ABSTRACT
CONTEXT: The abrupt cessation of school and sport participation during the COVID-19 pandemic may have negative implications for adolescent mental health. OBJECTIVE: (1) To compare mental, physical, and social health and behaviors during pandemic-related stay-at-home mandates with the same measures collected 1-2 years prior. (2) To assess the relationship of physical activity and sleep during the pandemic with anxiety, fatigue, and peer relationship changes between assessment timepoints. DESIGN: Prospective cohort study, repeated-measures. SETTING: Pediatric sports medicine center. PARTICIPANTS: High school athletes (n=39; 16.2±0.9 years of age; 64% female). MAIN OUTCOME MEASURES: Patient Reported Outcome Measurement System (PROMIS) anxiety, fatigue, and peer relationships short forms and the Pittsburgh Sleep Quality Index (PSQI) were completed at two timepoints (initial assessment: May 2018 or 2019; follow-up assessment: May/June 2020). Physical activity frequency and duration, and frequency of interaction with other individuals (family, peers, sport coaches, etc.), were self-reported at follow-up assessment for the two weeks prior to school/sport closure and the two weeks prior to questionnaire completion. RESULTS: Higher levels of anxiety (5.5±4.0 vs. 3.6±3.4; p=0.003) and fatigue (5.4±3.7 vs. 2.3±2.5; p<0.001), and worse sleep quality (6.6±2.9 vs. 4.3±2.3; p<0.001) were observed during the pandemic compared to previous assessments. Reductions in physical activity were observed between assessments (exercise duration: 86.4±41.0 vs 53.8±30.0 minutes). Sleep quality, but not physical activity, during the pandemic predicted changes in fatigue (p = 0.03, ß = 0.44 [0.06, 0.83]) and peer relationships (p = 0.01, ß = -0.65 [-1.16, -0.15]) from initial to follow-up assessment. CONCLUSIONS: Mental and physical health declined during stay-at-home mandates, compared to assessments 1-2 years earlier. Physical activity behaviors and sources of social interaction underwent significant changes following school and sport cessation. Quality sleep may provide some protection against declining adolescent mental health during the pandemic, although this relationship requires further investigation.
ABSTRACT
Background: The benefits of sport participation and physical activity within adolescent populations has been well established, including improved physical and psychological health, social functioning, and sleep quality.1-3 However, mandated stay-at-home orders during the COVID-19 pandemic resulted in an abrupt cessation of school and sport participation for many adolescent athletes. This sudden suspension of sports, physical activity and peer/social interaction may have negative implications on adolescent anxiety and fatigue, as well as peer relationships and sleep quality. Purpose: (1) Compare quality of life and sleep quality measures in adolescent athletes during the COVID-19 pandemic to measures obtained 1-2 years earlier. (2) Assess physical activity and social interaction behavior during the two weeks prior to school closure compared to a two-week period during school closure. Methods: Participants first completed Patient Reported Outcome Measurement System (PROMIS) anxiety, fatigue, and peer relationship short forms, and the Pittsburg Sleep Quality Inventory (PSQI) during pre-participation sport physical evaluations (May 2018 or 2019), and again during May or June (2020). Physical activity and social interaction were assessed at the second timepoint by asking participants to retrospectively report behaviors during the two weeks prior to school closure, and during the two weeks preceding questionnaire completion. We compared outcomes using paired samples t-tests (continuous outcome variables) and McNemar’s test (categorical outcome variables). All statistical tests were two-sided and evaluated at a significance level of α = 0.05. Results: A significant portion (92%) of participants (n=39;16.2±0.9 years of age;64% female;499±177 days between assessments) reported sport cessation due to COVID-19 (Table 1). Compared to pre-COVID assessments, participants reported significantly higher anxiety and fatigue scores, and significantly worse sleep quality after school and sport cessation (Figure 1). Physical activity frequency and duration were significantly reduced in the two weeks prior to questionnaire completion compared to the two weeks before sport and school closure (Table 2). No significant difference was found for quality of peer relationships (Figure 1), although characteristics of peer/social interactions differed significantly between timepoints. Conclusion: Following recent stay-at-home orders, high school athletes reported more anxiety and fatigue, worse sleep quality, and less physical activity compared to assessments obtained in the Spring of 2018 or 2019. The abrupt cessation of school and sport participation due to COVID-19, in combination with other life factors, likely contributed to reductions in physical activity, worse sleep quality, changes in social interaction, elevated levels of anxiety, and increased fatigue among high school athletes. References: Snyder AR, Martinez JC, Bay RC, Parsons JT, Sauers EL, Valovich McLeod TC. Health-related quality of life differs between adolescent athletes and adolescent nonathletes. J Sport Rehabil. 2010;19(3):237-248. doi:10.1123/jsr.19.3.237 Eime RM, Young JA, Harvey JT, Charity MJ, Payne WR. A systematic review of the psychological and social benefits of participation in sport for children and adolescents: informing development of a conceptual model of health through sport. Int J Behav Nutr Phys Act. 2013;10:98. Published 2013 Aug 15. doi:10.1186/1479-5868-10-98 Kredlow MA, Capozzoli MC, Hearon BA, Calkins AW, Otto MW. The effects of physical activity on sleep: a meta-analytic review. J Behav Med. 2015;38(3):427-449. doi:10.1007/s10865-015-9617-6 Tables/Figures: