Associations between self-reported changes in physical activities and sedentary behaviors and changes in mental health during the coronavirus disease 2019 (COVID-19) pandemic: findings from The Irish Longitudinal Study on Ageing (TILDA)

Cillian McDowell; Mark Ward; Christine McGarrigle; Aisling O'Halloran; Sarah Gibney; Rose Anne Kenny; Céline De Looze

doi:10.12688/hrbopenres.13374.1

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Research Article

Associations between self-reported changes in physical activities and sedentary behaviors and changes in mental health during the coronavirus disease 2019 (COVID-19) pandemic: findings from The Irish Longitudinal Study on Ageing (TILDA)

[version 1; peer review: 3 approved with reservations]

Cillian McDowell¹, Mark Ward¹, Christine McGarrigle¹, [...] Aisling O'Halloran¹, Sarah Gibney², Rose Anne Kenny^1,3, Céline De Looze ¹

Cillian McDowell¹, Mark Ward¹, [...] Christine McGarrigle¹, Aisling O'Halloran¹, Sarah Gibney², Rose Anne Kenny^1,3, Céline De Looze ¹

PUBLISHED 17 Sep 2021

Author details Author details

¹ The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
² Department of Health, Dublin, Ireland
³ Mercer’s Institute for Successful Ageing (MISA), St James’s Hospital, Dublin, Ireland

Cillian McDowell
Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing

Mark Ward
Roles: Funding Acquisition, Project Administration, Writing – Review & Editing

Christine McGarrigle
Roles: Funding Acquisition, Writing – Review & Editing

Aisling O'Halloran
Roles: Funding Acquisition

Sarah Gibney
Roles: Funding Acquisition, Writing – Review & Editing

Rose Anne Kenny
Roles: Funding Acquisition, Writing – Review & Editing

Céline De Looze
Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

This article is included in the TILDA gateway.

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic and containment strategies employed to limit its spread have profoundly impacted daily life. Emerging evidence shows that mental health worsened compared to pre-pandemic trends. In this study, we examine associations of self-reported changes in physical activities and sedentary behaviors with mental health changes during the COVID-19 pandemic among older Irish adults.
Methods: This study used data from Wave 5 (2018) and the COVID-19 study (July–November 2020) of the Irish Longitudinal Study on Ageing (TILDA). Depressive symptoms were measured using the 8-item Centre for Epidemiological Studies Depression Scale; Perceived stress, using the 4‐item Perceived Stress Scale. Participants reported perceived changes in participation in physical activities and sedentary behaviours before and after the outbreak of COVID-19. Linear regressions examined separate associations between changes in physical activities and sedentary behaviours and changes in perceived stress/depressive symptoms. Adjustment included demographics, body mass index, smoking, alcohol, chronic diseases and stress/depressive symptoms at Wave 5.
Results: Among 2,645 participants (mean age, 68.2yrs; 56% female), 19.5% (95%CI: 18.2–20.9) reported clinically significant depressive symptoms during the COVID-19 pandemic. Compared to before the pandemic, reduced and no exercise at home and walking were associated with increased depressive symptoms and stress. A reduction in home DIY (do it yourself) was also associated with both depression and stress while doing no DIY at all was associated with increased stress but not depressive symptoms (all p<.05). Reduced hobbies and reading were associated with higher depressive symptoms, and both reduced and increased screen time were associated with increased depressive symptoms.
Conclusions: Greater decreases in mental health were seen among those who reported negative changes in their physical and sedentary activities. These findings have important implications for mental health care both as we transition back to normal life and for responses to future pandemics.

Keywords

COVID-19 pandemic, physical activity, sedentary behaviours, perceived stress, depression

Corresponding author: Céline De Looze

Competing interests: No competing interests were disclosed.

Grant information: TILDA is co-funded by the Government of Ireland through the Department of Health, by Atlantic Philanthropies, and by Irish Life PLC. The COVID-19 study is funded the Health Research Board under the Rapid Response Research and Innovation Fund (Ref. COV19-2020-070). Cillian McDowell is funded by the Irish Research Council under the Government of Ireland Postdoctoral Programme (GOIPD/2019/1104).

Copyright: © 2021 McDowell C et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: McDowell C, Ward M, McGarrigle C et al. Associations between self-reported changes in physical activities and sedentary behaviors and changes in mental health during the coronavirus disease 2019 (COVID-19) pandemic: findings from The Irish Longitudinal Study on Ageing (TILDA) [version 1; peer review: 3 approved with reservations]. HRB Open Res 2021, 4:103 (https://doi.org/10.12688/hrbopenres.13374.1) First published: 17 Sep 2021, 4:103 (https://doi.org/10.12688/hrbopenres.13374.1) Latest published: 17 Sep 2021, 4:103 (https://doi.org/10.12688/hrbopenres.13374.1)

Introduction

The coronavirus disease 2019 (COVID-19) pandemic and containment strategies employed to limit its spread have profoundly impacted daily life¹. Many commentators expressed concerns around the mental health impact of the pandemic, particularly among older adults who had to obey the strictest restrictions². Indeed, emerging evidence has shown that mental health worsened compared to pre-pandemic trends^3–5. In Ireland, rates of clinically-relevant depressive symptoms increased three-fold compared to pre-pandemic prevalence⁶. Evidence suggests this is likely in part due to changes in activity behaviours, working conditions, and time spent outdoors^7–9, and it is likely that high rates of loneliness and social isolation played a substantive role^10–12. These increases in mental health problems are concerning as they further exacerbate a pre-existing problem among older adults. In Ireland, depressive and anxiety disorders are the fifth and seventh highest causes of disability adjusted life years¹³, and both are associated with increased risk of cardiovascular diseases and associated mortality^14,15.

The mental health benefits of being physically active are well established. For example, evidence from prospective cohort studies and randomised controlled trials show that physical activity can protect against and reduce symptoms of depression and anxiety^16–19. Evidence of the mental health impact of sedentary behaviour is more mixed in prospective cohort studies, but experimentally increasing sedentary time has been shown to be associated with immediate worsening mental health symptoms and biological states²⁰. This is not dissimilar to what has happened on a mass scale due to the COVID-19 pandemic, and, in effect, the COVID-19 pandemic provides natural or quasi-experimental conditions acting as a whole population level intervention. Physical activity rates dropped worldwide when the pandemic hit²¹ and there was also an increase in sedentary time. However, it seems that what people do whilst being sedentary is relevant to the effects of the behaviour on mental health^9,22. For example, evidence from a large Swedish cohort highlighted the protective benefits for mental health of “mentally-active” sedentary behaviours and found no negative effect of “mentally-passive” behaviours²³, although numerous other cohort studies have found negative associations between mentally-passive sedentary behaviours and mental health²⁴.

There is some evidence to suggest that changes to activity behaviours during the COVID-19 pandemic are associated with negative changes in mental health; although most studies are cross-sectional, have small samples, and are limited by the use of convenience samples which may bias their findings, as studies assessing psychological outcomes may be particularly susceptible to this issue^11,25. Additionally, few studies focused on older adult populations who are likely to be at high risk due to the stricter restrictions (e.g. cocooning or shielding at home was asked to the over 70s in Ireland) and increased threat of morbidity and mortality posed by COVID-19 to this population. Therefore, the current study aims to investigate the relationship between self-reported changes in physical activities and sedentary behaviors and changes in mental health during the COVID-19 pandemic among older adults in Ireland.

