Effect of the COVID-19 pandemic on barriers to middle-aged adults’ participation in physical activity in Turkey: a cross-sectional study

Background: Physical inactivity is one of the greatest problems facing the world today. The purpose of this study was to examine the level of barriers to physical activity for middle-aged adults during the COVID-19. Methods: Using an online survey, a sample of the Turkish population (n = 432: 48.6% female, 51.4% male; mean age 57.3 years) answered questions about sociodemographic characteristics as well as barriers to participation in physical activity during COVID-19 process. A scale of barriers to physical activity was used to determine the barriers to physical activity faced by the participants COVID-19 process. Since the data were homogeneously distributed across binary groups, independent t-tests and ANOVAs were performed for groups of three or more. In addition, if there were significant differences in the results of the ANOVA, Tukey’s post hoc test was also applied. The data were analyzed using SPSS Version 22.0. (IBM Corp., Armonk, NY, USA). Results: According to the findings of this study, barriers to physical activity increase significantly as perceived health status decreases, and women’s barriers to physical activity, participation are greater than those of men, and increase with age. At the same time, the strongest relationship was found for environmental factors. In addition, important results were found for the personal and social environment dimensions, and we also found that barriers to physical activity increase significantly with age. Conclusions: Finally, we determined that the barriers to physical activity for individuals with COVID-19 were significantly greater at the personal level compared to those who did not have COVID-19. That is the COVID-19 process negatively affected participation in physical activity.

Adults; Community; Health promotion; Pandemic; Physical activity; Social isolation

[1] Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk fac-tor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012; 380: 2224–2260.

[2] Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, Minson CT, Nigg CR, Salem GJ, et al. Exercise and Physical Activity for Older Adults. Medicine & Science in Sports & Exercise. 2009; 41: 1510–1530.

[3] Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, et al. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Medicine and Science in Sports and Exercise. 2007; 39: 1435–1445.

[4] Morris JN, Chave SP, Adam C, Sirey C, Epstein L, Sheehan DJ. Vigorous exercise in leisure-time and the incidence of coronary heart-disease. Lancet. 1973; 1: 333–339.

[5] Sattelmair J, Pertman J, Ding EL, Kohl HW, Haskell W, Lee I. Dose response between physical activity and risk of coronary heart disease: a meta-analysis. Circulation. 2011; 124: 789–795.

[6] Winzer EB, Woitek F, Linke A. Physical Activity in the Preven-tion and Treatment of Coronary Artery Disease. Journal of the American Heart Association. 2018; 7: e007725.

[7] Lara R, Fernández-Daza M, Zabarain-Cogollo S, Olivencia-Carrión MA, Jiménez-Torres M, Olivencia-Carrión MD, et al. Active Coping and Anxiety Symptoms during the COVID-19 Pandemic in Spanish Adults. International Journal of Environ-mental Research and Public Health. 2021; 18: 8240.

[8] Mora JC, Valencia WM. Exercise and Older Adults. Clinics in Geriatric Medicine. 2018; 34: 145–162.

[9] Soares-Miranda L, Siscovick DS, Psaty BM, Longstreth WT, Mozaffarian D. Physical Activity and Risk of Coronary Heart Disease and Stroke in Older Adults: the cardiovascular health study. Circulation. 2016; 133: 147–155.

[10] Marques A, Santos T, Martins J, Matos MGD, Valeiro MG. The association between physical activity and chronic diseases in European adults. European Journal of Sport Science. 2018; 18: 140–149.

[11] US Department of Health and Human Services. Physical activity guidelines for Americans: be active, healthy, and happy! 2008.

[12] Ward BW, Schiller JS, Goodman RA. Multiple chronic condi-tions among us adults: a 2012 update. Preventing Chronic Dis-ease. 2014; 11: E62.

