The present community based online survey was conducted in 372 adults of both sexes between 18 and 59 years between November 2020 and March 2021 after institutional ethics clearance. The study and protocol were performed according to the Declaration of Helsinki guidelines and used a self-administered questionnaire distributed through social media platforms.
The sample size was calculated based on previous estimates of the prevalence of physical inactivity across India [5]. Using the OpenEpi V3.01 software (Atlanta USA) with P = 50%, relative precision of 20%, confidence limit of 95%, and attrition of 20%, the sample size was calculated to be 287 [14]. The study participants were recruited from Chennai, the capital city of Tamil Nadu, India.
Adults with at least a bachelor degree of education and free of COVID-19 symptoms or those with a negative report of COVID test from the last 6 months were included in the study. Other inclusion criteria included adults providing verbal informed consent residing in Chennai for at least 6 months, having access to a smartphone with internet access, reading and writing English, and comprehending the questionnaire. Participants with any members within their household testing positive for coronavirus (including those on quarantine and self-isolation); those awaiting results of coronavirus testing; persons with physical and mental disabilities or chronic health conditions; pregnant and post-partum females; and patients recuperating from acute medical illness were excluded from the study.
A structured questionnaire (see Supplementary file 1) was used to obtain data on sociodemographic parameters. The participants were asked to recall information regarding their physical activity patterns before (before March 2020), during (March 2020–June 2020), and after (post unlock 3.0; August 2020) the lockdown period of the COVID-19 pandemic. At the time of administration of the questionnaire, the level of physical activity was recorded using the international physical activity questionnaire (IPAQ) [15]. Each item was included in the questionnaire after receiving consensus from all the authors. The questionnaire was tested on 30 random adult populations from the city of Chennai, India. The original questionnaire in English was used for the study purpose to avoid the practical difficulties in getting the questionnaire and the IPAQ short forms back-translated. As English is spoken widely in Chennai, this did not affect the study objectives and outcomes.
Demographic characteristics such as age, sex, body mass index based on self-reporting of height and weight, marital status (single, married, widowed, or separated), employment (employed or not-employed), and education level (graduate, post-graduate, or doctoral-level) were documented. The socioeconomic status (SES) of the participants was determined using the modified Kuppuswamy’s SES scale [16]. The SES was classified into five groups, namely upper (I), upper-middle (II), lower-middle (III), upper-lower (IV), and lower (V) based on per monthly family income. Then, questions were asked regarding their physical activity patterns (before, during, and after the lockdown) and COVID-19 history.
The physical activity (weekly vigorous and moderate exercise, walking, and sitting time) was documented for the week before completing the survey using the IPAQ-short form (IPAQ-SF) [17]. Although the extended version of the IPAQ is slightly more reliable than the short-form, the long-form is lengthy and less understandable [18]. All instructions while calculating the score adhered and responses to the IPAQ-SF were converted into the metabolic equivalent of task (MET) minutes per week (MET-min/week) as per the scoring protocol [17]. The MET-min/week was calculated by multiplying the MET values (walking = 3.3, moderate activity = 4, vigorous activity = 8) by the minutes of activity and the number of days. The overall MET minutes were summed up to obtain the total MET minutes per week, and the physical activity levels were classified as low, moderate, and high.
A physiotherapist network practicing in the urban and peri-urban area of Chennai were contacted by mobile and social media platforms, including WhatsApp groups and explained the study objectives in detail. Those who consented to assist in data collection were provided with a copy of the anonymous self-reported questionnaire along with the IPAQ-SF questionnaire to gather data from potential participants meeting our inclusion and exclusion criteria through e-mail, social media, and WhatsApp. This ensured the avoidance of virus exposure to potential participants.
Statistical analysis
SPSS (Statistical Analysis System) version 16.0 (IBM Corp., Armonk, NY) was used for statistical analysis. Estimates were expressed as mean ± standard deviation. One-way analysis of variance (ANOVA) (with post hoc Tukey-HSD procedure) was used to compare means of data between the three groups classified based on IPAQ-SF (low, moderate, and high). Furthermore, correlation coefficients were computed using the Pearson product analysis to understand the association between participant characteristics and changes in physical activity levels as reported by IPAQ-SF. Regression analysis was conducted where appropriate, and a P value of < 0.05 was considered statistically significant.