Introduction
COVID-19 was declared a global pandemic by the World Health Organization (WHO) in March 2020. In Canada, a state of emergency was declared between March 12–22, 2020 (province and territory dependant) [
1]. Travel restrictions, the physical closure of schools and universities, and closing of many businesses resulted [
1]. Changes to everyday activities and routines (e.g., physical distancing, intense personal hygiene practices, working from home) have been necessitated by public health mandates, and these changes have impacted leisure and work practices for many citizens [
2]. These changes might also be associated with wide-spread impacts on adults’ health. In fact, researchers recently reported that, because of similar restrictions mandated in other countries, adults have experienced a decline in health behaviors, well-being, and mental health [
3‐
6]. Many of the outcomes noted above are associated with increased risk of chronic disease and therefore, impacts to them may be particularly concerning for those already at highest risk for losing years of healthy life due to chronic disease (i.e., disability adjusted life years; adults aged 30–59) [
7‐
9]. Variations in COVID-19 rates and subsequent public health measures across Canada and around the world necessitate the need to explore these behaviors at a local level. The current paper is intended to compliment and fill in current gaps in understanding the health behaviors (i.e., physical activity, sedentary behaviors, and dietary intake), mental health, and well-being of adults during the early months of the COVID-19 pandemic.
The COVID-19 pandemic continues to impact the health of Canadian adults. Researchers of studies conducted during the same timeframe as the current study have found that the pandemic has influenced Canadians’ physical activity both positively [
10] and negatively [
2,
10,
11] while their screen time [
12] and sedentary behavior have increased [
11]. Canadian adults also reported higher levels of distress and negative mental health as a result of the pandemic [
11,
13], as well as improvements in healthy food consumption [
14] and increased junk food consumption [
12] compared to pre-pandemic. Specifically, Di Sebastiano and colleagues [
2] conducted a 10-week nation-wide study to investigate changes in the physical activity levels of Canadian adults (
n = 2338, 35–44 years) prior to and immediately following the introduction of physical distancing guidelines in Canada. Participants were sampled using a physical activity tracking app that collected the physical activity data of app users [
2]. The authors found that levels of objectively measured moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), and steps per day (measured via a national physical activity tracking app) significantly decreased as a result of the pandemic [
2]. Similarly, Peterson and colleagues [
10] explored how the pandemic impacted the physical activity and perceptions of health among adults in Calgary, a Canadian city, using a grounded theory methodology. A maximum variation sampling strategy was utilized to recruit 12 adults (20–70 years) during the months of June to October 2020 [
10]. The authors concluded that the COVID-19 pandemic impacted the daily routines of participants (e.g., work, school, home, family life, socializing) and the pandemic had both positive and negative effects on participants’ physical activity and perceptions of health [
10]. Jenkins and colleagues [
13] administered a cross-sectional survey to Canadian adults (
n = 3000; aged 18+) with the goal of investigating the impact of the pandemic on their mental health. The researchers distributed the survey via a national polling vendor who deployed the survey to a random selection of Canadian adults, stratified by Canadian Census-informed socioeconomic characteristics [
13]. The authors concluded that Canadian populations were experiencing a deterioration in mental health and coping strategies as a result of the pandemic [
13]. Lamarche and colleagues [
14] investigated the change in diet habits and quality of adults (
n = 2495; aged 18+ years) during the early stages of the COVID-19 pandemic lockdown in Quebec, Canada. The researchers recruited participants via a multimedia campaign, based on a needs assessment, and administered questionnaires before (June 2019–February 2020) and during (April–May 2020) early lockdown [
14]. Interestingly, they found that diet quality improved slightly, from pre- to during lockdown [
14]. In contrast, Zajacova and colleagues [
12] assessed changes in Canadian adults’ (
n = 4383; aged 25+) health behaviors (e.g., junk food consumption and screen time) during the early stages of the COVID-19 pandemic. To inform their work, the authors used publically available data from the Canadian Perspectives Survey Series 1: Impacts of COVID-19 (CPSS-COVID), a cross-sectional survey administered by Statistics Canada [
12]. The researchers found that 25% of participants increased their junk food consumption and 60% of participants increased their screen time during the early stages of the pandemic (March–April 2020) [
12]. Similarly, Woodruff and colleagues [
11] explored how the stress, physical activity, and sedentary behaviors of Canadian adults (
n = 121; aged 18+) changed during the early stages (April–May 2020) of the COVID-19 pandemic. The researchers recruited participants via social media advertisements; participants were asked to complete a fillable calendar with their step counts and and answer an online survey [
11]. They found that participants’ sedentary behavior and stress (daily and work-related) increased, while their physical activity decreased as a result of the COVID-19 pandemic [
11].
