The impact of COVID-19 restrictions on perceived health and wellbeing of adult Australian sport and physical activity participants

Australia had its first reported COVID-19 case in January 2020, and on March 11^th the World Health Organisation declared COVID-19 a pandemic, and following this, all Australian borders were closed on March 25^th [1]. From March to October 2020 there was widespread cancellation of elite and community sport in Australia. In May 2020 ‘return to sport guidelines’ were developed by National and State Governments, and by mid-October 2020 restrictions were significantly eased in the Australian state most impacted thus far, Victoria [1]. In October 2021, participation in competitive sport was still not allowed with a full return to competitive sport once vaccination rates have increased [2]. In Australia, the state of Victoria has been more impacted by restrictions and lockdowns than any other state, in terms of both length and intensity of restrictions, and the state capital Melbourne has become the world’s most locked-down city [3].

Restrictions on physical movement and limitations on social connections have been shown to significantly affect physical and mental wellbeing [4‐6]. A systematic review investigated the impact of COVID-19 on mental health in the general population across 8 countries and reported relatively high rates of anxiety, depression, post-traumatic stress disorder, psychological distress [4]. Other studies have reported that social distancing, self-isolation, and lockdown are among the major contributing factors towards high feelings of sadness, fear, frustration, feelings of helplessness, loneliness, and nervousness [5]. A multi country study of over 1,000 study participants reported that COVID-19 home confinement had a negative effect on both mental health as well as on mood and feelings compared to pre-COVID-19 restrictions [6].

The impacts can also be exacerbated in many cases due to limits on participation in sport and other leisure activities [7‐10], which can also be dependent on the type of sport or physical activity that people were involved in pre-COVID-19 as well as during-COVID-19. The restrictions across the globe included limits on time spent outdoors and resulted in reductions in leisure-time sport and physical activity [8]. However, while sport was cancelled, the government in Australia encouraged people to be active, and being active was one of a very few reasons people could leave their homes [2]. The World Health Organisation provided recommendations on how individuals could still meet the recommended physical activity guidelines of 150 min/wk of moderate to vigorous physical activity (MVPA) or 75 min/wk of vigorous physical activity (VPA) for adults, even at home with no special exercise equipment and with limited space [11].

Globally, individuals are more likely to be active in non-sporting activities like walking, running, cycling and swimming rather than participation in sport [12]. Further, children and youth are far more likely to participate in sport than adults and older adults [12‐14]. Internationally popular sports for adults include soccer, basketball, golf and tennis [12]. For adults, in Australia popular sport activities include swimming, soccer, tennis, basketball, golf and netball [15, 16].

In terms of restrictions on activity, when easing the restrictions out of total lockdown, some constraints with regard to participation in sport were lifted for children and youth but not for adults [17]. For example, in Regional Victoria children could return to playing sport outdoors, including team-based competitive contact sport, but adults could only train. Indoor sports and physical activities remained prohibited at this time, so that sports such as football and tennis resumed for children and youth, but not basketball or other gym-based activities [17]. COVID-19 restrictions will continue to impact children and youth differently compared to adults and older adults.

The impact on physical, social and mental health, as well as the economic impact, of COVID-19 varies across individuals and families, according to demographic factors such as gender, age and residential region (metropolitan versus regional and rural) [5, 18, 19].

Regarding gender, there is evidence that women may suffer greater psychological strain and stress and anxiety and depression compared to men. This can be attributed to a lockdown situation where all family members are at home and where women, more than men, had to juggle home duties with work commitments, which can be mentally and physically demanding [5]. This is consistent with another study reporting that women had higher rates of mental health problems than men [18]. This can relate to physical activity and work status. For example, sport participants are much more likely to be male than female, and this is consistent internationally [14, 20, 21]. However, in terms of impact of COVID-19 on gender, an international study investigated COVID-19 impacts on gender gaps in economic outcomes, and reported that women were more likely to permanently lose their job than men [22]. This study was conducted across 6 countries including China, South Korea, Japan, Italy, the United Kingdom and four of the largest states in the United States [22]. Further, there are also reports that the closure of schools across many nations might have a differential impact on women as they provide most of the informal care within families and as a consequence may have to limit their work [23]. Further, women are less likely to have decision making power in context of pandemic related matters and therefore their opinions and needs are less considered [23].

