Changes in physical activity and sleep habits among adults in Russian Federation during COVID-19: a cross-sectional study

Physical activity (PA) is an important determinant of health [1], and is associated with all-cause mortality [2], risk of cardiovascular diseases and diabetes [3]. In November 2020 the World Health Organization (WHO) issued updated guidelines which recommend the amount of PA necessary to maintain health. These guidelines recommend that adults should be engaged in 150 min of moderate PA or 75 min of vigorous PA per week [4]. This recommendation is confirmed by systematic reviews and meta-analyses of studies which show that meeting the WHO guidelines resulted in significant reduction of cardiovascular events risk, cardiovascular mortality, and incidence of type 2 diabetes [5]. The proportion of adults in Russia who meet the WHO PA guidelines is only 30% [4], a figure not dissimilar with global rates [6].

The outbreak of novel coronavirus (COVID-19) in late December 2019 in China, and subsequent declaration by the WHO as a global pandemic in March 2020 [7] forced countries to implement strict hygiene regimes and social distancing measures. Extensive social distancing policies were put into place restricting people’s daily activities. While these restrictions helped slow the rate of infection, there may be concomitant negative effects as a result of limiting participation in normal daily activities such as walking and cycling for transport and leisure and access to many types of recreational activities such as team sports, gyms, fitness centers, and dancing classes.

Several studies have shown the impact of COVID-19 on healthy levels of PA, sedentary behaviour (SB) and sleep, collectively referred to as 24-h movement behaviours [8]. A recent systematic review which included 13 PA and 26 SB studies found that all studies reported decreases in PA and increases in SB, respectively, from before to during COVID-19 [9]. An Australian survey of 1500 participants found that nearly half reported a decrease in PA levels in April 2020 compared with before COVID-19 [10]. Negative changes in PA were associated with higher depression, anxiety and stress symptoms in this study. An international survey of PA including 1000 adults from Europe, Africa, Asia and the Americas showed that home confinement during the pandemic had a negative effect on all PA intensity levels [11]. Sitting (measured in hours/day) increased by 28.6%, Vigorous intensity PA decreased by 22.7%, and the number of days/week of walking decreased by 35% [11]. In Spain, participants reduced their weekly PA levels by 20% (~ 45.2 weekly minutes) during the first week of confinement compared with the previous week and the proportion who met the WHO guidelines decreased from 61 to 49% [12]. In Greece, a survey of 8495 adults found that time spent in daily occupational activity, active transport, and sporting activities reduced substantially, with overall PA decreasing by 16% [13]. In the United Kingdom, a survey involving 723 adults during a week of lockdown in April 2020 found that although 35% reported exercising less during COVID than before, 49% reported exercising more than before [14]. These results were similar when the study was extended to a larger sample (N = 2002) and prolonged until the 22nd of May with 40% reporting a decrease in PA, and 45% an increase in PA [15]. In an earlier global study, 19.1 million daily step count measurements were provided by 455,404 unique users from 187 countries, within 10 days of the pandemic declaration. There was a 5.5% decrease in mean steps (287 steps), and within 30 days, there was a 27.3% decrease in mean steps (1432 steps) [16].

Several studies have investigated the association between COVID-19 and changes in sleep habits, including sleep duration and perceptions of sleep quality. In the Spanish study described above the percentage of adults who slept for fewer than 6 h per day decreased [17]. In Jordan, it was reported that anxiety and depression during lockdown were associated with poorer sleep quality and shorter sleep duration [18]. A study of nearly 1000 participants in India found that compared to before lockdown, adults were going to bed and waking up later, sleeping less at night, and napping more during the day [19].

The Russian Federation has reported one of the largest number of COVID-19 infections (https://​epidemic-stats.​com/​) [20]. Social distancing, travel bans, the cancellation of sporting and other mass participation events, and changes to work practices have dramatically affected daily life throughout the country. Major restrictions were introduced on the 28th March 2020 with the level of restrictions varied depending on the epidemiology of the virus from region to region. Cities with a large number of cases had the strictest restrictions, such as limitations on any outdoor activities. Further, citizens were required to possess an electronic pass to leave their house and this was only permitted for workers during work hours, and to access essential services such as medical or health care, to shop for groceries, or to visit parks and green zones (excluding outdoor activities entirely). In cities with a smaller number of cases, limitations were less strict especially with outdoor activities. Indoor sport activities were limited across the country and outdoor sports were restricted – depending on the situation in the region. Social distancing measures such as keeping a minimum 1.5 m between people were introduced, as well as a ban on any public gatherings of more than 50 people. On-line learning for schools and universities and recommendations for remote working for employees were introduced.