Methods

Study design

This study is embedded within the Irish Longitudinal Study on Ageing (TILDA), a large population-based study of a nationally-representative sample of community-dwelling older adults aged 50 years and older. TILDA’s random sampling procedure and study design is available elsewhere²⁶. In brief, the first wave of data collection (Wave 1) was completed in 2011 and data was then collected biennially (Wave 5 in 2018). At each wave, participants completed a computer-assisted personal interview, carried out by social interviewers in the participants’ own home, and a self-completion questionnaire (SCQ), completed and returned by the participant. At Wave 1 and 3, a subset of the respondents also completed a comprehensive centre-based health assessment or a modified home-based health assessment, carried out by trained research nurses.

TILDA COVID-19 Study

When the COVID-19 pandemic reached Ireland in March 2020, TILDA was uniquely positioned to document the impact the pandemic has on the lives of older adults. TILDA surveyed its existing participants between July and November 2020^27,28. The COVID-19 study data was collected via SCQs. SCQs were sent to the homes of TILDA participants and once completed, they were returned by pre-paid post. All study materials including the participant information sheet, consent form and questionnaire can be found as extended data²⁹. In total, 3,922 questionnaires were returned, giving a response rate of 71%. The TILDA COVID-19 study covered a range of aspects of the lives of older adults aged 60 years and older, including changes to normal day activities due to social-distancing and other restrictions on social interactions, physical and mental wellbeing. At the time of collection, people in Ireland aged ≥70 years were advised to stay indoors, have groceries and medicines delivered, and avoid contact with friends and family so as to minimise spread within this high-risk group, delay peaks in case numbers, and relieve pressure on health services.

Changes in physical activity and sedentary behaviours

Participants reported perceived changes in participation in specific physical activities before and after the outbreak of COVID-19. These activities included exercising at home, walking outside for more than 20 minutes, and doing garden work or home repairs. Self-reported changes in participation in specific sedentary behaviours before and after the outbreak were also assessed. These activities included doing hobbies, crafts, or puzzles; watching TV, Netflix, stream movies, or shows; reading books, magazines, or newspapers (in print or online); and meeting with social groups on Zoom or other online video conference sites. Each of these questions had four response options (not at all = 0; less often = 1; about the same = 2; more often = 3).

Perceived stress

Perceived stress over the previous month at Wave 5 and during the initial months of the COVID-19 pandemic (COVID-19 Wave) was recorded using the 4-item version of the Perceived Stress Scale (PSS-4)³⁰. The PSS, originally developed as a 14-item questionnaire, is a measure of chronic stress associated with global stress perception. The PSS-4 includes four questions, answered from “Never” (0) to “Very Often” (4) on a 5-point Likert scale. A composite stress score was derived by summing the four question responses (range 0–16), with higher scores representing more stress.

Depressive symptoms

Depressive symptoms at Wave 5 and COVID-19 Wave were measured using the 8-item Centre for Epidemiological Studies Depression Scale (CESD-8). The CESD-8 consists of eight items taken from this original CESD-20 rated on a four-point Likert scale from none or almost none of the time (score 0) to all or almost or all of the time (score 3). The CESD-8 ranges from 0 to 24, with higher scores indicating higher depressive symptom severity. It has been shown to be consistent, reliable, and valid for use within the TILDA cohort³¹. A score ≥9 was used in additional analyses to define cases of clinically-meaningful depressive symptoms, which has been demonstrated to have good sensitivity and specificity in TILDA³².

Covariates

Covariates at Wave 5 included age (years), sex (male/female), education (none/primary, secondary, or tertiary/higher); marital status (married/never married/separated or divorced/widowed); self-reported chronic conditions (lung disease, asthma, arthritis, osteoporosis, cancer, Parkinson’s disease, stomach ulcer, varicose ulcer, liver disease, thyroid disease, or kidney disease). A dichotomous measure was generated for absence or presence (≥1) of chronic conditions. Body mass index (BMI) was calculated by dividing the participants’ weight (kilograms) by height (metres) squared. Participants’ height was measured to the nearest 0.01m (Seca 240 Stadiometer, Seca Ltd, Birmingham, UK), weight to the nearest 0.1 kg (Seca 861 Electronic Scales, Seca Ltd, Birmingham, UK). Smoker status was defined as Never, Past or Current. Problematic drinking (yes/ no) was assessed using the CAGE scale³³. A dummy category was generated for the missing observations of the CAGE (4% of the study sample) to reduce the loss of statistical power. Antidepressant medication (yes/ no) was classified by Anatomical Therapeutic Chemical (ATC) code N06A. Covariates were selected based on previous literature showing the impact of these factors on mental health, representing potential confounders of the relationship between physical activities/sedentary behaviours and perceived stress/depressive symptoms.

Analyses

The TILDA COVID-19 dataset is publicly accessible via the Irish Social Science Data Archive (ISSDA, University College Dublin) alongside existing public TILDA data files (see underlying data). Data were analysed using Stata 14.0. All statistical analyses could also be performed using the open access R software (R Foundation for Statistical Computing, Vienna, Austria [Team, 2018]). Participant characteristics are first reported as proportions (with 95% confidence intervals [CI]) for categorical variables and as means (95% CI) for continuous variables. Linear regressions were used to assess the separate associations between changes in physical activities and sedentary behaviours before and after the outbreak of COVID-19 and perceived stress / depressive symptoms levels (continuous) during the COVID-19 Wave . “About the same” response was set as the reference level. The first set of models (Level 1) were adjusted for age, gender and education; the second set of models (Level 2) were further adjusted for marital status, BMI, smoking, alcohol and chronic diseases; the third set of models (Level 3) also included stress / depressive symptoms levels at Wave 5. Binary logistic regressions with the same adjustments were also used to assess the separate associations between changes in physical activities and sedentary behaviours before and after the outbreak of COVID-19 and depression (dichotomous: clinically depressed vs. non depressed) during the COVID-19 Wave.

Ethics

Ethical approval for the TILDA study was granted by the Faculty of Health Sciences research Ethics Committee in trinity College Dublin. TILDA adheres to the guidelines set out in the 1964 Helsinki declaration and its later amendments. The TILDA COVID-19 study was granted ethical approval from the National Research Ethics Committee: NREC Application number: 20NREC-COV-030-2. Fully informed written consent was requested of all participants wishing to participate in the study. This study adheres to GDPR and Health Research Regulations and has many safeguarding measures in place to protect participants.

Results

Participant characteristics

In total, 3,895 participants aged ≥50 years took part in the TILDA COVID-19 study. Perceived stress and depression measures were available for 3,123 individuals. Measures of changes in physical activity and sedentary behaviours were missing for 202 participants (n=2,921). Additional missingness on covariates left 2,645 individuals with full data for analysis. Table 1 shows the baseline characteristics of TILDA participants who took part in the COVID-19 study and had full data for analysis (study sample). Table 2 reports the levels of stress and depression at Wave 5 and COVID-19 Wave and self-reported changes in physical activity and sedentary behaviours before and after the outbreak for the study sample. Perceived stress and depressive symptoms were substantially higher in the early months of the COVID-19 pandemic compared to Wave 5. The prevalence of clinically significant depressive symptoms significantly increased during the pandemic (19.5%; 95% CI 18.2 – 20.9) compared to Wave 5 (9.1%; 95% CI 8.4 – 10.1). Most participants reported doing about the same amount of exercise at home compared to before COVID-19 Wave (47%), while similar proportions reported increases (16%) and decreases (17%) in their exercise. A similar pattern was seen for walking. A large proportion of participants reported increases in home DIY (do it yourself)/gardening (48%) while few reported decreases (7%) or none at all (11%). Most participants spent about the same amount of time on their hobbies, reading or watching TV, although a substantial proportion of participants reported watching TV more often. Although a majority did not spend time socialising online, a quarter (25%) reported doing it more often.