There are also age-related trends in the impact of COVID-19 on mental health with an Austrian study of adults reporting that mental health problems were higher in adults aged under 35 years, as well as among people who were out of work or on low incomes [18]. The requirement to socially distance during lockdown and other restrictions on the number of people congregating outside the home or the ability to visit people in their home has placed insurmountable pressure on social relationships and therefore social health and wellbeing. This in turn also affects mental health. For example, economic hardship can impact the quality and stability of couples’ relationships [24]. Further, in a UK study among younger adults, those separated or divorced were more likely to suffer poorer mental health [25].

In Australia participation in community sport is much more popular in regional and rural areas compared to metropolitan [14]. More specifically, the metropolitan growth areas have lower than average participation compared to longer established suburbs [26]. This can be explained by many factors including the (important) social nature of community sport in regional and rural areas, the availability of traditional club-based community sport versus other leisure-time activities and socio-economic status, as well as population density [26, 27].

In terms of impact of COVID-19 by region, to date there have been considerable differences across states and also within states. Regional and rural areas had lower numbers of COVID-19 cases and were less impacted by social restrictions and lockdowns than metropolitan areas, and most specifically Melbourne in Victoria [28]. Therefore, the ability of people to be active and return to activities including sport and indoor leisure varied considerably across regions and across timepoints [2]. There was also a significant seasonal impact in Australia in 2020 with summer sports like cricket and tennis largely unaffected. However, most winter sports like Australian football, soccer and netball, which generally run April-August had to cancel their competitions for almost the whole season.

Internationally, there were different impacts of COVID-19 between regions, which can be attributed to population density but also demographic factors such as age. In Australia, pre-COVID-19 there were already differences in health status according to residential location. For example, a lack of health care services in regional and rural areas, poor internet leading to limited telehealth, and a lack of social capital and availability of social services makes rural communities particularly vulnerable compared to metropolitan cities [19]. However, metropolitan populations were at risk due to community spread from higher population density [19].

There is limited research on adults in regard to their community level sport involvement. Most research has targeted the young and the elite sport participants, the majority of which tend to focus on general physical activity and not specifically on sport. In this paper we seek to determine the association between perceived health and wellbeing of adults and the impact of COVID-19 related restrictions on different types and settings of participation in sport and physical activity, together with different genders, age groups and regions.

This study is part of a broader program of research in Australia, which involves the longitudinal measurement of sport and physical activity participation and the physical, mental and social health and wellbeing outcomes of this participation. This study was conducted via two waves of online surveying (Qualtrics) during the COVID-19 period (2020 and 2021), the first of which also included participation and health data that related to the pre-COVID-19 baseline in 2019. Ethics approval was obtained by Flinders University (project number 8654) and Victoria University (project number HRE20-049) human research ethics committees.

The present study is based on data collected in the first wave using an online survey of sport participants conducted during May and June 2020. Recruitment to the survey was primarily facilitated by sports including Australian football, bowls, cricket, golf, tennis and football. The present study is one of three age-based studies, each focusing on a different stage of the lifespan. The other studies are focused on adolescence (13–17 years) and older adulthood (60 + years). The present study is focused on early and middle adulthood. The target population for this paper was adults aged 18–59 years at the time of the survey who were registered in the 2019 and/or 2020 playing seasons to participate in one or more sports. Separate analysis and papers are being developed for youth and older adults. The sports organisations that sent out the invitation to the survey to their registered participants represent major sports in Victoria and Australia [16, 29]. The research team has extensive research experience in working with these sports at national, state and local levels [10, 30‐35].

In order to broaden the scope of the survey sample to include people who participate in recreational physical activity only in settings other than sports clubs, and potentially also people who do not participate in any recreational physical activity, the primary recruitment strategy was supplemented by the use of snowball sampling, through social media pages of sports organisations and research-oriented social media pages (e.g. research team social media pages, university social media pages and websites).

The first wave, or baseline, of the longitudinal survey included, among others, questions about:

Date of birth was used to determine age in years at the time the survey was completed. Age was then recoded into three age cohorts (18–29 years, 30–49 years, and 50–59 years), broadly aligning with ‘young and free’, ‘homebuilding and child rearing’, and ‘empty nesting’. Residential postcode concordances [36] were used to assign each postcode to one of two broad geographical zones or regions: Metropolitan, comprising the capital cities of the Australian states; and Non-metropolitan, comprising regional cities, towns and rural areas.

