Exercise frequency during the COVID-19 pandemic: A longitudinal probability survey of the US population

Regular physical activity is important for general health and reduces the risk for COVID-19 infections and for severe outcomes among infected people. However, measures to mitigate COVID-19 likely decrease population physical activity. This study aimed to examine 1) changes in exercise frequency in a representative sample of US adults during the pandemic (04/01/2020-07/21/2021), and 2) how sociodemographic characteristics, pre-COVID health-related behaviors and outcomes, and state-level stringency of COVID-19 containment measures predict exercise frequency. Self-reported exercise frequency and its individual-level predictors were determined based on 151,155 observations from 6,540 adult participants (aged ≥ 18 years) in all US states from the Understanding America Study. State-level stringency of COVID-19 control measures was examined from the Oxford COVID-19 Government Response Tracker. Exercise frequency varied significantly over 28 survey waves across 475 days of follow-up (F _1,473 = 185.5, p < 0.001, η² = 0.28, 95% CI = 0.23-1.00), where exercise frequency decreased between April 2020 and January 2021, and then increased from January 2021 to July 2021. Those who were younger, living alone, non-White, had no college degree, lower household income, low pre-pandemic physical activity levels, obesity, diabetes, kidney disease and hypertension had lower exercise frequency. State-level stringency of COVID-19 control measures was inversely associated with exercise frequency (B = 0.002, SE = 0.001, p < 0.01) between April and December 2020 when the overall stringency level was relatively high; but the association was non-significant (B = 0.001, SE = 0.001, p > 0.05) between January and July 2021, during which the stringency index sharply declined to a low level. This longitudinal probability survey of the US population revealed significant fluctuations in exercise during COVID-19. Low exercise levels are concerning and deserve public health attention. Health inequalities from physical inactivity are likely to exacerbate because of COVID-19. Physical activity promotion in safe environments is urgently warranted, especially in at-risk population subgroups.