The COVID-19 pandemic has not only influenced the lives of Canadian adults but has also negatively impacted adults on a global scale. Most notably, and similar to what has been found in Canadian studies, adults’ physical activity has decreased [
4‐
6,
15], their sedentary behavior has increased [
5,
6,
15], and they are reporting higher levels of distress and negative mental health [
5,
16], as well as weight gain and unhealthy food consumption [
15,
17]. Specifically, Zheng and colleagues [
6] conducted a study to investigate the physical activity, sedentary behavior, and sleep of young adults (
n = 631, 18–35 years) during the initial stages of the COVID-19 pandemic in China (April 15–26, 2020). Participants were recruited via online advertisements and word of mouth and were sent a survey administered through Google forms [
6]. The researchers concluded that there was an inverse relationship between physical activity and sedentary behavior, such that participants’ physical activity levels declined significantly with concurrent increases in their sedentary time [
6]. In the United States, Meyer and colleagues [
5] evaluated the impact of the pandemic (April 3–8, 2020) on adults’ levels of physical activity, sedentary behavior, and mental health (
n = 3052, 18–24 years). Both convenience and snowball sampling were used to recruit participants [
5]. Self-report data was collected cross-sectionally, wherein participants reflected on pre- and post-COVID health behaviors [
5]. These authors also concluded that there was a decline in participants’ physical activity levels and an increase in their sedentary behavior which, in turn, were associated with higher negative mental health and lower positive mental health [
5]. This was found to be particularly true for those who were previously active, as well as those who had self-isolated/quarantined [
5]. Lopez-Bueno and colleagues [
4] investigated the physical activity levels of adults in Spain during mandated confinement (March 22–29, 2020), via a cross-sectional survey. Individuals were recruited through social media and convenience sampling was used to select study participants [
4]. The researchers found that participants’ weekly physical activity levels declined by 20% (i.e., approximately 45 min of physical activity per week) [
4]. Researchers administered an international online survey to examine how COVID-19 home confinement (April 2020) impacted adults’ levels of physical activity and sedentary time, as well as their nutrition behaviors [
15]. Participants were recruited via email, social media platforms, and faculty websites and were administered a survey, that was reviewed and edited by over 50 researchers worldwide, through Google forms [
15]. Ammar and colleagues [
15] surveyed adults (
n = 1047, aged 18+) primarily from Asia, Africa, and Europe and concluded that home confinement had a negative impact on all physical activity intensity levels, and participants’ daily sitting time increased from 5 to 8 h. Further, participants reported engaging in increased unhealthy food consumption and meal patterns during confinement [
15]. In Poland, Sidor and Rzymski [
17] administered an online survey to adults (
n = 1097, aged 18+ years) to investigate nutritional and consumer habits during the nationwide quarantine period (April 17–May 1, 2020). This survey was self-designed and not based on previously validated scales [
17]. The authors concluded that 43% of participants reported eating more and 52% reported snacking more during quarantine, and that these behaviors were more common in individuals with overweight and obesity [
17]. Further, nearly 30% of respondents reported weight gain and an increased BMI that was associated with low vegetable, fruit, and legume consumption, as well as high consumption of meat, dairy, and fast-food [
17]. Mazza and colleagues’ [
16] investigation of Italian adults (
n = 2766) revealed psychological distress during COVID-19 (May 18–22, 2020). The authors administered a cross-sectional online survey and concluded that, compared to European epidemiological statistics, participants demonstrated high and very high levels of distress [
16]. The researchers also found a significant association between being female and increased depression, anxiety, and stress [
16]. In a study conducted in the United Kingdom by White and Van Der Boor [
18], the authors investigated the impact of the COVID-19 pandemic – inclusive of the initial lockdown period (March 31–April 13, 2020) – on the mental health and well-being of adults. A convenience sample of participants were recruited via social media platforms and a cross-sectional online survey was administered [
18]. Participants that self-isolated prior to the lockdown reported increased feelings of isolation, and the majority reported poorer mental health, well-being, and quality of life leading from concerns about their livelihood due to COVID-19 [
18].
