020 (during the COVID-19 epidemic).
epidemic) and April 2020 (during the COVID-19 epidemic) in The participants were required to provide 2 kinds of answers
community-dwelling Japanese older adults. We hypothesized as a result of this investigation: recalled answer in January
Received May 7, 2020 Published online June 23, 2020, http://10.1007/s12603-020-1424-2
Accepted for publication May 26, 2020 948
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THE JOURNAL OF NUTRITION, HEALTH & AGING

Table 1
The demographic variables and total PA time

Overall Robust Pre-frail Frail

n=1,600 n=574 n=638 n=388
Age, mean (SD) 74.0(5.6) 73.6(5.4) 73.9(5.7) 74.7(5.9)
Women, n (%) 800(50.0) 320(55.7) 284(44.5) 196(50.5)
Height, mean (SD) 160.1(8.5) 159.7(8.5) 160.8(8.2) 159.6(8.8)
Weight, mean (SD) 57.9(10.5) 57.1(10.0) 58.5(10.4) 58.0(11.4)
BMI, mean (SD) 22.5(3.0) 22.3(2.6) 22.5(3.0) 22.6(3.5)
Living alone, n (%) 250(15.6) 81(14.1) 102(16.0) 67(17.3)
KCL, mean (SD) 5.3(3.6) 1.8(1.0) 5.3(1.1) 10.5(2.6)
Lower health literacy, n %) 804(50.3) 216(37.6) 333(52.2) 255(65.7)
Polypharmacy, n (%) 315(19.7) 80(13.9) 117(18.3) 118(30.4)
Morbidity
Hypertension, n (%) 566(35.4) 191(33.3) 219(34.3) 156(40.2)
Hyperlipidemia, n (%) 212(13.3) 69(12.0) 85(13.3) 58(14.9)
Orthopedic disease, n (%) 93(5.8) 24(4.2) 32(5.0) 37(9.5)
Respiratory disease, n (%) 57(3.6) 17(3.0) 16(2.5) 24(6.2)
Cardiovascular disease, n (%) 106(6.6) 29(5.1) 37(5.8) 40(10.3)
Diabetes, n (%) 175(10.9) 41(7.1) 81(12.7) 53(13.7)
Cancer, n (%) 92(5.8) 26(4.5) 40(6.3) 26(6.7)
Total PA time (minutes)
January-2020, median (IQR) 245(90-480) 330(148-600) 270(120-480) 123(0-360)
April-2020, median (IQR) 180(0-420) 210(60-450) 180(4-420) 85(0-240)
SD: standard deviation, IQR: interquartile range, BMI: body mass index, PA: physical activity

situation and non-recalled answer in the current situation Statistical analysis

(April), respectively. We multiplied by activity frequency per We examined the effect of the COVID-19 epidemic in
week and activity time per day (minutes) at each activity level, the main and subgroup analyses for total PA time using the
and determined the total PA time (minutes) as added values for Wilcoxon rank-sum test. For subgroup analysis according
each level. to the three frailty categories, we divided the patients into
three groups: robustness, pre-frailty, and frailty. The data
Definition of the frailty category were analyzed using SPSS (Statistical Package for the Social
We assessed the frailty status with the Kihon checklist (7), Sciences, Windows version 26.0; SPSS, Inc., Chicago, IL,
which consists of 25 items (with yes/no responses) that are USA). A P value less than 0.05 was considered to indicate
divided into seven domains: lifestyle (5 items), motor abilities statistical significance for all analyses.
(5 items), nutrition (2 items), oral functions (3 items), seclusion
(2 items), forgetfulness (3 items), and emotions (5 items). We Results
defined scores of 8 or more as frailty, 4 to 7 as pre-frailty, and 0
to 3 as robustness, according to a previous study (8). The demographic variables are listed in Table 1. The mean
age, proportion of women, and mean BMI were 74.0±5.6 years,
Demographic data 50% (n=800), and 22.5±3.0, respectively. According to the
The following 9 items were obtained: age, gender, height, Kihon checklist, 388 participants (24.3%) had a score of 8 or
weight, body mass index (BMI), living alone, number of more (frail), 638 (39.9%) had a score of 4 to 7 (pre-frail), and
medications, morbidity, and health literacy. We defined the 574 participants (35.9%) had a score of 0 to 3 (robust).
number of medications; 5 or more as polypharmacy (9). We Table 1 and Figure 1 show the median total PA time in
assessed the level of health literacy using the Critical Health January 2020 and April 2020. Overall, we found a significant
Literacy (CCHL) scale (10), which includes 5 items (each decrease in total PA time in April 2020 (median [interquartile
item is rated on a 5-point scale: 1 being “strongly disagree” to range (IQR)], 180 [0 to 420]) when compared to January
5 being “strongly agree”). We added each item and divided it 2020 (median [IQR], 245 [90 to 480]) (P<0.001). We also
by 5 and defined a score of less than 4 points as lower health performed a subgroup analysis according to the frailty category
literacy according to a previous study (10). and found that the total PA time significantly decreased in April
2020 when compared to January 2020 for all frailty categories
(P<0.001).

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EFFECT OF COVID-19 ON PHYSICAL ACTIVITY

Figure 1 the near future. Thus, we must promote indoor exercise and
Overall median total PA time in January 2020 and April 2020 walking habits around houses, and focus on the maintenance of
(A), robust (B), pre-frail (C), and frail (D) participants. Overall, healthy performance in older populations.
total PA time significantly decreased from January 2020 to There are both strengths and weaknesses to this online
April 2020 (P<0.001) (A). In a subgroup analysis according survey. The strength of this survey was the elucidation of up
to the frailty category, total PA time significantly decreased to date status of PA in the older population. We believe that
in April 2020 when compared to January 2020 for all frailty these findings can be useful to maintain healthy conditions
categories (P<0.001) (B, C, and D) and prevent disabilities in older adults worldwide. However,
there was a sampling bias and lack of external validity in this
survey because the study comprised participants who could use
Internet connected devices and were registered with a survey
company.
In conclusion, due to the COVID-19 epidemic, the total
PA time in April 2020 was significantly lower than that in
January 2020 in older adults. This finding may lead to a higher
incidence of disability in the near future. Thus, we should assist
older adults and promote indoor exercise and walking habits
around the house.

Aknowledgment: This work was supported by the Research Fund for Longevity Science
from the Grants-in-Aid for Comprehensive Research on Aging and Health from the
Ministry of Health, Labor, and Welfare, Japan.

Disclosures: The authors have no potential conflicts of interest to disclose.

Conflict of interest: None

Ethical Standards: The ethics committee approved the study.

Discussion
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