In the Russian Federation, population levels of PA are sub-optimal [21, 22]. This low prevalence of adequate PA is a main contributing factor to the high prevalence of overweight and obesity [23]. In addition, the prevalence of adequate sleep (defined by the US CDC and National Sleep Foundation as 7–9 h per night for adults) was only 37% [24]. However, the relationship between COVID-19 and perceived changes in PA and sleep is not known.

This study provides the first known data on the changes in PA and sleep habits during the period of COVID-19 among adults in the Russia Federation. Given the size of Russia, it was important to examine how these behaviours changed at a national level, given the variability in restrictions across regions.

The aim of this study was to examine the associated between COVID-19 and changes in levels of PA and sleep and to examine specific COVID-19 factors that may be related to changes in PA and sleep among adults in Russia.

The research questions were:

The characteristics of the study sample are presented in Table 1. A total of 2540 participants from 62 regions commenced the survey with 18 participants (0.7%) failing to complete and their data not being used in the analyses. Of the 2432 participants who completed the survey, 83% were females. Compared with males, females tended to be older, married, have children under 18 living with them, and in full-time employment, less likely to have completed higher education, and more likely to follow self-isolation recommendations. In terms of employment status, 1714 (70.5%) participants had a full-time job, 399 (16.4%) were students, 65 (2.7%) were unemployed, and 47 (1.9%) were retired.

Changes in sleep and PA from pre-COVID to during COVID are reported in Table 2. There was a significant decline in the number of days per week participants reported not getting enough sleep (3.21 ± 2.44 to 2.86 ± 2.57; P < 0.001) and participants also reported an increase in the number of days per week they had trouble falling asleep (1.70 ± 2.24 to 2.13 ± 2.48; P < 0.001). All PA outcomes declined significantly from pre- to during COVID. The average time spent in MPA and VPA each declined by around 12 min per day (42.43 ± 37.57 to 30.44 ± 35.35 and 37.79 ± 37.80 to 26.56 ± 34.69, respectively [all P < 0.001]). The number of minutes per day spent walking decreased by around 20 min from 60.5 ± 38.66 to 40.83 ± 38.6 (P < 0.001).

The proportion of participants who met the WHO Guidelines for any type of PA declined from 68 to 49% (P < 0.001). The proportion who participated in muscle strengthening activities for 2 or more days per week declined from 53 to 45% (P < 0.001).

Associations between changes in days and time spent in PA and sleep habits and selected COVID-19 factors are reported in Table 3. Factors consistently associated with a greater decline in minutes per week spent in VPA, in MPA and in walking included an increase in number of days with sleep problems (β = − 28, 95%CI − 41 to − 15; β = − 42, 95%CI − 59 to − 29; and β = − 83, 95%CI − 104 to − 62, respectively), closure of fitness centre/gym (β = − 99, 95%CI − 116 to − 84; β = − 77, 95%CI − 96 to − 59; and β = − 41, 95%CI − 66 to − 15, respectively) and not being able to leave the house for PA (β = − 93, 95%CI − 109 to − 78; β = − 123, 95%CI − 141 to − 105, and β = − 217, 95%CI − 243 to − 192, respectively). Factors associated with a smaller decline in minutes per week in VPA and MPA included using digital or online resources (β = 19, 95%CI 5 to 33 and β = 23, 95%CI 7 to 38, respectively) and having access to a home gym (β = 38, 95%CI 15 to 62 and (β = 33, 95%CI 7 to 60, respectively). Factors associated with a greater decline in days per week participating in muscle strengthening activities included closure of fitness centre/gym (β = − 99, 95%CI − 116 to − 84) and not being able to leave the house for PA (β = − 93, 95%CI − 109 to − 78). Factors associated with a smaller decline in days per week participating in muscle strengthening activities included using digital or online resources (β = 0.4, 95%CI 0.2 to 0.6), being able to participate in simple calisthenics at home (β = 1, 95%CI 0.8 to 1.3), and having access to a home gym (β = 0.9, 95%CI 0.5 to 1.2). Following self-isolation recommendations (β = − 0.6, 95%CI − 0.8 to − 0.3) and having access to a home gym (β = − 0.1, 95%CI − 0.4 to 0.2) were associated with a greater reduction in the number of days per week participants reported not getting enough sleep. In contrast, having children under 18 years of age in the residence (β = 0.4, 95%CI 0.2 to 0.6) and not being able to leave the house for PA (β = 0.2, 95%CI 0.02 to 0.4) were associated with a smaller reduction in the number of days per week participants reported not getting enough sleep.