Regarding sport and physical activity, two separate sections of the survey dealt respectively with two ‘sport and physical activity settings’: organised club sport involving membership and registration (designated ‘club’), and less structured sport and recreational physical activity (designated ‘informal’). In each section, a list of the most common activities was presented – 16 for club sports and 26 for informal (which also included 12 of the 16 club sports). Respondents indicated the activities in which they participated, with provision for adding other activities that were not listed. Based on these responses, a combined list of 88 activities was established. Further, each of the 88 activities was classified as either ‘team’ or ‘individual’, which we refer to as ‘sport and physical activity modes’. Each respondent was then assigned a single overall category for each of settings (club only, club and informal, informal only, and inactive) and modes (team only, team and individual, individual only, inactive).

Six survey items were devoted to self-assessed health – three pertaining to the time of the survey (during COVID-19 lockdown) and three comparing current health to health 12 months prior to the survey (before COVID-19). The general health item was a 5-point Likert scale item (poor, fair, good, very good, excellent) derived from the Short-form Health Survey (SF-36) instrument [37]. The same format was used for the assessment of physical health and mental health. The three comparative items used a 5-point Likert scale (much worse, somewhat worse, about the same, somewhat better, much better).

General wellbeing was assessed using a scale derived by averaging the responses to a battery of 14 items regarding frequency of positive and negative feelings, derived from [38]. Each item was scored on a 5-point scale (all of the time, most, some, a little, none), with reverse coding of the negative items, so that higher average scores represented greater wellbeing.

Resilience was similarly assessed using a scale derived by averaging the responses to a battery of 4 items derived from [39]. Each item consisted of a statement about the respondent, with responses on a 5-point scale (strongly agree, agree, neutral or unsure, disagree, strongly disagree).

Life satisfaction was assessed using a direct question {Women's Health Australia, 2008 #2448} with the response on a 10-point scale from 1 (least satisfied) to 10 (most satisfied).

The survey was completed by 2,146 adults aged 18–59 years. Table 1 shows profiles of gender, age groups and region of residence, for the survey sample and for the corresponding age cohort of the Australian population. Men were over-represented and women under-represented in the survey, which is consistent with the known higher rate of sports participation by men, and the fact that the distribution of survey invitations was facilitated predominantly by the organisations of male-dominated sports. The younger and middle-aged adults (18–49 years), were also under-represented, which is consistent with the known drop in sports participation during adolescence, with lower participation continuing through the years of higher education, the pursuit of careers and the establishment and raising of families. Participation rates rose again during the “empty nest” ages of 50–59 years. The two types of region were close to proportionately represented in the survey sample, with a slight over-representation of non-metropolitan areas which may reflect the more central role of traditional forms of sport in these areas.

Consistently with the methods of recruitment, the great majority of survey repondents were participants in club sport (n = 1779, 83%). Fewer played only informally (n = 356, 17%), and very few were inactive (n = 20, < 1%). The majority played team sport (n = 1455, 68%), and fewer participated in only individual activities (n = 680, 32%).

This study reports on the perceived health of Australian adults during the first period of COVID-19 restrictions and lockdowns in 2020, and compared those health status measures to pre-COVID status. The study sample was predominantly physically active, and most were active through team-based sports. This bias was due to the nature of the survey distribution through State Sporting Associations which had a higher uptake than the general social media post invitations.

Globally, individuals were impacted by COVID-19 restrictions, including limits on their ability to leave the home and on the amount and types of physical activity and sport that they could undertake. These restrictions differed in different regions and at different times, with restrictions often changing rapidly. However, in Australia at least, governments realised the importance of people being physically active and this remained one of very few legitimate reasons for people to leave their homes [2]. There were public awareness campaigns, including media campaigns, which were similar to previous public health measures. Further, there was widespread availability of many online activities (such as yoga and Pilates). However, the COVID-19 enforced home confinement was unprecedented, and in a first, public health advice included recommendations for maintaining and increasing physical activity while confined at home [6].