Table 1. Baseline characteristics of The Irish Longitudinal Study on Ageing (TILDA) participants who took part in the coronavirus disease 2019 (COVID-19) study.

	COVID-19 study sample n = 2,645
Mean Age (95% CI), years	68.2 (67.9 – 68.5)
Sex: Female	56.1% (54.2 – 58.0)
Educational Attainment: - Primary - Secondary - Tertiary / Higher	13.9% (12.6 – 15.3) 39.1% (37.2 – 40.9) 46.9% (45.0 – 48.8)
Marital status: - Married - Never married - Separated/ divorced - Widowed	72.5% (70.8 – 74.2) 7.8% (6.8 – 8.9) 6.8% (5.9 – 7.8) 12.8% (11.6 – 14.1)
Chronic conditions: yes	35.4% (33.6 – 37.2)
Mean Body Mass Index (95% CI)	26.1 (25.8 – 26.4)
CAGE Alcohol Scale: Problematic	11.7 (10.5 – 13.0)
Smoking Status: - Never Smoked - Ex-smoker - Current smoker	48.2% (46.3 – 50.1) 43.7% (41.8 – 45.6) 8.0% (7.1 – 9.1)
Antidepressant medication: Yes	8.4% (7.4 – 9.5)

Table 2. Levels of stress and depression at Wave 5 and during the coronavirus disease 2019 (COVID-19) pandemic and self-reported changes in physical activity and sedentary behaviours before and after the outbreak for the study sample.

	COVID-19 study sample n = 2,645
Mean perceived stress (95% CI) - Wave 5 - During COVID-19	3.7 (3.5 – 3.8) 4.6 (4.5 – 4.8)
Mean depressive symptoms (95% CI) - Wave 5 - During COVID-19	2.9 (2.8 – 3.07) 5.2 (5.0 – 5.5)
Exercising at home: - Not at all - Less often - About the same - More often	19.1% (17.1 – 21.1) 16.2% (14.4 – 18.2) 46.8% (44.5 – 49.1) 17.8% (16.1 – 19.7)
Walking: - Not at all - Less often - About the same - More often	11.1% (9.7 – 12.8) 23.9% (21.9 – 26.1) 36.5% (34.1 – 38.9) 28.3% (26.1 – 30.6)
Home DIY/ gardening: - Not at all - Less often - About the same - More often	10.5% (9.1 – 12.2) 6.6% (5.5 – 7.9) 34.9% (32.6 – 37.3) 47.7% (45.3 – 50.3)
Hobbies: - Not at all - Less often - About the same - More often	23.2% (21.1 – 25.3) 11.1% (9.6 – 12.7) 40.5% (38.2 – 42.8) 25.2% (23.2 – 27.4)
Screen time: - Not at all - Less often - About the same - More often	3.3% (2.5 – 4.4) 5.6% (4.6 – 6.8) 54.0% (51.6 – 56.4) 36.9% (34.7 – 39.3)
Reading: - Not at all - Less often - About the same - More often	6.6% (5.3 – 8.1) 4.4% (3.5 – 5.4) 52.5% (50.0 – 54.8) 36.5% (34.1 – 39.0)
Online socialising: - Not at all - Less often - About the same - More often	58.6% (56.3 – 60.9) 5.2% (4.3 – 6.4) 11.3% (9.8 – 12.9) 24.7% (22.9 – 26.7)

Abbreviations: CI: confidence interval; DIY: do it yourself.

Association between changes in physical activity and sedentary behaviours and levels of perceived stress during the COVID-19 Wave

Table 3 reports the coefficients and 95% confidence intervals derived from linear regression analyses as indicators of the associations between changes in physical activity and sedentary behaviours and perceived stress during the COVID-19 Wave. Levels of perceived stress were higher for individuals who did not exercise or walk at all (p<.0001), for those who did not do any home DIY/ gardening (p=.001) or who had no hobbies (p<.0001) and for those who did not read (p=.01). The same trends were observed for those who reported doing each of these activities less often during the COVID-19 Wave compared to those who reported doing about the same amount as before the pandemic (p<.0001). By contrast, participants who reported increases in exercising at home had lower levels of perceived stress compared to those who reported doing about the same amount (p=.03). These associations remained significant when additionally adjusting for marital status, BMI, smoking, alcohol and chronic diseases (level 2 models; p<.005) and for perceived stress levels at Wave 5 (level 3 models; p<.01), except for the association with reading. No associations between the amount of screen time or online socialising and levels of perceived stress were observed (p>.05).

Table 3. Coefficients and 95% confidence intervals (CI) derived from linear regression analyses as indicators of associations between changes in physical activity and sedentary behaviours and perceived stress (continuous) during the coronavirus disease 2019 (COVID-19) pandemic for the study sample (n=2,645).

	Model 1	Model 2	Model 3
Exercising at home: About the same Not at all Less often More often	REF 0.64 (0.31 – 0.96)^c 1.15 (0.77 – 1.54)^c -0.33 (-0.63 – -0.03)^a	REF 0.58 (0.25 – 0.91)^c 1.09 (0.71 – 1.47)^c -0.32 (-0.62 – -0.03)^a	REF 0.39 (0.07 – 0.72)^b 0.68 (0.34 – 1.02)^c -0.11 (-0.39 – 0.17)
Walking: About the same Not at all Less often More often	REF 1.11 (0.68 – 1.53)^c 0.84 (0.52 – 1.16)^c -0.25 (-0.54 – 0.04)	REF 1.03 (0.62 – 1.45)^c 0.79 (0.47 – 1.11)^c -0.24 (-0.53 – 0.05)	REF 0.72 (0.31 – 1.12)^c 0.64 (0.34 – 0.94)^c -0.18 (-0.45 – 0.08)
Home DIY/ gardening: About the same Not at all Less often More often	REF 0.81 (0.32 – 1.30)^c 1.03 (0.57 – 1.49)^c -0.08 (-0.36 – 0.19)	REF 0.67 (0.19 – 1.15)^b 0.97 (0.52 – 1.43)^c -0.09 (-0.37 – 0.18)	REF 0.67 (0.24 – 1.10)^b 0.77 (0.29 – 1.25)^c -0.00 (-0.24 – 0.22)
Hobbies: About the same Not at all Less often More often	REF 0.80 (0.47 – 1.14)^c 0.85 (0.45 – 1.25)^c 0.05 (-0.24 – 0.35)	REF 0.80 (0.47 – 1.14)^c 0.85 (0.45 – 1.24)^c 0.05 (-0.24 – 0.35)	REF 0.55 (0.23 – 0.86)^c 0.59 (0.22 – 0.96)^c 0.19 (-0.07 – 0.47)
Screen time: About the same Not at all Less often More often	REF -0.08 (-0.79 – 0.63) 0.11 (-0.35 – 0.58) 0.32 (0.04 – 0.59)	REF -0.26 (-0.92 – 0.38) 0.08 (-0.37 – 0.56) 0.24 (-0.03 – 0.52)	REF -0.06 (-0.20 – 0.08) -0.01 (-0.11 – 0.09) 0.03 (-0.02 – 0.09)
Reading: About the same Not at all Less often More often	REF 0.74 (0.15 – 1.33)^b 0.99 (0.50 – 1.47)^c 0.11 (-0.14 – 0.37)	REF 0.71 (0.12 – 1.29)^b 0.93 (0.46 – 1.40)^c 0.12 (-0.12 – 0.37)	REF 0.12 (-0.45 – 0.69) 0.18 (-0.27 – 0.65) 0.12 (-0.11 – 0.37)
Online socialising: About the same Not at all Less often More often	REF 0.45 (-0.01 – 0.91) 0.40 (-0.24 – 1.06) -0.11 (-0.59 – 0.36)	REF 0.45 (-0.00 – 0.90) 0.49 (-0.14 – 1.13) -0.10 (-0.57 – 0.37)	REF 0.27 (-0.12 – 0.66) 0.09 (-0.50 – 0.69) 0.04 (-0.36 – 0.44)

Model 1 adjusted for age, sex and education.