[13] Crisafulli A, Pagliaro P. Physical activity/inactivity and COVID- 19. European Journal of Preventive Cardiology. 2020. (in press)

[14] Stevens J, Cai J, Evenson KR, Thomas R. Fitness and fatness as predictors of mortality from all causes and from cardiovascular disease in men and women in the lipid research clinics study. American Journal of Epidemiology. 2002; 156: 832–841.

[15] Blair SN, Kampert JB, Kohl HW, Barlow CE, Macera CA, Paf-fenbarger RS, et al. Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortal-ity in men and women. The Journal of the American Medical Association. 1996; 276: 205–210.

[16] WHO W. Global recommendations on physical activity for health. Geneva World Heal Organ. 2010; 60.

[17] Diniz TA, Christofaro DG, Tebar WR, Cucato GG, Botero JP, Correia MA, et al. Reduction of physical activity levels during the COVID-19 pandemic might negatively disturb sleep pattern. Frontiers in Psychology. 2020; 11: 586157.

[18] Watson KB, Carlson SA, Gunn JP, Galuska DA, O’Connor A, Greenlund KJ, et al. Physical inactivity among adults aged 50 years and older—United States, 2014. Morbidity and Mortality Weekly Report. 2016; 65: 954–958.

[19] Souza AMR, Fillenbaum GG, Blay SL. Prevalence and corre-lates of physical inactivity among older adults in Rio Grande do Sul, Brazil. PLoS ONE. 2015; 10: e0117060.

[20] Murtagh EM, Murphy MH, Murphy NM, Woods C, Nevill AM, Lane A. Prevalence and correlates of physical inactivity in community-dwelling older adults in Ireland. PLoS ONE. 2015; 10: e0118293.

[21] Harvey JA, Chastin SFM, Skelton DA. How Sedentary are Older People? a Systematic Review of the Amount of Sedentary Be-havior. Journal of Aging and Physical Activity. 2015; 23: 471–487.

[22] Dumith SC, Hallal PC, Reis RS, Kohl HW. Worldwide preva-lence of physical inactivity and its association with human de-velopment index in 76 countries. Preventive Medicine. 2011; 53: 24–28.

[23] Bakanlığı TS. Türkiye fiziksel aktivite rehberi. Türkiye Halk Sağlığı Kurumu, Ankara. 2014.

[24] Kotwal AA, Holt‐Lunstad J, Newmark RL, Cenzer I, Smith AK, Covinsky KE, et al. Social isolation and loneliness among San Francisco Bay Area older adults during the COVID‐19 shel-ter‐in‐place orders. Journal of the American Geriatrics Society. 2021; 69: 20–29.

[25] Petretto DR, Pili R. Ageing and COVID-19: what is the role for elderly people? Geriatrics. 2020.

[26] Vahia IV, Jeste DV, Reynolds CF. Older Adults and the Men-tal Health Effects of COVID-19. The Journal of the American Medical Association. 2020; 324: 2253.

[27] van Tilburg TG, Steinmetz S, Stolte E, van der Roest H, de Vries DH. Loneliness and Mental Health during the COVID-19 Pan-demic: a Study among Dutch Older Adults. The Journals of Gerontology: Series B. 2021; 76: e249–e255.

[28] Spiteri K, Broom D, Hassan Bekhet A, Xerri de Caro J, Laven-ture B, Grafton K. Barriers and Motivators of Physical Activity Participation in Middle-Aged and Older Adults—a Systematic Review. Journal of Aging and Physical Activity. 2019; 27: 929–944.

[29] Spirduso WW, Francis KL, MacRae PG. Physical dimensions of aging, 2nd ed. Champaign, IL: Human Kinetics. 2005.

[30] Baxter S, Blank L, Johnson M, Everson-Hock E, Woods HB, Goyder E, et al. Interventions to promote or maintain physical activity during and after the transition to retirement: an evidence synthesis. Public Health Research. 2016; 4.

