Effectiveness of Physical Activity Interventions in Sedentary People during COVID-19 Lockdown: A Systematic Review of Randomized Controlled Trials
Consequently, there is no doubt about the foremost importance of identifying strategies to maintain or even improve physical activity during restrictions on social life. A number of methods have been proposed in periods of lockdown, including tele-coaching and other digital techniques, which can be used to promote and advise physical activity without having contact with people.
Based on this background, with the present systematic review, we aimed to evaluate whether the interventions reported in randomized controlled trials (RCTs) were effective in terms of the effects of physical activity (tele-coaching) during the COVID-19 lockdown on people with sedentary behavior.
2. Materials and Methods
2.1. Data Sources and Searches
Six investigators (S.C., C.C., A.D.A., A.G., S.M.L., F.B.) conducted a literature search using PubMed/Medline and Web of Science from database inception until 1 April 2023.
In PubMed, the following search strategy was used: (Sedentary Behavior* OR Sedentary Lifestyle OR Physical Inactivity OR Lack of Physical Activity OR Sedentary Time) AND (“covid 19” [MeSH Terms] OR “covid 19” [All Fields] OR “covid19” [All Fields] OR “covid 19” [All Fields] OR “covid 19” [MeSH Terms] OR “sars cov 2” [All Fields] OR “sars cov 2” [MeSH Terms] OR “severe acute respiratory syndrome coronavirus 2” [All Fields] OR “ncov” [All Fields] OR “2019 ncov” [All Fields] OR “coronavirus” [MeSH Terms] OR “coronavirus” [All Fields] OR “cov” [All Fields])”. Any inconsistencies were resolved by consensus with a senior author (L.J.D.).
2.2. Study Selection
We used the following PICO question for the study inclusion: in people with sedentary behavior during the COVID-19 pandemic social restrictions (P), compared with a control group (C), what was the effect of any physical activity intervention (I) in increasing the physical activity level (O) based on the evidence derived from intervention studies with a control group (S)?
2.3. Data Extraction
The six independent investigators cited before (S.C., C.C., A.D.A., A.G., S.M.L., F.B.), in couples, extracted key data from the included articles into a standardized Excel spread sheet, with two senior authors (N.V. and M.B.) checking the data. For each article, we extracted data on the author names, year of publication, country, sample size, demographics, setting/population, type of study and type of intervention, and follow-up (weeks). Concerning physical activity, we extracted data regarding the baseline presence of physical inactivity/sedentary behavior, the instruments used for the defining physical activity levels in the studies, and the tools used to increase the physical activity levels.
The outcome of interest in our systematic review was the physical activity level, defined as any bodily movement produced by skeletal muscles that results in energy expenditure, as defined by the World Health Organization (World Health Organization 2019), after a follow-up period with a specific training intervention compared to a control group not undertaking any specific training. The physical activity level was recorded according to the data originally reported in the studies, i.e., using questionnaires or objective tools, such as accelerometers.
2.5. Quality Assessment
Study Design Consideration: JBI provides specific tools tailored to different study designs. For intervention studies, common designs include RCTs, non-randomized controlled trials, and quasi-experimental designs.
Structured Criteria: Each tool consists of a set of structured criteria relevant to the specific study design. These criteria guide the appraiser in evaluating various aspects of the study methodology, including the study population, intervention, comparison groups, outcomes, and statistical analysis.
Validity and Reliability: The tools assess the validity and reliability of the included studies. This involves examining the appropriateness of the study design for addressing the research question, ensuring the proper randomization and allocation concealment in RCTs, and evaluating the potential for bias.
Outcome Measurement: Evaluation of the tools involves scrutinizing the clarity and appropriateness of the outcome measures, whether objective or subjective. It considers whether the outcomes align with the research question and whether they are measured consistently across groups.
Data Analysis: The tools assess the statistical methods used in data analysis, including whether appropriate statistical tests were applied, whether the analysis accounts for potential confounding variables, and whether the results are reported clearly.
2.6. Data Synthesis and Analysis
The data are reported descriptively since extremely heterogeneous definitions of physical activity or tools for improving this aspect were used in the studies. We therefore reported the main findings of the studies included, indicating whether the associations reported were statistically significant at a p-value < 0.05.
In the present systematic review, we aimed to appraise the effects of interventions on physical activity (such as tele-exercise, tele-coaching) among people with sedentary behavior during the COVID-19 lockdown. Starting from over 2400 records in the original literature search and after reviewing them according to the latest PRISMA recommendations, 11 studies with a total of 1770 participants were available and were included in the systematic review. We found that most of the studies examined reported the beneficial effects of the proposed interventions in improving the level of physical activity, reducing the sedentary time, and positively contributing to the psychological well-being of the participants.
The strengths of the present systematic review comprise the possibility of identifying quality RCTs among the numerous publications proposed on the subject during the pandemic period, which allowed us to verify the effectiveness of the remote interventions in improving physical activity, which may be applied even outside the pandemic in circumstances that prevent in-person programs. Another strength is the possibility of updating the available information in the medical literature on a relevant public health burden such as fighting against a sedentary lifestyle. However, the findings of the present systematic review should be interpreted with reference to its limitations. First, only 11 RCTs were identified as suitable for the analyses according to the PRISMA recommendations. Although this may seem a small number, these studies were of discrete quality according to JBI, and the number of participants was adequate (1770 participants, half in the intervention groups and half in the control groups). Another limitation is that the studies used different methods for the interventions, and there was not enough information to allow the performance of a meta-analysis. Finally, the data on some important determinants of the response to physical activity, such as ethnicity, were poorly reported, not allowing any speculation about this point. Likewise, given the heterogeneity of the information available, it is not possible to quantify the degree of improvement that physical activity can produce in sedentary people.
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