Model 2 adjusted for Model 1 and marital status, bmi, smoking, alcohol and chronic diseases.

Model 3 adjusted for Model 2 and perceived stress at Wave 5.

Abbreviations: REF: reference category; DIY=do it yourself.

^a p<0.05. ^b p<0.01. ^c p<0.001.

The association between changes in physical activity and sedentary behaviours and levels of depressive symptoms during the COVID-19 Wave

Table 4 reports the coefficients and 95% confidence intervals derived from linear regression analyses as indicators of the associations between changes in physical activity and sedentary behaviours and depressive symptoms during the COVID-19 Wave. Depressive symptoms were higher for participants who did not exercise or walk at all, for those who did not do any home DIY/ gardening or who had no hobbies and for those who did not read (p<.004). They were also higher for those who reported doing less often of each of these activities during the COVID-19 Wave compared to those who reported doing about the same amount as before the pandemic (p<.0001). The same tendencies were observed for those who reported increases in screen time too (p<.0001). By contrast, individuals who reported increases in walking had lower levels of depressive symptoms (p=.004) compared to those who reported doing about the same amount. These associations remained significant in level 2 models (p<.0001) and level 3 models (p<.01), except for Home DIY/gardening. The amount of online socialising was not associated with levels of depressive symptoms (p>.05). Analyses examining the association between physical activity/ sedentary behaviours and clinically significant depressive symptoms reveal similar results (Table 5). Individuals who exercised at home, walked or did home DIY/ gardening about the same amount as before the COVID-19 Wave and those who kept as many hobbies had between 54% to double reduced odds of depression compared to those who did less often or not at all of these activities (p<.004). These associations remained significant in level 2 models (p<.03), as well as in level 3 models (p<.04) with the exception of exercising at home and doing home DIY/gardening for those who responded ‘not at all’ (p>.05). Those who walked more often had 32% reduced odds of depression (p=.03) compared to individuals who did the same amount. This association remained significant in level 2 models (p=.02) but not when adjusting further for depression at Wave 5 (p>.05). By contrast, participants who reported increases in screen time had 51% (p=.001) increased odds of depression (36% in the fully adjusted model; p=.02).

Table 4. Coefficients and 95% confidence intervals (CI) derived from linear regression analyses as indicators of associations between changes in physical activity and sedentary behaviours and depressive symptoms (continuous) during the coronavirus disease 2019 (COVID-19) pandemic for the study sample (n=2,645).

	Model 1	Model 2	Model 3
Exercising at home: About the same Not at all Less often More often	REF 1.31 (0.77 – 1.85)^c 1.83 (1.19 – 2.47)^c -0.06 (-0.55 – 0.42)	REF 1.09 (0.57 – 1.61)^c 1.56 (0.94 – 2.17)^c -0.11 (-0.59 – 0.36)	REF 0.76 (0.23 – 1.28)^b 1.09 (0.58 – 1.61)^c 0.01 (-0.42 – 0.45)
Walking: About the same Not at all Less often More often	REF 1.77 (1.03 – 2.51)^c 1.25 (0.70 – 1.80)^c -0.69 (-1.16 – 0.22)^b	REF 1.50 (0.76 – 2.25)^c 1.01 (0.47 – 1.54)^c -0.70 (-1.14 – -0.25)^b	REF 1.14 (0.43 – 1.85)^c 0.69 (0.22 – 1.16)^b -0.40 (-0.82 – 0.02)^a
Home DIY/ gardening: About the same Not at all Less often More often	REF 1.25 (0.41 – 2.09)^b 1.52 (0.72 – 2.33)^c -0.27 (-0.71 – 0.16)	REF 0.90 (0.09 – 1.72)^b 1.22 (0.49 – 2.01)^b -0.33 (-0.76 – 0.09)	REF 0.35 (-0.33 – 1.05) 0.92 (0.17 – 1.67)^b -0.17 (-0.56 – 0.21)
Hobbies: About the same Not at all Less often More often	REF 1.73 (1.15 – 2.31)^c 1.69 (1.06 – 2.33)^c 0.08 (-0.36 – 0.54)	REF 1.57 (1.01 – 2.13)^c 1.51 (0.88 – 2.14)^c -0.00 (-0.45 – 0.43)	REF 1.20 (0.69 – 1.70)^c 1.23 (0.66 – 1.80)^c 0.16 (-0.25 – 0.57)
Screen time: About the same Not at all Less often More often	REF 0.43 (-0.94 – 1.79) 0.62 (-0.09 – 1.34) 0.86 (0.44 – 1.28)^c	REF -0.03 (-1.26 – 1.19) 0.56 (-0.13 – 1.26) 0.55 (0.13 – 0.97)^b	REF -0.00 (-0.87 – 0.86) 0.70 (0.06 – 1.33)^a 0.55 (1.17 – 0.92)^b
Reading: About the same Not at all Less often More often	REF 2.50 (1.48 – 3.51)^c 1.65 (0.78 – 2.51)^c 0.11 (-0.29 – 0.52)	REF 2.35 (1.35 – 3.34)^c 1.48 (0.71 – 2.26)^c 0.08 (-0.31 – 0.47)	REF 1.71 (0.74 – 2.68)^c 0.78 (0.01 – 1.55)^a 0.12 (-0.22 – 0.47)
Online socialising: About the same Not at all Less often More often	REF 0.62 (-0.08 – 1.32) 0.29 (-0.61 – 1.20) -0.47 (-1.16 – 0.21)	REF 0.62 (-0.02 – 1.27) 0.45 (-0.39 – 1.30) -0.35 (-0.99 – 0.28)	REF 0.59 (-0.02 – 0.16) 0.68 (-0.08 – 1.45) -0.21 (-0.79 – 0.36)

Model 1 adjusted for age, sex and education.

Model 2 adjusted for Model 1 and marital status, bmi, smoking, alcohol and chronic diseases.

Model 3 adjusted for Model 2 and depressive symptoms at Wave 5.

Abbreviations: REF: reference category; DIY=do it yourself.

^a p<0.05. ^b p<0.01. ^c p<0.001.

Table 5. Odds ratios (OR) and 95% confidence intervals (CI) derived from binary logistic regression analyses as indicators of associations between changes in physical activity and sedentary behaviours and depression (dichotomous) during the coronavirus disease 2019 (COVID-19) pandemic for the study sample (n=2,645).

