INTRODUCTION
Regular physical activity has been consistently shown to be a powerful contributor to good health, especially in the prevention of non-communicable diseases.(1) During the COVID-19 pandemic, the significant benefits of regular physical activity in also providing enhanced protection against communicable diseases has been highlighted.(2) These benefits arise from changes to a number of physiological parameters that improve immune response.(3) Conversely, a sedentary lifestyle has been closely associated with adverse health outcomes.(4) WHO guidelines recommend 150-300 minutes of moderate-intensity or 75-150 minutes of vigorous-intensity aerobic physical activity weekly.(5) International medical insurance data during the COVID-19 pandemic, shows significantly better prognosis in physically active people who contract COVID-19.(6) Unpublished South African data support these findings. Acknowledging the aforementioned benefits, it appears counterintuitive that exercise opportunities were significantly restricted during the “hard” lockdown implemented in South Africa at the start of the COVID-19 pandemic in March 2020. We report on the effects of the various stages of lockdown on physical activity from a cohort of over 350 000 physically engaged members on the Active Rewards platform of the Vitality Health programme.
THE VITALITY HEALTH PROGRAMME
The Vitality Health programme is a health behaviour change programme linked to the Discovery Health and Discovery Life plans. The programme offers a range of interventions aimed at changing lifestyle behaviours. These include rebates on purchases of healthy food, smoking cessation programmes, mental wellbeing programmes and an array of physical activity interventions. The physical activity interventions are incentivized by discounted membership to gyms, running and cycling clubs and discounts on wearable devices. Members’ physical activities, including heart-rate data, are captured on the Active Rewards platform on the Discovery smartphone app. Vitality uses goal-directed incentives to motivate its members to engage in regular physical activity. The Active Rewards platform incorporates several other behavioural tools, including the setting and tracking of personalised weekly goals
HEALTHY HABITS - WHO LOCKDOWN AFFECTED MOST
Data from the Vitality programme reveals the significant negative impact that lockdown regulations had on members’ exercise routines. In the month immediately after the “hard” lockdown was instituted there was a 49% drop in members logging physical activity points compared to the 2019 baseline (Figure 1). Engagement in physical activity has, however, improved through successive waves of the pandemic and the accompanying lockdowns. A deeper analysis reveals more accurately which members’ activities were curtailed and to what extent.
Specifically, those members that historically were less physically active were more likely to stop exercising than those with regular weekly exercise patterns. Owning a heart rate device also increased the likelihood of remaining physically active, while members who relied on gym memberships and organised outdoor activities showed diminished engagement.
SWITCHING TO ONLINE EXERCISE
Soon after the imposition of the hard lockdown in March 2020, Vitality introduced online exercise classes with various partners. This intervention enabled members to continue engagement in the Vitality programme, earn rewards and, most importantly, accrue health benefits. Within two months of the launch of online workouts, about 22 000 workouts per month were being recorded. This increased to over 40 000 workouts per month by June 2020 although the number had come down by June 2021 (Figure 2). Close to 32 000 individuals engaged in more than 325 000 online workouts in the period April 2020 to June 2021. Vitality continues allocating points for these novel exercise platforms, allowing for an increased range of opportunities for members to be physically active and engage with the Vitality programme. Almost all members who carry on engaging in online workouts also engage in traditional modes of physical activity.
A PREFERENCE FOR FITNESS CENTRESt
Significantly, gyms remain popular with Vitality members as their preferred means of engaging in physical activity. The closure of gyms during Level 5 to Level 3 unavoidably led to a significant drop-off in members who exercised (Figure 3). Online and heart rate exercise formats partially replaced gym workouts as an exercise format during lockdown. Once gyms reopened in Level 2, attendance increased to around 62% of pre-COVID levels. The failure to match previous gym attendance figures is possibly due to persisting concerns about virus transmission and also members opting for alternative exercise options. To counter the potential increased risk of SARS-CoV-2 transmission indoors,(7,8) gyms have adopted stringent infection control processes, based on international guidelines and best practice.(8) The specific precautions implemented by health facilities during the pandemic include limiting the number of members using gyms, spacing of equipment, sanitising apparatus after every use and marshalling locker room use. Many of these may remain in place after the pandemic.
IMPROVED AND ONGOING GYM SAFETY
Finding solutions to creating safe gym environments during and beyond the pandemic has become a focus for commercial entities whose viability has been threatened, as well as for sports clubs, universities and schools who wish athletes to maintain conditioning. The THiNK Active report details the findings of a study overseen by investigators from universities in the UK and Spain.(9) It set out to understand to what extent gyms, fitness clubs and leisure centres (during the COVID-19 pandemic) provide individuals with a safe environment in which to be physically active. The cross-sectional survey that involved 4 360 organisations in 14 countries documented 115 million gym visits over 25 weeks and showed a COVID-19 infection rate of only 1,12/100 000 visits. Although the study has limitations in that the data was self reported and emanating from predominantly large facilities in which physical distancing is easier, these data do suggest that with appropriate precautions, viral transmission rates in gyms is exceptionally low.
THE IMPACT OF DEVICES
Device workouts appeared to be the most effective way to encourage engagement during lockdown. Most of those who used at-gym and device workouts pre-COVID-19 continued logging device workouts while gyms were closed. A small proportion of those who only preferred at-gym workouts pre-COVID also recorded device workouts during the period of gym closure. The number of members using online and device workouts in combination increased during lockdown indicating that there may have been synergy between these workout options. Increasing accessibility to exercise devices may be a strategy to encourage greater physical activity engagement. In April 2019, 44% of physical activity points were earned by heart rate work outs and 28% by attending gym. A year later 61% of members were earning points from heart-rate workouts and 18% from gym.
WORKING OUT - THE FUTURE
The benefits of regular physical activity as significant protection against communicable diseases has been highlighted by morbidity and mortality data emerging from the pandemic.4,6 Information from these variable forms of physical activity engagement may inform future models for encouraging ongoing exercising during pandemics as well as other contexts such as travel or work-related pressures where usual modes of exercise are not accessible. The increased accessibility of online exercise classes complements existing exercise routines, especially gyms and fitness centres which remain first choice for many. The pandemic has also prompted an ongoing awareness about hygiene practices in fitness facilities, many of which may be permanently implemented. Also, sustained, regular engagement in physical activity and the use of a heart rate devices appear to be good indicators for continued exercise through changed circumstances. The intensity of the pandemic that drove changes in activity rates and practices are bound to change as vaccination gains traction as it is our most effective weapon against the serious consequences of SARS-CoV-2 infection. Importantly, exercise has also been shown to enhance the efficacy of COVID-19 vaccinations.(10)
In conclusion, the COVID-19 pandemic and the measures undertaken to contain it have had a considerable impact on people's lives. This paper highlights the negative impact of the Covid-19 pandemic on physical activity during the various stages of lockdown. It also shows that novel interventions are needed, including the use of wearable devices and online workouts to keep people active. As the pandemic evolves, it has become increasingly evident that maintaining fitness is not only important for overall physical and mental health, but it is also important for improving outcomes from COVID-19 infection.