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Table 1 Characteristics and the main results of the association of physical activity/exercise on mental health among adults

From: The association between physical activity and mental health during the first year of the COVID-19 pandemic: a systematic review

Authors Study design, sample characteristics (n, sex, age), recruitment, country Outcomes (instruments) Study qualitya Main findings
Abate Daga et al. 2021 [24] Cross-sectional, 595 participants (mean age 30.47 ± 13.57, 50,3% male), online survey between March 9 and April 10, 2020, Italy. Well-being (WHO-5-J).
Physical activity (IPAQ).
6 Significant difference in subjective well-being among physical activity rates, inactive people meanly lose 6.53 point of wll-being score versus moderately active and 11,14 points versus very active responders.
Bird et al. 2021 [25] Cross-sectional, 392 adults (mean age 25.48 ± 5.05; 314 women) recruitment through word-of-mouth and facilitated by social media posts, UK. Anxiety, depression, and social
Dysfunction (GHQ-12).
Physical activity (BLPAQ).
6 Planned and unplanned PA were significant explanatory variables for mental health both pre- and during lockdown, but sedentary behaviour was not. Regular PA confers some minor benefits for mental health.
Carvalho et al. 2021 [26] Cross-sectional, 68 older adults (mean age 74.24 ± 5.67), recruitment by community-based exercise program, Portugal. Depression (GDS-15).
Physical activity (IPAQ-SF).
6 MVPA was significantly higher within the non-depressed group compared with those in the depressed group. Most participants from the depressed group were categorized as low physical activity levels, whereas the majority of the non-depressed group were classified as moderate or high physical activity level.
Carriedo et al. 2020 [27] Cross-sectional, 483 elderlies (50.9% women, mean age 65.49 ± 5.14), online survey, Spain. Physical activity (IPAQ).
Resilience (CD-RISC).
Affects (The Positive and Negative Affect Schedule).
Depressive symptoms (six-item self-report scale developed by Kandel and Davies).
4 Older adults who regularly engaged in vigorous (VPA) and moderate-vigorous physical activity (MVPA) during the quarantine reported higher scores in resilience (Locus, Self-efficacy, and Optimism), positive affect, and lower in depressive symptoms.
Cecchini et al. 2021 [28] Longitudinal, 595 participants (mean age 45.60 ± 15.17, 342 females), four different times during the confinement by telephone call, Spain. Physical activity (IPAQ).
Depressive symptoms (six-item self-report scale developed by Kandel and Davies).
4 In the third week of confidement the risk rate of increasing depressive symptoms affected 68% od the populations, these changes were inversely associated with levels of PA. The 150 min/week of MVPA produced a significant effect in the reduction of depressive symptoms, and the effects can be increased up to 18 h of weekly MVPA. At leas 4 h of MVPA reduce by 49% odds of depressive symptoms.
Chouchou et al. 2020 [29] Cross-sectional, 400 participants (58.2% women, mean age 29.8 ± 11.5 years), recruitment by online survey between the 35th and 54th days of lockdown, Reunion Island. Subjective well-being (WHO-5).
Sleep quality (PSQI).
Physical activity (IPAQ).
6 Those reporting the highest decrease in well-being (4th and 3th quartiles) also reported the highest decrease in their total, moderate and intense weekly PA.
Impairment in well-being was independently associated with weekly PA.
Coughenour et al. 2020 [30] Cross-sectional, 194 universities (73% women, mean age 25.1 ± 7.8 years), online survey between May 7 and May 28, 2020, United States (Southern Nevada). Estimated cardiorespiratory fitness (algorithm include age, body composition, resting heart rate and PA).
Depressive symptoms (PHQ-9).
3 Significant but small correlation between the change in weekly physical activity minutes and the change in PHQ-9 scores.
Eric et al. (2020) [31] Cross-sectional, 1800 adults (42.7% women, 50.7% aged between 21 and 35 years) online survey, Nigeria. Subjective well-being (WHO-5).
Physical activity (EPQ).
5 Total Daily Energy Expenditure on exercise during the pandemic was found to be significantly related to mental wellbeing.