	Model 1	Model 2	Model 3
Exercising at home: About the same Not at all Less often More often	REF 1.54 (1.15 – 2.06)^c 2.01 (1.47 – 2.75)^c 0.92 (0.67 – 1.28)	REF 1.40 (1.03 – 1.90)^b 1.85 (1.35 – 2.55)^c 0.90 (0.64 – 1.26)	REF 1.23 (0.86 – 1.76) 1.62 (1.15 – 2.27)^b 0.99 (0.70 – 1.39)
Walking: About the same Not at all Less often More often	REF 1.93 (1.36 – 2.75)^c 1.69 (1.25 – 2.27)^c 0.68 (0.48 – 0.96)^b	REF 1.76 (1.22 – 2.55)^b 1.54 (1.13 – 2.10)^b 0.67 (0.48 – 0.94)^a	REF 1.61 (1.08 – 2.40)^a 1.41 (1.01 – 1.97)^a 0.76 (0.52 – 1.10)
Home DIY/ gardening: About the same Not at all Less often More often	REF 1.81 (1.23 – 2.64)^b 1.96 (1.27 – 3.01)^b 0.87 0.67 – 1.15)	REF 1.51 (1.02 – 2.24)^a 1.82 (1.17 – 2.81)^b 0.84 (0.64 – 1.10)	REF 1.22 (0.79 – 1.89) 1.67 (1.03 – 2.70)^a 0.89 (0.66 – 1.20)
Hobbies: About the same Not at all Less often More often	REF 1.97 (1.44 – 2.68)^c 2.40 (1.66 – 3.48)^c 0.93 (0.68 – 1.28)	REF 1.85 (1.35 – 2.53)^c 2.34 (1.59 – 3.44)^c 0.88 (0.64 – 1.22)	REF 1.67 (1.19 – 2.35)^b 2.29 (1.52 – 3.45)^c 0.97 (0.69 – 1.38)
Screen time: About the same Not at all Less often More often	REF 1.50 (0.73 – 3.09) 1.08 (0.66 – 1.77) 1.51 (1.19 – 1.93)^c	REF 1.21 (0.61 – 2.39) 1.06 (0.64 – 1.75) 1.32 (1.03 – 1.70)^b	REF 1.24 (0.64 – 2.42) 1.18 (0.69 – 2.02) 1.36 (1.04 – 1.78)^a
Reading: About the same Not at all Less often More often	REF 2.47 (1.59 – 3.82)^c 1.49 (0.91 – 2.47) 0.99 (0.77 – 1.27)	REF 2.33 (1.46 – 3.73)^c 1.37 (0.85 – 2.22)^c 0.97 (0.75 – 1.25)	REF 2.04 (1.17 – 3.53)^b 0.98 (0.57 – 1.69) 0.98 (0.75 – 1.29)
Online socialising: About the same Not at all Less often More often	REF 1.46 (0.96 – 2.22) 1.11 (0.59 – 2.06) 0.74 (0.47 – 1.17)	REF 1.48 (0.99 – 2.22) 1.22 (0.65 – 2.28) 0.77 (0.49 – 1.21)	REF 1.51 (1.00 – 2.28)^a 1.43 (0.74 – 2.76) 0.80 (0.49 – 1.28)

Model 1 adjusted for age, sex and education.

Model 2 adjusted for Model 1 and marital status, bmi, smoking, alcohol and chronic diseases.

Model 3 adjusted for Model 2 and depression at Wave 5.

Abbreviations: REF: reference category; DIY=do it yourself.

^a p<0.05. ^b p<0.01. ^c p<0.001.

Discussion

This nationally-representative study of community dwelling adults aged ≥50 years examined associations of self-reported changes in physical activities and sedentary behaviours during the COVID-19 pandemic with changes in depressive symptoms and perceived stress. Both depressive symptoms and stress increased during the COVID-19 pandemic. With regards to physical activities: 1) reduced (“less often”) exercising at home, walking, and DIY were associated with increased depressive symptoms and stress, 2) reduced (“not at all”) exercising at home and walking were associated with increased depressive symptoms and stress, and 3) reduced (“not at all”) DIY was associated with increased stress but not depressive symptoms. Regarding sedentary behaviours: 1) there were no associations with perceived stress, 2) reduced (“less often” and “not at all”) hobbies and reading were associated with higher depressive symptoms, and 3) both reduced (“less often”) and increased (“more often”) screen time were associated with increased depressive symptoms. These findings are broadly in line with related previous research and support the need to facilitate physical activities, particularly among those who reduced their activity levels due to COVID-19. Similarly, participation in hobbies and reading among those who reduced their engagement in these activities may be beneficial; however, the mental health impact of sedentary behaviours warrants future research to ascertain how different types impact mental health differently.

While a third of participants reported a reduction in exercising at home compared to before the pandemic, we also observed increases in exercise and home-based activities. These findings, in conjunction with findings from Sport Ireland that more people self-reported exercising throughout the COVID-19 containment strategies than previously³⁴, are encouraging as they indicate that a proportion of the population have made efforts to be active despite challenges posed by COVID-19 and its associated containment strategies. Indeed, in a recent report from Sport England, 62% of adults reported that being physically active was more important than before COVID-19³⁵. Of concern however, are those who reported less or no activity, as reductions were associated with greater depressive symptoms and stress. This is consistent with previous findings from a sample of approximately 3,000 US adults that self-reported reduced physical activity during COVID-19 was associated with worse mental health outcomes⁹. Similarly, previous experimental evidence has demonstrated that preventing people from exercise was associated with increases in depressive and anxiety symptoms, with larger increases seen when withdrawal lasted more than two weeks³⁶.

Sedentary activities and hobbies increased during the pandemic and while they had no association with changes in perceived stress, but reductions in hobbies and reading were associated with higher depressive symptoms. This finding concurs with recent evidence from the English Longitudinal Study on Ageing which found that taking up a hobby was associated with a decrease in depressive symptoms³⁷, although, in the current study, those who reported engaging in these activities more often did not report decreased depressive symptoms. Recent evidence from the UK during COVID-19 found that those who spent 30+ minutes per week reading reported lower depressive symptoms than those who spent no time reading³⁸. These findings were also replicated for time engaged in hobbies³⁸. Findings regarding screen time are somewhat unclear as both increased and reduced screen time were associated with increased depressive symptoms. Previous evidence has shown that screen time is associated with worse mental health⁹; however, it is unclear why participants in the current study who reported reduced screen time also reported greater depressive symptoms. Of note, the proportion of participants who did report decreasing screen time was small (6%).

During the pandemic, people in Ireland aged ≥70 years were advised to stay indoors and avoid contact with friends and family, likely leading to an increase in online socialising among some participants. However, recent evidence from TILDA showed that 44% of adults aged 70+ years did not have internet access³⁹. In this context it is not surprising that the majority of participants (59%) in the current study reported online socialising “not at all.” We hypothesised that online socialising may be associated with better mental health due to the known mental health benefits of maintaining social contact; however, we found no evidence of an association with stress or depressive symptoms. It is plausible that online socialising may not have the same benefits as in person. Additionally, internet access decreased with age and was lower among those living alone³⁹. It is plausible that those who would have benefitted most from the option to socialise online were unable to do so.

The mental health impact of the pandemic has been severe, and those who reported that their physical and sedentary activities were reduced had worse mental health compared to those whose activities were unchanged. These findings have important implications both for how we respond to future pandemics and as we begin to transition back to normal life following the current one. This study has several important limitations to report. Firstly, changes in activities were retrospectively recalled. Secondly, the magnitudes of the changes were not measured. Finally, these retrospective findings cannot infer causation. Nonetheless, this study has important strengths, in particular the nationally-representative sample which is uncommon in the related literature.