Worth noting are the methodology strategies utilized in the above-described studies. Specifically, in the Canadian studies sampling methods ranged from maximum variation sampling [
10] to random sampling stratified by census information [
13]. Other Canadian studies did not recruit participants but rather analyzed publicly available population data [
12] or utilized data available from physical activity tracking apps [
2]. Studies conducted outside of Canada primarily utilized convenience [
4,
5,
18] and snowball sampling [
4]. While the majority of the studies (both Canadian and external) were cross-sectional and survey-based, they differed in terms of rigour. For example, Meyer and colleagues [
5] relied on retrospective self-report data, a method of data collection where participants tend to overestimate their responses and demonstrate recall bias [
19,
20]. To combat retrospective data collection and recall bias, researchers use technology such as wearable activity trackers [
11] and apps [
2]. Lamarche and colleagues [
14] improved the rigour of their recruitment and data collection process through use of a needs assessment and Ammar and colleagues [
15] administered a survey that was reviewed by 50 experts in the field prior to dissemination. In contrast, some researchers created surveys without the inclusion of valid measurements [
17], and others strictly used publicly available data [
12]. The use of previously validated and reliable instruments in surveys has been recognized as crucial in social and health science research [
21]. The decision to create a survey without valid and reliable measurements alters the integrity of the tool, which is concerning. Further, using publicly available data has posed ethical concerns, as described in a recent analysis conducted by Stommel and de Rijk [
22].
It is evident, based on the literature reviewed above, that the COVID-19 pandemic has, on a global scale, negatively influenced individuals’ health behaviors, mental health, and well-being. The impact of the pandemic on the full complement of these outcomes among the various provinces of Canada remains unclear, as none of the studies described above have investigated these outcomes strictly in the province of Ontario. Despite Canada’s federated model of government, each province is responsible for organizing their own health systems with variations based on population needs. Consequently, each province has not experienced COVID-19 in the same ways, inclusive of prevalence rates and provincially mandated public health measures. Further, to our knowledge no studies conducted in Ontario have explored the difference between physical activity and well-being, mental health, and dietary intake, respectively. Given the work conducted by Meyers and colleagues [
5] in the United States – who found that participants’ physical activity levels were negatively correlated with their sedentary behavior and mental health – there is a need to also explore this within Canadian populations. Additionally, one study described above used publicly available population data instead of recruiting participants [
12], which warrants caution as secondary data collection is at a greater risk for biases and error compared to primary data collection [
23]. Another study [
17] used tools that were suitable for responding to the study purpose but were not validated, thus requiring caution when interpreting the findings. As such, there is a need for studies with primary data collection and valid and reliable measurements. To this end, the purpose of this paper is two-fold: (1) to provide an overview of Ontario adults’ health behaviors (i.e., physical activity, sedentary behaviors, and dietary intake), mental health, and well-being during the first few months of the COVID-19 pandemic (April–July 2020); and (2) to explore the difference between physical activity and various health behaviors (i.e., well-being, mental health, and dietary intake).
Discussion
The purpose of this paper was to provide an overview of the health behaviors (physical activity, sedentary behavior, and dietary intake), mental health, and well-being of adults in Ontario during the first few months of the COVID-19 pandemic (April–July 2020). The findings underscore the importance of focusing on healthy behaviors to support positive mental health and well-being during the COVID-19 pandemic and will be discussed below.