Associations between meeting WHO Global PA and muscle-strengthening recommendations and selected COVID-19 factors are reported in Table 4. Compared with those who did not use online PA resources, those who did were 1.4 (95%CI 1.3, 1.5) and 1.9 (95%CI 1.8, 2.1) times more likely to meet the recommendations for PA and for muscle-strengthening activities, respectively. Compared with those who did not have access to a green space, those who did were more likely to meet the PA (OR = 1.2, 95%CI 1.1, 1.2) and muscle strengthening (OR = 1.1, 95%CI 1.1, 1.2) recommendations. Those who owned a pet dog (OR = 1.2, 95%CI 1.1, 1.3) and those who followed the self-isolation rules (OR = 1.3, 95%CI 1.2, 1.4) were more likely to meet the PA and muscle strengthening recommendations, respectively, than those who did not. Conversely, compared with their urban counterparts, rural adults were less likely to meet the PA recommendation (OR = 0.9, 95%CI 0.8, 0.9).

We found that as a result of COVID-19 restrictions in Russia, there were perceptions among adults that their participation in PA and their sleep duration had significantly declined compared with pre-COVID levels. Not being allowed to leave the house for PA and the closure of fitness centres were policies associated with greater declines in PA and sleep. Conversely, those individuals who could access a green space or who participated in activities at home – using online resources or with the necessary equipment – showed much smaller declines in PA and sleep. In addition, we found that those who lived in apartments and in rural areas were more likely to be adversely affected in terms of their participation in PA.

In our study the number of days per week that participants got enough sleep decreased while the number of days per week that participants had trouble falling asleep increased. These results are consistent with studies in China [27], and Italy [28, 29] showing the negative impact of COVID-19 home confinement on sleep, but in contrast with Spanish survey where overall duration of sleep increased without worsening its quality [17]. In Russia, COVID-19 upended daily routines in a number of ways: more people were working from home, meals times were altered, SB – especially screen time – increased. These factors, in addition to the social distancing requirements, likely resulted in a disruption to circadian rhythms [30]. Home confinement is associated with reduced levels of PA which, in addition to the social isolation, may increase stress levels and disrupt night-time sleep. Physiological factors such as reduced sunlight exposure and weaker light–dark cycles as a result of less time spent outdoors may also have affected sleep and circadian rhythms [31].

We found that the restrictions during COVID may have been associated with a reduction in number of days per week and number of hours per day spent in PA and a reduction in all types of activities. It is important to note that the number of days participating in resistance or strength training also decreased significantly as did the proportion who met the 2020 WHO recommendation to do muscle-strengthening activities on at last 2 days per week. During home confinement, such activities can be performed using digital or online resources, which we found was positively associated with a higher number of days per week of muscle strengthening activities. Despite an increased offering of digital or online resources that could be accessed at home, participants perceived that they were not able to maintain their normal pre-COVID PA levels. Those who did take up the offering and use such resources were more likely to meet PA recommendations. More support needs to be provided to those who were not able to access these resources, which may have been exacerbated by the higher increased levels of stress and uncertainty.

Providing opportunities for PA is important in building strong immune systems and reducing the susceptibility to infection. A recent study using Mendelian randomization demonstrated that higher levels of PA was associated with a lower probability of being admitted as an outpatient for COVID-19 [32]. Conversely, a decline in PA in patients with a chronic noncommunicable disease increase both the risk of COVID-19 as well as the risk of cardiovascular and other adverse events [33].

However, the extent to which changes in PA participation may be associated with the COVID-19 pandemic is dependent upon the confinement policies of individual governments. For example, in China different policies at regional levels was associated with differences in PA participation [34].

We found that a perceived increase in sleep problems was associated with a perceived greater decline in PA and less likelihood to meet the PA guidelines. This reinforces how PA and sleep are interrelated, which is consistent with evidence from systematic reviews demonstrating the association between sleep and exercise. Exercise promotes increased sleep efficiency and duration regardless of the mode and intensity of activity, especially in populations suffering from disease [35].

We identified several factors that were associated with healthier levels of PA and sleep habits during COVID-19. These suggest that the impact of the pandemic has not been uniform among Russian adults. People living in urban area were less likely to achieve the PA recommendations, which is consistent with findings from before the pandemic and demonstrates that those living in urban areas are more active that their rural counterparts [21]. Living in a detached house, owning a dog, having a home gym were all favorably associated with healthy movement behaviours. In addition, having access to a green space was positively associated with PA. This information may be helpful to policymakers of population sub-groups who are at highest risk of being inactive during COVID in potentially informing what should be considered when planning a response to provide opportunities to be active while at the same time adhering to social distancing requirements. Participants living in a house versus an apartment may have easier access to front or back yards for outdoor play and PA [36]. Families who had a dog had higher PA and outdoor time. A recent systematic review also showed that dog-related interventions increased PA [37].