Conclusion

To conclude, the COVID-19 pandemic has severely, negatively impacted the mental health of older adults in Ireland. Greater decreases in mental health were seen among those who reported negative impacts changes in their physical and sedentary activities. Future public health interventions should fully consider the potential negative effects of remain at home orders for the older population in the event of future COVID-19 waves. Both physical activity and hobbies are important for the maintenance of both mental health and physical health in ageing, and can be protective against both physical and cognitive decline. More alternative population protection strategies should be considered that will allow the older population to maintain their physical activity levels.

Data availability

Underlying data

The data file, codebook, and accompanying documentation are publicly available via the Irish Social Science Data Archive (ISSDA, University College Dublin) alongside existing public TILDA data files at https://www.ucd.ie/issda/data/tilda/tildacovidscq2020/. The fully pseudonymised public dataset will also be made available via the Inter-university Consortium for Political and Social Research (ICPSR) at the University of Michigan for the purpose of long-term data storage and dissemination. International researchers and educators from within and outside the European Economic Area can apply to access this data for teaching and research purposes. Individual identifiers will not be included in these datasets and data will be shared in line with participant consent and relevant data protection legislation. TILDA COVID-19 SCQ data sharing is in accordance with the FAIR data research principles to ensure data is findable, accessible, interoperable and reusable and with the European Union and national data protection regulations (GDPR and HRR). In line with GDPR regulations for processing of personal information for research purposes, the data is restricted and contractual arrangements must be put in place prior to any data transfers. Researchers who wish to analyse the TILDA SCQ COVID dataset must complete and sign an application form stating their subject-matter, duration, nature and purpose of their research before access is granted. Terms and conditions of use of the dataset are clearly outlined in the application form, and all applications are screened by ISSDA prior to acceptance.

Extended data

Harvard Dataverse: TILDA COVID-19 study. https://doi.org/10.7910/DVN/UJCW1T²⁹.

This project contains the following extended data:

- TILDA COVID SCQ (Information sheet.pdf)
- TILDA COVID SCQ (Questionnaire and consent.pdf)

Data are available under the terms of the Creative Commons Zero "No rights reserved" data waiver (CC0 1.0 Public domain dedication).

Acknowledgements

We thank the administrative and research teams and TILDA participants for their continued commitment and cooperation.

Faculty Opinions recommended

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Author details Author details

¹ The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
² Department of Health, Dublin, Ireland
³ Mercer’s Institute for Successful Ageing (MISA), St James’s Hospital, Dublin, Ireland

Cillian McDowell
Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing

Mark Ward
Roles: Funding Acquisition, Project Administration, Writing – Review & Editing

Christine McGarrigle
Roles: Funding Acquisition, Writing – Review & Editing

Aisling O'Halloran
Roles: Funding Acquisition

Sarah Gibney
Roles: Funding Acquisition, Writing – Review & Editing

Rose Anne Kenny
Roles: Funding Acquisition, Writing – Review & Editing

Céline De Looze
Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

TILDA is co-funded by the Government of Ireland through the Department of Health, by Atlantic Philanthropies, and by Irish Life PLC. The COVID-19 study is funded the Health Research Board under the Rapid Response Research and Innovation Fund (Ref. COV19-2020-070). Cillian McDowell is funded by the Irish Research Council under the Government of Ireland Postdoctoral Programme (GOIPD/2019/1104).

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Published: 17 Sep 2021, 4:103

https://doi.org/10.12688/hrbopenres.13374.1

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© 2021 McDowell C et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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McDowell C, Ward M, McGarrigle C et al. Associations between self-reported changes in physical activities and sedentary behaviors and changes in mental health during the coronavirus disease 2019 (COVID-19) pandemic: findings from The Irish Longitudinal Study on Ageing (TILDA) [version 1; peer review: 3 approved with reservations]. HRB Open Res 2021, 4:103 (https://doi.org/10.12688/hrbopenres.13374.1)

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ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested

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Reviewer Report 22 May 2024

Bjorg Helgadottir, Department of Sports Science, The Swedish School of Sport and Health Sciences, Stockholm, Sweden

Approved with Reservations

https://doi.org/10.21956/hrbopenres.14567.r39691

Thank you for the opportunity to review this article. Below are my concerns.

Introduction

“The coronavirus disease 2019 (COVID-19) pandemic and containment strategies employed to limit its spread have profoundly impacted daily life.”

Thank you for the opportunity to review this article. Below are my concerns.

Introduction

“The coronavirus disease 2019 (COVID-19) pandemic and containment strategies employed to limit its spread have profoundly impacted daily life.” It did impact life at the time but not daily life now so the phrasing of this sentence could be improved.

Methods

It sounds like it is always the same participants who participate in each wave. This means that the sample in wave 5 will likely be quite selective and healthier (survival bias) than the original sample.
71% response rate of what? Original wave 1 sample, the previous wave? This is unclear
The questions on changes in activity are inherently problematic because they lack info on quantity. If for an example a person watched a lot of TV before the pandemic and increased a lot, they will be in the same category as someone how watched very little and increased a little bit. this needs to be addressed in the limitation section.
I looked at the exact question in the file you provided in the data repository. If I stopped doing something altogether, do I then choose the option of not at all or less often? It feels like there is a potential to misunderstand this question.
What did you do with the information on depressive medication? I don’t see it listed as a covariate in the models
“At Wave 1 and 3, a subset of the respondents also completed a comprehensive centre-based health assessment or a modified home-based health assessment, carried out by trained research nurses.” What is this information used for? The variables you mention all seem to be measured at wave 5

Results

You have a very selective sample in the full analysis, this could lead to biases that should be discussed.
“Perceived stress and depressive symptoms were substantially higher in the early months of the COVID-19 pandemic” This is a bit unclear, are you using all of your data from July to November? To me early months sounds like March until the summer since the situation was a bit easier during the summer

Discussion

You say in the introduction that the downside of previous studies is often only having cross-sectional data. Although you have longitudinal data on the outcomes your exposures are still measured at the same time as the outcome which weakens the argument that you have stronger data. Asking people to assess whether their behaviour has changed due to a specific event is not the same as having longitudinal data and really showing that their behaviour has changed.
I think there is a missed opportunity here to analyse the sample split into 50-69 and 70+ years old. Since you state multiple times that those older than 70 years were especially isolated this seems like a golden opportunity to compare these two groups. Otherwise you need to tone down the focus on the instructions to the older than 70 years group in both the introduction and discussion.