Faulkner et al. 2020 [32] Cross-sectional, 8425 participants (70.7% female; mean age 44.5 ± 14.8 years), online survey within the first 2–6 weeks of government-mandated COVID-19 restrictions, UK, Ireland, New Zealand and Australia. Physical activity (IPAQ).
Exercise behaviour change (Stages of Change scale).
Subjective well-being (WHO-5).
Depressive, anxiety and stress symptoms (DASS-9).
7 Moderate positive correlations between PA and WHO-5 scores and negative correlations between PA and depressive, anxiety and stress symptoms during the initial COVID-19 restrictions.
Glerc et al. 2021 [33] Cross-sectional, 417 participants (mean age 32.2 ± 13.6, 86.8% women) recruited online through social media between March 24 and May 8, 2020, Canada. Physical activity (IPAQ).
Mental health (PHQ-9).
Anxiety (GAD-7).
Satisfaction with Life (SWLS).
7 Changes in;VPA accounted for significant variability in the PHQ-9, GAD-7 and SWLS. Participants sufficiently active during covid-19 reported significantly lowe depression and anxiety, and higher life satisfaction.
Lage et al. 2021 [34] Cross-sectional, 1123 older adults (mena age 67.68 ± 5.91, 91% female), interviewed by telephone call, Brazil. Depression (GDS-15).
Physical activity (IPAQ-SF).
  Greater times spent in MPA and MVPA was associated with lower depressive score. Daily walking and sitting time were not associated with depression.
Lesser and Nienhuis, (2020) [35] Cross-sectional, 1098 participants (79.3% women, mean age 42 ± 15 years) online survey during April and early May 2020, Canada Physical activity (GLQ).
Motivation to exercise (BREQ-3).
Anxiety (GAD-7).
Overall well-being (MHC-SF).
4 Inactive participants scored significantly lower on the mental health continuum than active participants, though was a non-significant difference in generalized anxiety.
Lin et al. (2020) [36] Cross-sectional, 628 healthy college students (64.8% female, mean aged 20.18 ± 1.8 years), online survey, China. Depression (CES-D).
Physical activity (IPAQ-SF).
6 Depression negatively correlated with MET-minutes/week in moderate-intensity PA but not vigorous and walking scores.
Marachi et al. 2021 [37] Cross-sectional, 1669 participants (36.9% aged between 18 and 29 years, 82.4& woman), online survey from April 23 to June 30, 2020, Canada. Physical activity (PASB-Q)
Anxiety (GAD-7)
Depression (PHQ-9)
Stress (PSS)
3 Participants whose mental health got worse or much worse had greater reductions in physical activity since COVID-19. Mental outcomes such as anxiety relief was the most important motivator to stay active.
Maugeri et al. (2020) [38] Cross-sectional, 2524 participants (56.4% women, 46% aged between 21 and 40 years), online survey from April 1 to April 30, 2020, Italy. Physical activity (IPAQ-SF).
Well-being (PGWBI).
5 A significant positive correlation was found between the variation of physical activity and mental well-being.
Méndez-Giménez et al. (2020) [39] Cross-sectional, 4811 participants (61.4% women, 50.7% aged between 27 and 53 years), online survey from March 19 to April 18, 2020, Spain. Physical activity (IPAQ).
Depressive symptoms (6-item self-report scale).
7 PA components were inversely associated with NDS. Performing at least 477 METs-min/week was associated with a 33% decrease in the probability of NDS, and reaching 3000 METs-min/week was associated with the lowest risk of NDS (47%).
Nie et al. 2021 [40] Cross-sectional, 14,715 participants (aged between 17 and 69 years, 53% male) data collected by online survey between June 20 and July 30, 2020, China. Physical activity (IPAQ).
Mental Health (50-item Self-evaluation table for Chinese residents’mental health).
3 There was a significant association between PA and mental health, the largest associations were seen for home-based group entertainment exercise. Moderate-intensity exercise was better than both light and vigorous intensity exercise for mental health.
Nienhuis and Lesser (2020) [41] Cross-sectional, 1098 participants (79.3% women, mean age 42 ± 15 years) online survey during April and early May 2020, Canada Physical activity (GLQ).