Important findings were that the men reported significantly poorer health outcomes (general, physical, and mental) and life satisfaction than the women. Further, the men reported that their health (general, physical and mental) was significantly worse during COVID-19 lockdowns compared to a year previously, than was the case for women. These findings were surprising, especially given that there is consistent evidence that women across many different countries reported poorer health during COVID-19 [22, 23, 41‐43]. This international finding can be due to women being more likely to lose jobs than men due to COVID-19 [22] and more likely to be impacted by school closures and more likely to assist with remote learning of children compared to men [23]. In other multi-national studies including adults from the UK, the US, Canada and Australia, women have been impacted greater through caregiving responsibilities and have reported higher distress and anxiety than men [42]. This is consistent with another UK study which reported that women were at risk of worse mental health during COVID-19 compared to men, and that men had a relatively stable trajectory of mental health across the pandemic compared to women [43]. It is not known why the men in this Australian study reported poorer health and that their health was more heavily impacted negatively during COVID-19 than women. The sample in this study consisted of almost exclusively physically active adults, as opposed to other international health studies, where samples were a more general cross section of the population. Why men seemed to be more negatively impacted than women may relate to this fact that the sample consisted of mostly active men, and that their actual levels of physical activity during COVID-19 were more severely affected or interrupted than activity levels of men in studies that included more inactive respondents. A study of twins reported that a perceived decrease in physical activity or exercise was associated with higher stress and anxiety [44], and it is possible that in our predominantly active sporting sample the men were more likely to have higher physical activity levels pre-COVID and be less active during-COVID than the women. This is also in line with a study reporting that individuals who were in a sports club were likely to exercise less during lockdown [45]. The authors stated that the interests and goals of people who exercise in a sports club compared to those in non-organised forms of physical activity differ [45], and perhaps sports club participants were less likely to be active during lockdown.

Younger (active) adults were significantly more likely than the older adults to report poorer health outcomes and worse health during COVID-19 lockdown compared to a year ago. This is consistent with other studies showing that younger adults’ mental health is more impacted than older adults [41, 46, 47]. A UK study measured mental health during COVID-19 lockdown and found that young adults (18–29 years) were more likely to report worse mental health outcomes [47]. Similarly, an Italian study of adults reported that younger age was associated with increased depression, anxiety and high perceived stress [41]. The authors report that these health outcomes were associated with discontinued work [41]. Further, another UK study reported that psychological distress during lockdown was worse for young adults [46]. However, these studies did not go into any further detail as to why this was the case.

There were no significant differences in the health outcomes for those living in regional areas compared to metropolitan cities. In Victoria, Australia where most of the study participants resided, the COVID-19 lockdown restrictions were harsher and longer in metropolitan Melbourne which may have impacted more heavily on individuals’ health. It could therefore be anticipated that rural residents may have reported better health outcomes than their metropolitan counterparts. However, in Australia the pre-COVID health of non-metropolitan individuals was generally poorer than metropolitan individuals, which can be related to large disparities in access to health care and health services, and to geographical isolation [48], and this may have contributed to the results reported in this study. In an American study of working adults aged 18–64 years, those rural residents reported worse health outcomes related to COVID-19 experiences such as physical and mental health than metropolitan residents [49].

When the physical activity type was broken down by setting (club and informal) and mode (team or individual) there were limited differences in health outcomes. Inactive adults were more likely than active adults to report worse general and physical health compared to a year earlier. However, club sport participants were more likely to report a decline in mental health than those active only in informal settings or those who were inactive. On the one hand, compared to inactive adults, those who were active seemed to have a ‘health buffer’ during the COVID-19 restrictions and lockdowns. On the other hand, the mental health of club sport participants was perhaps more specifically impacted by the loss of the psycho-social benefits of club sport [50‐52].

In conclusion, this study of mainly active sporting adults indicates that health and wellbeing of men was significantly more impacted than that of women through the absence of participation in sport due to COVID-19 lockdown restrictions. Further, the younger active sporting adults were more likely to report poorer health outcomes during lockdown than the older adults. Participation in team and club-based sport can play an important role not only for physical health but also for social and psychological health and wellbeing [50]. It seems that the absence of playing competitive sport and training with friends, teams and within clubs has severely impacted men and younger adults in particular. Sports clubs provide an important setting for individuals’ health and wellbeing and sport organisations need to focus on ensuring that clubs have the capacity to rebound and that individuals, both volunteers and participants, are given support and encouragement to return. Clubs may need to also consider how they pay particular attention to re-engaging at-risk men who have experienced worse mental health.