Regarding the access to the data, it is available on request so I could not verify the analyses but the authors have made a lot of material available including the questionnaire which is a good step.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Partly
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

No
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Epidemiology and public health with focus on physical activity and mental health among adolescents

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Reviewer Report 13 May 2024

Maryam Marashi, Department of Kinesiology & Physical Education, University of Toronto, Toronto, Ontario, Canada

Approved with Reservations

https://doi.org/10.21956/hrbopenres.14567.r38670

This study from The Irish Longitudinal Study on Ageing (TILDA) investigates the association between self-reported changes in physical activities and sedentary behaviors and their impact on mental health during the COVID-19 pandemic among older Irish adults. Utilizing data from pre-pandemic ... Continue reading

This study from The Irish Longitudinal Study on Ageing (TILDA) investigates the association between self-reported changes in physical activities and sedentary behaviors and their impact on mental health during the COVID-19 pandemic among older Irish adults. Utilizing data from pre-pandemic (2018) and during the pandemic (July–November 2020), the study explores how changes in lifestyle due to pandemic restrictions correlate with changes in mental health metrics. Key findings indicate that decreases in physical activity and increases in sedentary behavior are significantly associated with increased depressive symptoms and stress levels, among other interesting findings related to leisure time behavior and lifestyle factors. I believe it is a worthwhile study as it provides insights into how lifestyle disruptions during the COVID-19 pandemic have impacted the mental health of older adults in Ireland using a robust methodological approach with a nationally representative longitudinal dataset. This research addresses a significant public health issue, offering data that could inform interventions designed to mitigate similar impacts in future public health crises. Moreover, the availability of the study data through a public archive enhances the transparency and reproducibility of the research.
A few comments to improve the manuscript:

Theoretical frameworks: The introduction and discussion could benefit from including a theoretical framework such as the Biopsychosocial model. This model could provide a lens through which to view the interplay of biological, psychological, and social factors influencing the mental health of older adults during the pandemic.
Conflicting literature: Given the plethora of studies on the impact of COVID-19 on mental health and physical activity published in the last four years, some of which present conflicting findings [Ref-1,2], it would be beneficial to discuss these discrepancies. Mentioning the challenges associated with studying this topic, such as varying methodologies, differing sample populations, or the evolving nature of the pandemic, could be included in either the introduction or the discussion.
Types of physical activity: The manuscript currently does not distinguish between different types and intensities of physical activity, representing a limitation. Physical activities vary widely in intensity and the kind of engagement they require, from light walking to vigorous exercise, resistance training, sport, etc., and these variations could have differential impacts on mental health. The discussion section should acknowledge that this lack of differentiation could affect the study’s findings. For instance, moderate to vigorous physical activities might have more pronounced mental health benefits than lighter activities.
Speculations and suggested mechanistic research: In the discussion section, it would be helpful to speculate further on potential explanations for the observed relationships, such as exploring the role of social isolation, the quality of physical activity, or individual psychological resilience. Discussing potential avenues for mechanistic research, such as longitudinal studies focusing on biological markers of stress, ways to objectively measure PA or detailed qualitative research on personal coping strategies, would highlight gaps in the current understanding and suggest directions for readers interested in conducting future research on this topic.

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

I cannot comment. A qualified statistician is required.
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

References

1. Sylvestre MP, Tchouangue Dinkou GD, Armasu A, Pelekanakis A, et al.: Symptoms of depression and anxiety increased marginally from before to during the COVID-19 pandemic among young adults in Canada.Sci Rep. 2022; 12 (1): 16033 PubMed Abstract | Publisher Full Text
2. O'Loughlin EK, Riglea T, Sylvestre MP, Pelekanakis A, et al.: Stable physical activity patterns predominate in a longitudinal study of physical activity among young adults in Canada from before to during the COVID-19 pandemic.Prev Med Rep. 2022; 27: 101782 PubMed Abstract | Publisher Full Text

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: I am a researcher and PhD student with interests in the intersection of mental health and physical activity. My academic and professional experiences have provided me with an understanding of the relationships between physical behavior and mental health outcomes.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Reviewer Report 16 Apr 2024

Fitria Dwi Andriyani, Department of Sports Education, Universitas Negeri Yogyakarta, Yogyakarta, Special Region of Yogyakarta, Indonesia

Approved with Reservations

https://doi.org/10.21956/hrbopenres.14567.r38410

The authors aim to investigate the associations of self-reported changes in physical activities and sedentary behaviors with mental health changes during the COVID-19 pandemic among older Irish adults.
Overall, the article was well-presented, the quality of the study design ... Continue reading

The authors aim to investigate the associations of self-reported changes in physical activities and sedentary behaviors with mental health changes during the COVID-19 pandemic among older Irish adults.
Overall, the article was well-presented, the quality of the study design is sound. The study also involved a nationwide sample, supporting the strength of the study. Please see below my recommendations for the article.

Physical activity rates dropped worldwide when the pandemic hit²¹ and there was also an increase in sedentary time. (Please add citation).
Although numerous other cohort studies have found negative associations between mentally-passive sedentary behaviours and mental health²⁴(I suggests the authors to provide more citations while using 'numerous' and preferably from primary sources or systematic reviews).
There is some evidence to suggest that changes to activity behaviours during the COVID-19 pandemic are associated with negative changes in mental health; although most studies are cross-sectional, have small samples, and are limited by the use of convenience samples which may bias their findings, (please add citations)
Additionally, few studies focused on older adult populations who are likely to be at high risk due to the stricter restrictions (e.g. cocooning or shielding at home was asked to the over 70s in Ireland) and increased threat of morbidity and mortality posed by COVID-19 to this population (please add citations).
The authors should explain more regarding the instruments to collect data. While they may have been explained elsewhere, but key points or information should be explained in the paper, including the validity and reliability of the instruments.
Please adjust the location of “Changes in physical activity and sedentary behaviours” on page 3.
Depressive symptoms at Wave 5 and COVID-19 Wave were measured using the 8-item Centre for Epidemiological Studies Depression Scale (CESD-8). (please add citation)
It has been shown to be consistent, reliable, and valid for use within the TILDA cohort³¹ (please specify the reliability and validity scores).
Participants’ height was measured to the nearest 0.01m (Seca 240 Stadiometer, Seca Ltd, Birmingham, UK), weight to the nearest 0.1 kg (Seca 861 Electronic Scales, Seca Ltd, Birmingham, UK).(please clarify whether the data of participants’ height and weight were self-reported or measured by the researcher. When these kinds of measurements have been done? In which wave?)
All statistical analyses could also be performed using the open access R software (R Foundation for Statistical Computing, Vienna, Austria [Team, 2018]).(please clarify the necessity of mentioning this as this research didn’t use R for analysis)
Linear regressions were used to assess the separate associations between changes in physical activities and sedentary behaviours before and after the outbreak of COVID-19 and perceived stress / depressive symptoms levels (continuous) during the COVID-19 Wave .(please edit extra space before full stop)
Please clarify in the article whether participants got compensations for their participation in the research.
Measures of changes in physical activity and sedentary behaviours were missing for 202 participants (n=2,921). Additional missingness on covariates left 2,645 individuals with full data for analysis.(please explain the reasons for “the missing”)
Most participants reported doing about the same amount of exercise at home compared to before COVID-19 Wave (47%)(the use of “most participants” seemed to be not match with 47% proportion)
A large proportion of participants reported increases in home DIY (do it yourself)/gardening (add full stop).
The layout of Table 1 need to be adjusted so that the table will be on the same page.
The author need to edit the detail in the table 2 (Exercising at home)
Please explain the necessity or the reason for implementing model 1-3 in the analysis.
Discussion. These findings are broadly in line with related previous research and support the need to facilitate physical activities, particularly among those who reduced their activity levels due to COVID-19. (please add citation) Similarly, participation in hobbies and reading among those who reduced their engagement in these activities may be beneficial (please add citation)
Conclusion. To conclude, the COVID-19 pandemic has severely, negatively impacted the mental health of older adults in Ireland. (the author may need to soften the tone of the language).

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

I cannot comment. A qualified statistician is required.
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: physical activity, sedentary behaviour

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Version 1 17 Sep 21	read	read	read

Fitria Dwi Andriyani, Universitas Negeri Yogyakarta, Yogyakarta, Indonesia
Maryam Marashi, University of Toronto, Toronto, Canada
Bjorg Helgadottir, The Swedish School of Sport and Health Sciences, Stockholm, Sweden

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22 May 2024 | for Version 1

Bjorg Helgadottir, Department of Sports Science, The Swedish School of Sport and Health Sciences, Stockholm, Sweden

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Approved With Reservations

Thank you for the opportunity to review this article. Below are my concerns.