Motivation to exercise (BREQ-3).
Anxiety (GAD-7).
Overall well-being (MHC-SF).
4 Women with severe anxiety reported more physical activity those with moderate anxiety. Women’s physical activity levels were more significantly impacted by the increased difficulty and challenge due to the onset of COVID-19 restrictions.
O’brien et al. 2021 [42] Cross-sectional, 4007 participants (mean age 46.5 ± 14.7 years, 70% female) online survey during 10–26 April 2020, New Zealand. Physical activity (IPAQ-SF)
Depression, Anxiety and Stress (DASS-9).
Subjective well-being (WHO-5)
6 Participants who had moderate levels of PA had better mental health status. PA had a strong effect on wellbeing.
Ozdemir et al. (2020) [43] Cross-sectional, 2301 participants (61.1% women, mean age 36.2 ± 10.9), online survey started 8 weeks after the first case of COVID-19 was officially reported, Turkey. Physical activity (IPAQ).
Depression (BDI).
Anxiety symptoms (BAI).
Quality of life (WHOQOL- BREF TR).
8 Weak positive relationship between physical activity levels and quality of life, while there was a weak negative relationship between physical activity levels, depression and anxiety.
Savage et al. (2020) [44] Longitudinal cohort study, 214 students (72% women, mean age 20 years), online survey on the first week of ‘lockdown’ 20 March 2020 and during the fifth week of lockdown 27 April 2020, UK. Physical activity (EVS).
Mental well-being (WEMWBS).
2 Positive association was found between perceived stress and sedentary behaviour.
Stanton et al. (2020) [45] Cross-sectional, 1491 adults (67% women, mean age 50.5 ± 14.9 years), online survey during April 2020, Australia. Physical activity (AAS).
Depressive and anxiety symptoms (DASS21).
6 Negative changes in physical activity were associated with higher depressive and anxiety symptoms.
Suzuki, et al. 2020 [46] Longitudinal study, 165 participants (69.7% women, mean age 78.5 ± 8.0 years), mailing questionnaire two moments, one four weeks before the declaration of the state of emergency (from 20 March–15 April), and the second was in the 4 weeks after the declaration of the state of emergency for follow-up (from 16 April to 13 May), China. Physical activity (PAQ-EJ).
Neighbourhood Physical activity (IPAQ-E).
Functional health (TMIG-IC).
Well-Being (WHO-5-J).
Health-Related Quality of Life (SF-12v2).
5 SWB scores significantly decreased in the less active group but this was not seen in the more or equally active group. HRQoL scores were reduced by COVID-19 restrictions regardless of changes in PA.
Trabelsi et al. 2021 [47] Cross-sectional, 517 older adults (76% young old 56–65 years, 52.2% female) 41 research institutions from Europe, Western-Asia, North-Africa and the American promoted the survey on April 2020. Well-being (Short Warwick–Edinburgh Mental Wellbeing Scale).
Sleep Quality (PSQI)
Physical activity (IPAQ)
6 Change in total physical activity energy expenditure was significant predictor of the decrease in mental wellbeing from pre to during lockdown.
Xiang et al. (2020) [48] Cross-sectional, 1396 college students (36.9% women, mean age 20.68 ± 1.84), online survey, China. Anxiety and depressive symptoms (SAS and SDS).
Physical activity (IPAQ).
6 A high level of physical activity was significantly closely associated with low anxiety, while a moderate or high level of physical activity was significantly associated with reduced depression after adjusting confounding demographic factors.
Zalewska et al. 2021 [49] Cross-sectional, 141 physiotherapy students (104 women, aged 18–25 years), online survey, Poland. Depression (Beck Depression
Inventory).
Physical activity (IPAQ).
3 More physical activity had a positive effect on mental health.
Zhang et al. (2020) [50] Longitudinal survey, 66 participants (62.12% women, mean age 20.70 ± 2.11), online survey February 19, on March 5 and on March 20, China. Physical activity (IPAQ).
Depressive, anxiety and stress symptoms (DASS21).