To the best of our knowledge, this is the first published study to report on PA and sleep among Russian adults during the COVID-19 pandemic. Another international online survey on PA had similar findings but did not include participants from the Russian Federation [11]. Other studies from Australia [10], Poland [38], Spain [12], Greece [13] reported similar reductions in PA and increases in SB during lockdown in adults. In United Kingdom survey 35% participants reported less than before exercising, but 49% more than before [14].

There is a need to address the impact of COVID-19 on healthy levels of movement behaviours and subsequent NCD risk, including using modern technologies (on-line) as part of a suite of strategies [39]. To prevent the unintended consequences of COVID-19 restrictions and ‘stay home’ advice on PA and sleep – and as a corollary mental and social health, a balance is needed between preventing the spread of infection and providing opportunities for people to participate in healthy levels of movement behaviours.

Our results can be used to further research and development in public health promotion in Russia during the COVID-19 pandemic. Health promotion campaigns aimed at informing the population about the risks of physical inactivity are recommended. Evidence also suggests that web -[39] and app-based [40] interventions that people can access in their home might be especially beneficial if participants are motivated to adhere to the requirements. Some technology and social media have used gamification to overcome challenges in adherence, fitness influencers on Instagram can be one of the drivers of increasing PA [41]. Further enhancements such as providing opportunities for social interaction should also be considered.

While there are a number of strengths of the present study, such as the large sample size, and the timing of data collection relative to lockdown restrictions in Russia, there are a number of limitations. First, our study was cross-sectional meaning participants perceived the changes in their PA and sleep from before to during COVID-19. As such, participants may have been more likely to overstate the changes in PA and sleep in the absence of any true baseline data. Second, all data were self-reported and subject to recall bias such as overestimation of time spent in PA and in sleep. Although the sleep questions were modified from questions found in other questionnaires [42‐44], these items were not able to be validated in a Russian population before the survey was administered during the initial stage of COVID-19. They also only ask about one aspect of sleep quality and insomnia, namely difficulty in falling asleep and in getting enough sleep. Other aspects related to insomnia and sleep quality would provide a more detailed description of the impact of COVID-19 on these important aspects of sleep. Third, our sample included an under-representation of males, which although unfortunate is consistent with other COVID-19 survey research among adults [10, 13, 14, 38]. As such, these data may not be reflective of males living in Russia. In our opinion this survey can be generalized to some groups in the Russian population, predominantly women of young and middle age from five regions who actively use Internet (Tver, Tatarstan, Irkutsk, Sakhalin, and Bashkortostan). This group could be a target for any or web- or app-based interventions to promote healthy levels of PA and sleep considering that it will likely impact not only on them but potentially to members of their families, children and male partners. Fourth, we adjusted for sex and age but not for other covariates such as socioeconomic status in the analyses. Finally, during the COVID-19 outbreak, the main instruments used to investigate perceived changes in PA and sleep habits were on-line surveys [11, 45]. This method has limitations but was the preferred method available during this period, being easier to collect data compared with a telephone survey. Online research is therefore a recommended approach if the aim is to reach a large group of participants in a short period of time, ensuring their safety under pandemic conditions [46].

Results of on-line cross-sectional surveys can be important to guide the development of interventions aimed to improve negative lifestyle behaviours associated with COVID-19 confinement. Health promotion strategies directed at promoting positive health-related behaviors should be introduced to counter the negative impact of the pandemic. Ongoing evaluation of the impact of different levels of restrictions – which will be present in some jurisdictions for an extended period of time – on health behaviors is necessary to inform these targeted health promotion strategies. Healthy levels of PA and sleep also affect the immune system through promoting healthy circadian rhythms and as such might serve as a protective strategy against infectious diseases.

This study has implications for policymakers in Russia. It demonstrates the need for efforts to stimulate wider use of on-line resources for PA, and to consider the possibility of re-opening gyms and fitness centres, with all possible safety contingencies, during the period of restrictions. Local councils should consider the importance of providing access to green spaces as part of their COVID-19 policies, especially if accompanied by infection control measures such as social distancing and wearing face masks. Special considerations should also be made for high risk groups such as older adults and people living with chronic diseases.

Future studies should also evaluate the longer-term associations between the COVID-19 virus outbreak and recovery on PA, sedentary and sleep behaviours. To develop targeted health promotion strategies in Russia, it would be useful to identify province-specific or geographic differences influencing health behaviours.