With respondents self-reporting 199 min of moderate physical activity and 97 min of vigorous physical activity per week, our sample, on average, met the physical activity goal identified in the newly released Canadian 24-Hour Movement Guidelines for Adults, which recommend at least 150 min of MVPA per week as well as several hours of LPA [
26]. This finding aligns with the qualitative work of Peterson and colleagues [
10]; participants in their study described how the COVID-19 pandemic positively influenced their physical activity, as many participants adapted and developed strategies to maintain their pre-pandemic fitness levels. Similarly, with respondents indicating 7 h per day engaged in sedentary pursuits, our sample also, on average, fell below the recommended threshold of 8 h or less according to the guidelines. Interestingly, this finding differs from previous Canadian research conducted by Woodruff and colleagues [
11], who found that sedentary behavior increased during the early months of the pandemic. The difference in findings may be attributed to the fact that Woodruff and colleagues [
11] included participants across Canada, though the majority of their sample also resided in Ontario. More likely to explain the difference, the authors measured physical activity using daily step count via a wearable activity tracker [
11]. It is known that individuals tend to over-estimate their levels of physical activity when using self-report measures [
31] and thus, it is likely that the work by Woodruff and colleagues [
11] is a more accurate reflection of the physical activity levels in Canada. However, with respect to screen time, respondents reported about double the amount of recommended recreational use (at 6 h per day versus the guideline of no more than 3). That said, recreational- and work-related screen use were not distinct variables within the tool and as such, it is plausible that a portion of the reported screen use was for reasons other than recreation. Our findings are in line with those by Lesser and Nienhuis [
32], who conducted a nationally representative study to investigate the impact of COVID-19 on Canadian adults’ (
n = 1098) levels of physical activity and well-being. They found that 33% of individuals who were classified as “inactive” became more active and 40.3% of individuals classified as “active” also became more active during the months of April and early May 2020 (i.e., during the initial public health mandates in Canada) [
32]. This may be due to a surge in participants engagement in home-based exercise, which can have both physical and psychological benefits [
33]. However, it is worth noting that approximately 43% of participants in the current study were classified as engaging in
no recreational-related physical activity, which is concerning given that the data was collected during the spring/summer, a time when individuals are typically more active than in the winter months [
34]. It is plausible that this number might increase as the pandemic continues into the winter months and environments become colder. It is also worth noting that participants who engaged in MVPA reported significant improvements in their wellbeing and mental health and consumed a healthier diet than those who did not engage in MVPA. This is not surprising given the plethora of evidence to support the positive association between physical activity and numerous health outcomes [
35‐
37]. Such trends are important to consider and observe over time, given the longitudinal nature of the current study.
The average score for participants’ dietary intake (i.e., 7.12 on a scale that ranged from 0 to 15) suggests that participants reported eating moderately healthy [
27]. In a pre-pandemic Canadian survey, 28.6% of individuals (12+ years) reported consuming fruits and vegetables five or more times per day [
38]. By contrast, in the current study, approximately 4% and just over 11% of participants reported consuming fruits and vegetables five or more times per day, respectively. In a pre-pandemic study conducted by Nardocci and colleagues [
39], high processed foods were found to have made up nearly half (45%) of the daily calories consumed by Canadian adults and were positively associated with obesity. In the current study, more than one third of participants reported eating fast food/snacks 1–3 times/week, and 14% reported this for 4 or more times per week. Similarly, in a Canadian study conducted by Zajacova and colleagues [
12], the authors found that 25% of participants increased their junk food consumption during the early stages of the COVID-19 pandemic. These numbers are alarming as consumption of high processed food, such as some fast food, are highly correlated with the development of chronic disease (e.g., obesity, diabetes, cancer) [
40]. In other recent studies investigating adults’ dietary habits during COVID-19 confinement/lockdown periods globally, researchers have also reported increased unhealthy food consumption [
15], low fruit and vegetable consumption, and high consumption of fast food [
17].
The average score for participants’ mental health (i.e., 60.3) was somewhat concerning. For interpretation, researchers have typically chosen MHI-5 cut scores ranging from 70 to 76 to identify mental health problems [
41‐
43]. Therefore, it appears that many participants may have experienced mental health problems and challenges during the early stages of the pandemic. This is consistent with previous research conducted in Canada during the COVID-19 pandemic, as researchers found that participants are experiencing a deterioration in mental health and coping strategies as a result of the pandemic [
13]. While there could be many reasons for participants’ poor mental health, based on previous research, it is possible that these findings could, in part, be associated with the dramatic changes/restrictions citizens experienced during Ontario’s most stringent public health mandates. For instance, although fewer people were impacted directly, the Torontonians who were quarantined during the severe acute respiratory syndrome (SARS) outbreak in 2003 experienced substantial psychological distress and depression [
44]. Regardless of their causes, our findings are consistent with a systematic review conducted by Xiong and colleagues [
45], who found that symptoms of anxiety, depression, post-traumatic stress disorder, psychological distress, and stress during the COVID-19 pandemic were reported by individuals in China, Spain, Italy, Iran, the US, Turkey, Nepal, and Denmark. Similarly, in a secondary analysis of a national, longitudinal cohort study conducted by Pierce and colleagues [
46] (
n = 17,452) the authors found that the mental distress of adults’ (aged 16+) increased by roughly 8% one month into lockdown (April 23–30, 2020) in the United Kingdom (UK). In another UK-based study, O’Connor and colleagues [
47] surveyed 3044 adults (aged 18+) during the first month of lockdown (March 31–April 9, 2020) and found that suicidal ideation increased over time. Interestingly, the authors found that symptoms of anxiety decreased, and depressive symptoms and feelings of loneliness did not change [
46,
47]. The discrepancy in findings between the two UK-based studies may be due to the difference in sample size and timeframe of data collection, as Pierce and colleagues [
46] sampled a larger population further into the COVID-19 pandemic. Thus, while O’Connor and colleagues [
47] did not see significant changes in participants’ mental health this may be because their sample size was smaller and they collected data early into the COVID-19 pandemic, when perhaps participants had not experienced the effects of the pandemic to the fullest extent.