3 Physical activity directly alleviated general negative emotions and the maximal mitigation effect occurred when weekly physical activity was about 2500 METs.
Young et al. 2021 [51] Longitudinal, 20,000 adults (60% women, 93% over the age of 50), recruited from the U.S. Kaiser Permanente Research Bank, online srvey at 3 moments, United States. Physical activity (Godin Leisure-Time Exercise
Questionnaire.
Depressive symptoms ((PHQ-2).
5 Participants in the lowest physical activity category (no physical activity) had the highest depression and anxiety scores compared to each successive physical activity category
Carriedo et al. (2020) [27] Cross-sectional study, 483 elderlies (50.9% women, mean age 65.49 ± 5.14), online survey, Spain. Physical activity (IPAQ).
Resilience (CD-RISC).
Affects (The Positive and Negative Affect Schedule).
Depressive symptoms (six-item self-report scale developed by Kandel and Davies).
4 Older adults who regularly engaged in vigorous (VPA) and moderate-vigorous physical activity (MVPA) during the quarantine reported higher scores in resilience (Locus, Self-efficacy, and Optimism), positive affect, and lower in depressive symptoms.
Suzuki, et al. (2020) [46] Longitudinal study, 165 participants (69.7% women, mean age 78.5 ± 8.0 years), mailing questionnaire two moments, one four weeks before the declaration of the state of emergency (from 20 March–15 April), and the second was in the 4 weeks after the declaration of the state of emergency for follow-up (from 16 April to 13 May), China. Physical activity (PAQ-EJ).
Neighbourhood Physical activity (IPAQ-E).
Functional health (TMIG-IC).
Well-Being (WHO-5-J).
Health-Related Quality of Life (SF-12v2).
5 SWB scores significantly decreased in the less active group but this was not seen in the more or equally active group. HRQoL scores were reduced by COVID-19 restrictions regardless of changes in PA.
  1. Abbreviation: AAS Active Australia Survey, BAI Beck Anxiety Inventory, BDI Beck Depression Inventory, BLPAQ Brunel Lifestyle Physical Activity Questionnaire, BREQ-3 Behavioural Regulations in Exercise Questionnaire, CES-D Center for Epidemiological Studies Depression Scales, DASS 21 21-item Depression, Anxiety and Stress Scale, DASS-9 Depression Anxiety and Stress Scale-9, EPQ Exercise Participation Questionnaire, EVS Exercise Vital Sign, GAD-7 General Anxiety Disorder-7, GDS-15 Geriatric Depression Scale – 15 items, GLQ Godin Leisure Questionnaire, GHQ-12 General Health Questionnaire-12, IPAQ International Physical Activity Questionnaire, IPAQ-SF International Physical Activity Questionnaire - Short Form, MHC-SF Mental Health Continuum, MVPA moderate vigorous physical activity, NDS notable depressive symptoms, PA physical activity, PASB-Q Physical Activity and Sedentary Behavior Questionnaire, PGWBI Psychological General Well Being Index, PHQ-2 2 item Patient Health Questionnaire, PHQ-9 9 item Patient Health Questionnaire, PSQI 6-items of the Pittsburgh Sleep Quality Index, PSS Perceived Stress Scale, SAS Self-Rating Anxiety Scale, SDS Self-Rating Depression Scale, WEMWBS Warwick-Edinburgh Mental Wellbeing Scale, WHO-5 5-World Health Organization Well-Being index, WHOQOL- BREF TR World Health Organization Quality of Life Scale, VPA Vigorous Physical Activity, MVPA Moderate-vigorous Physical Activity, CD-RISC The Connor-Davidson resilience scale, SWB Subjective Well-Being, TMIG-IC Tokyo Metropolitan Institute of Gerontology Index of Competence, IPAQ-E International Physical Activity Questionnaire Environment Module, PAQ-EJ Physical Activity Questionnaire for Elderly Japanese, WHO-5-J World Health Organization’s Five Well-being Index, SWLS Satisfaction with Life Scale, SF-12v2 Medical Outcome Study 12-Item Short-Form Survey v2, SWB Subjective Well-Being
  2. aAccording to the Newcastle-Ottawa Scale (NOS)