[31] King AC, Rejeski WJ, Buchner DM. Physical activity interven-tions targeting older adults: A critical review and recommenda-tions. American Journal of Preventive Medicine. 1998; 15: 316–333.

[32] Baert V, Gorus E, Mets T, Geerts C, Bautmans I. Motivators and barriers for physical activity in the oldest old: a systematic review. Ageing Research Reviews. 2011; 10: 464–474.

[33] Robinson E, Boyland E, Chisholm A, Harrold J, Maloney NG, Marty L, et al. Obesity, eating behavior and physical activity during COVID-19 lockdown: a study of UK adults. Appetite. 2021; 156: 104853.

[34] Pescatello LS, Thompson WR, Gordon NF. A preview of ACSM’s guidelines for exercise testing and prescription. ACSM’s Health & Fitness Journal. 2009; 13: 23–26.

[35] Keysor J. Does late-life physical activity or exercise prevent or minimize disablement? a critical review of the scientific ev-idence. American Journal of Preventive Medicine. 2003; 25: 129–136.

[36] Ayyildiz E, Sunay H, Kose B, Atli A. Investigation of the life quality of women in Ankara according to their participation in physical activity. Acta Medica Mediterranea. 2019.

[37] Rejeski WJ, Mihalko SL. Physical activity and quality of life in older adults. The Journals of Gerontology: Series A. 2001; 56: 23–35.

[38] Allender S, Cowburn G, Foster C. Understanding participation in sport and physical activity among children and adults: a re-view of qualitative studies. Health Education Research. 2006; 21: 826–835.

[39] Booth ML, Bauman A, Owen N. Perceived Barriers to Physical Activity among Older Australians. Journal of Aging and Physi-cal Activity. 2002; 10: 271–280.

[40] Rütten A, Abu-Omar K, Meierjürgen R, Lutz A, Adlwarth W. Was bewegt die Nicht-Beweger? PräVention Und Gesundheits-föRderung. 2009; 4: 245–250.

[41] Hirvensalo M, Lampinen P, Rantanen T. Physical Exercise in Old Age: an Eight-Year Follow-up Study on Involvement, Mo-tives, and Obstacles among Persons Age 65–84. Journal of Ag-ing and Physical Activity. 1998; 6: 157–168.

[42] Karasar N. Bilimsel Araştırma Yöntemi (31. Basım) Ankara: Nobel Akademik Yayıncılık. 2016.

[43] Yurtçiçek S, Şahin NH. The study of the validity and reliability of the Turkish version of physical activity barriers questionnaire. The Journal of Academic Social Science. 2018; 71: 396–404.

[44] Hoare E, Stavreski B, Jennings GL, Kingwell BA. Exploring Motivation and Barriers to Physical Activity among Active and Inactive Australian Adults. Sports. 2017; 5: 47.

[45] Hoebeke R. Low-income women’s perceived barriers to phys-ical activity: focus group results. Applied Nursing Research. 2008; 21: 60–65.

[46] Portela-Pino I, Alvariñas-Villaverde M, Pino-Juste M. Environ-mental Barriers as a Determining Factor of Physical Activity. Sustainability. 2021; 13: 3019.

[47] Lovell GP, El Ansari W, Parker JK. Perceived exercise ben-efits and barriers of non-exercising female university students in the United Kingdom. International Journal of Environmental Research and Public Health. 2010; 7: 784–798.

[48] Sherwood NE, Jeffery RW. The behavioral determinants of ex-ercise: implications for physical activity interventions. Annual Review of Nutrition. 2000; 20: 21–44.

[49] Abbasi IN. Socio-cultural Barriers to Attaining Recommended Levels of Physical Activity among Females: a Review of Liter-ature. Quest. 2014; 66: 448–467.

[50] Bird S, Kurowski W, Feldman S, Browning C, Lau R, Raderma-cher H, et al. The Influence of the Built Environment and other Factors on the Physical Activity of Older Women from Differ-ent Ethnic Communities. Journal of Women & Aging. 2009; 21: 33–47.