Per the tool’s scoring protocol, participants’ well-being was below the “normative” range (i.e., 70–80 points) for means in Western populations in several domains, as measured via the PWI-A [
29]. Specifically, participants scored about 5–6 points below the low end of “normal” when asked how satisfied they were with their physical and mental health, respectively. Equally concerning were participants’ scores regarding their satisfaction with feeling part of their communities and their future security, as they also had average scores that were more than 5 points below “normal”. Our findings suggest that, on average, participants experienced a rather poor sense of well-being in these domains during the first few months of the pandemic in Ontario. That said, regarding their satisfaction with life as a whole and what they are achieving in life, participants were within decimals of falling into the “normal” range, with average scores of 69.0 and 68.9, respectively. Worth noting are the domains that participants scored within the range deemed “normal”, including their satisfaction with their standard of living, their personal relationships, their safety, and their spirituality/religion. Interestingly, participants scores were within the “normative” range regarding their satisfaction with safety, but below the “normative” range in terms of their anticipated future security (e.g., financial or job security). It is possible that one such reason for this might be due to individuals’ fear of potential repercussions of the pandemic, which could negatively influence their future security. Additionally, it was suspected that individuals’ scores would be below “normal” in terms of their satisfaction with personal relationships and spirituality/religion, given that people might have experienced feelings of isolation/loneliness due to limited physical contact and as a result of places of worship being closed due to public health restrictions [
48], respectively; however, this was not the case. It is possible that participants connected with others virtually, rather than in-person, thus maintaining their personal relationships [
48,
49]. Further, 78.1% of the sample identified as being married/common law/engaged, which might also explain our findings. Many places of worship also offered virtual services, providing individuals with the opportunity to practice their spirituality/religion [
49,
50].
Strengths, limitations, and future directions
There are several strengths to this study. First, to the best of our knowledge, this is the first study to provide an overview of Ontario adults’ well-being, mental health, physical activity, sedentary behavior, and dietary intake during the early months of the COVID-19 pandemic. The sample was large (> 2000) and the tools used were all previously validated while being sufficiently brief to minimize participant burden and increase completion rates. Nevertheless, there are also limitations worth noting. First, all data were collected using self-report measures which have the tendency to lend themselves to social desirability bias. However, given the size of the sample, nature of the pandemic, and the government restrictions in place, it was not possible to collect data via wearables and as such, this limitation was unavoidable. Honesty demands were employed to limit the risk of bias [
24]. Second, while participants’ screen time use was measured, it was determined via only one question. We were unable to locate a brief previously validated tool to assess screen use, and as such, one question was used to collect these data. As a result, we did not specify recreational versus work-related screen use and were unable to compare our results to the recommended guidelines. Lastly, the demographics of our sample limit the generalizability of our study. Most of our sample identified as white females of high socioeconomic status, having completed an undergraduate degree or higher. Given that the sample of participants is fairly well-educated and higher income, they might not face barriers to being physical activity, compared to those with lower education and incomes. Further, the high proportion of females in the current study might be attributed to our recruitment methods. Participants were recruited via social media platforms (i.e., Facebook, Twitter, Instagram, and LinkedIn), which women reportedly use more than men [
51]. Future studies might utilize stratified sampling and include an exploration of the impact of the pandemic on the lifestyle-related behaviors, mental health, and well-being of multiple genders, less affluent individuals, and other ethnicities.