[51] Cohen-Mansfield J, Marx MS, Guralnik JM. Motivators and Barriers to Exercise in an Older Community-Dwelling Popula-tion. Journal of Aging and Physical Activity. 2003; 11: 242–253.

[52] Dawson J, Hillsdon M, Boller I, Foster C. Perceived barriers to walking in the neighborhood environment: a survey of middle-aged and older adults. Journal of Aging and Physical Activity. 2007; 15: 318–335.

[53] Lees FD, Clarkr PG, Nigg CR, Newman P. Barriers to exercise behavior among older adults: a focus-group study. Journal of Aging and Physical Activity. 2005; 13: 23–33.

[54] Mathews AE, Laditka SB, Laditka JN, Wilcox S, Corwin SJ, Liu R, et al. Older adults’ perceived physical activity enablers and barriers: a multicultural perspective. Journal of Aging and Physical Activity. 2010; 18: 119–140.

[55] Moschny A, Platen P, Klaassen-Mielke R, Trampisch U, Hin-richs T. Barriers to physical activity in older adults in Germany: a cross-sectional study. The International Journal of Behavioral Nutrition and Physical Activity. 2011; 8: 121.

[56] Bauman AE, Sallis JF, Dzewaltowski DA, Owen N. Toward a better understanding of the influences on physical activity: the role of determinants, correlates, causal variables, mediators, moderators, and confounders. American Journal of Preventive Medicine. 2002; 23: 5–14.

[57] Rhodes RE, Martin AD, Taunton JE, Rhodes EC, Donnelly M, Elliot J. Factors Associated with Exercise Adherence among Older Adults. Sports Medicine. 1999; 28: 397–411.

[58] Brazeau A, Rabasa-Lhoret R, Strychar I, Mircescu H. Barriers to physical activity among patients with type 1 diabetes. Diabetes Care. 2008; 31: 2108–2109.

[59] Marconnot R, Pérez-Corrales J, Cuenca-Zaldívar JN, Güeita-Rodríguez J, Carrasco-Garrido P, García-Bravo C, et al. The Perspective of Physical Education Teachers in Spain Regarding Barriers to the Practice of Physical Activity among Immigrant Children and Adolescents: A Qualitative Study. International Journal of Environmental Research and Public Health. 2021; 18: 5598.

[60] King AC, Castro C, Wilcox S, Eyler AA, Sallis JF, Brownson RC. Personal and environmental factors associated with physical inactivity among different racial-ethnic groups of U.S. middle-aged and older-aged women. Health Psychology. 2000; 19: 354–364.

[61] Karuc J, Sorić M, Radman I, Mišigoj-Duraković M. Moderators of Change in Physical Activity Levels during Restrictions Due to COVID-19 Pandemic in Young Urban Adults. Sustainability. 2020; 12: 6392.

[62] Lesser IA, Nienhuis CP. The Impact of COVID-19 on Physical Activity Behavior and Well-Being of Canadians. International Journal of Environmental Research and Public Health. 2020; 17: 3899.

[63] Giustino V, Parroco AM, Gennaro A, Musumeci G, Palma A, Battaglia G. Physical Activity Levels and Related Energy Ex-penditure during COVID-19 Quarantine among the Sicilian Ac-tive Population: A Cross-Sectional Online Survey Study. Sus-tainability. 2020; 12: 4356.

[64] Rutkowska A, Kacperak K, Rutkowski S, Cacciante L, Kiper P, Szczegielniak J. The Impact of Isolation Due to COVID-19 on Physical Activity Levels in Adult Students. Sustainability. 2021; 13: 446.

[65] López-Bueno R, Calatayud J, Andersen LL, Balsalobre-Fernández C, Casaña J, Casajús JA, et al. Immediate Impact of the COVID-19 Confinement on Physical Activity Levels in Spanish Adults. Sustainability. 2020; 12: 5708.