Introduction

“The coronavirus disease 2019 (COVID-19) pandemic and containment strategies employed to limit its spread have profoundly impacted daily life.” It did impact life at the time but not daily life now so the phrasing of this sentence could be improved.

Methods

It sounds like it is always the same participants who participate in each wave. This means that the sample in wave 5 will likely be quite selective and healthier (survival bias) than the original sample.
71% response rate of what? Original wave 1 sample, the previous wave? This is unclear
The questions on changes in activity are inherently problematic because they lack info on quantity. If for an example a person watched a lot of TV before the pandemic and increased a lot, they will be in the same category as someone how watched very little and increased a little bit. this needs to be addressed in the limitation section.
I looked at the exact question in the file you provided in the data repository. If I stopped doing something altogether, do I then choose the option of not at all or less often? It feels like there is a potential to misunderstand this question.
What did you do with the information on depressive medication? I don’t see it listed as a covariate in the models
“At Wave 1 and 3, a subset of the respondents also completed a comprehensive centre-based health assessment or a modified home-based health assessment, carried out by trained research nurses.” What is this information used for? The variables you mention all seem to be measured at wave 5

Results

You have a very selective sample in the full analysis, this could lead to biases that should be discussed.
“Perceived stress and depressive symptoms were substantially higher in the early months of the COVID-19 pandemic” This is a bit unclear, are you using all of your data from July to November? To me early months sounds like March until the summer since the situation was a bit easier during the summer

Discussion

You say in the introduction that the downside of previous studies is often only having cross-sectional data. Although you have longitudinal data on the outcomes your exposures are still measured at the same time as the outcome which weakens the argument that you have stronger data. Asking people to assess whether their behaviour has changed due to a specific event is not the same as having longitudinal data and really showing that their behaviour has changed.
I think there is a missed opportunity here to analyse the sample split into 50-69 and 70+ years old. Since you state multiple times that those older than 70 years were especially isolated this seems like a golden opportunity to compare these two groups. Otherwise you need to tone down the focus on the instructions to the older than 70 years group in both the introduction and discussion.

Regarding the access to the data, it is available on request so I could not verify the analyses but the authors have made a lot of material available including the questionnaire which is a good step.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Partly
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

No
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Epidemiology and public health with focus on physical activity and mental health among adolescents

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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13 May 2024 | for Version 1

Maryam Marashi, Department of Kinesiology & Physical Education, University of Toronto, Toronto, Ontario, Canada

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Approved With Reservations

This study from The Irish Longitudinal Study on Ageing (TILDA) investigates the association between self-reported changes in physical activities and sedentary behaviors and their impact on mental health during the COVID-19 pandemic among older Irish adults. Utilizing data from pre-pandemic (2018) and during the pandemic (July–November 2020), the study explores how changes in lifestyle due to pandemic restrictions correlate with changes in mental health metrics. Key findings indicate that decreases in physical activity and increases in sedentary behavior are significantly associated with increased depressive symptoms and stress levels, among other interesting findings related to leisure time behavior and lifestyle factors. I believe it is a worthwhile study as it provides insights into how lifestyle disruptions during the COVID-19 pandemic have impacted the mental health of older adults in Ireland using a robust methodological approach with a nationally representative longitudinal dataset. This research addresses a significant public health issue, offering data that could inform interventions designed to mitigate similar impacts in future public health crises. Moreover, the availability of the study data through a public archive enhances the transparency and reproducibility of the research.
A few comments to improve the manuscript:

Theoretical frameworks: The introduction and discussion could benefit from including a theoretical framework such as the Biopsychosocial model. This model could provide a lens through which to view the interplay of biological, psychological, and social factors influencing the mental health of older adults during the pandemic.
Conflicting literature: Given the plethora of studies on the impact of COVID-19 on mental health and physical activity published in the last four years, some of which present conflicting findings [Ref-1,2], it would be beneficial to discuss these discrepancies. Mentioning the challenges associated with studying this topic, such as varying methodologies, differing sample populations, or the evolving nature of the pandemic, could be included in either the introduction or the discussion.
Types of physical activity: The manuscript currently does not distinguish between different types and intensities of physical activity, representing a limitation. Physical activities vary widely in intensity and the kind of engagement they require, from light walking to vigorous exercise, resistance training, sport, etc., and these variations could have differential impacts on mental health. The discussion section should acknowledge that this lack of differentiation could affect the study’s findings. For instance, moderate to vigorous physical activities might have more pronounced mental health benefits than lighter activities.
Speculations and suggested mechanistic research: In the discussion section, it would be helpful to speculate further on potential explanations for the observed relationships, such as exploring the role of social isolation, the quality of physical activity, or individual psychological resilience. Discussing potential avenues for mechanistic research, such as longitudinal studies focusing on biological markers of stress, ways to objectively measure PA or detailed qualitative research on personal coping strategies, would highlight gaps in the current understanding and suggest directions for readers interested in conducting future research on this topic.

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

I cannot comment. A qualified statistician is required.
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

References

1. Sylvestre MP, Tchouangue Dinkou GD, Armasu A, Pelekanakis A, et al.: Symptoms of depression and anxiety increased marginally from before to during the COVID-19 pandemic among young adults in Canada.Sci Rep. 2022; 12 (1): 16033 PubMed Abstract | Publisher Full Text
2. O'Loughlin EK, Riglea T, Sylvestre MP, Pelekanakis A, et al.: Stable physical activity patterns predominate in a longitudinal study of physical activity among young adults in Canada from before to during the COVID-19 pandemic.Prev Med Rep. 2022; 27: 101782 PubMed Abstract | Publisher Full Text

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

I am a researcher and PhD student with interests in the intersection of mental health and physical activity. My academic and professional experiences have provided me with an understanding of the relationships between physical behavior and mental health outcomes.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Reviewer Report

18 Views

16 Apr 2024 | for Version 1

Fitria Dwi Andriyani, Department of Sports Education, Universitas Negeri Yogyakarta, Yogyakarta, Special Region of Yogyakarta, Indonesia

18 Views Cite this report Responses(0)

Approved With Reservations

The authors aim to investigate the associations of self-reported changes in physical activities and sedentary behaviors with mental health changes during the COVID-19 pandemic among older Irish adults.
Overall, the article was well-presented, the quality of the study design is sound. The study also involved a nationwide sample, supporting the strength of the study. Please see below my recommendations for the article.

Physical activity rates dropped worldwide when the pandemic hit²¹ and there was also an increase in sedentary time. (Please add citation).
Although numerous other cohort studies have found negative associations between mentally-passive sedentary behaviours and mental health²⁴(I suggests the authors to provide more citations while using 'numerous' and preferably from primary sources or systematic reviews).
There is some evidence to suggest that changes to activity behaviours during the COVID-19 pandemic are associated with negative changes in mental health; although most studies are cross-sectional, have small samples, and are limited by the use of convenience samples which may bias their findings, (please add citations)
Additionally, few studies focused on older adult populations who are likely to be at high risk due to the stricter restrictions (e.g. cocooning or shielding at home was asked to the over 70s in Ireland) and increased threat of morbidity and mortality posed by COVID-19 to this population (please add citations).
The authors should explain more regarding the instruments to collect data. While they may have been explained elsewhere, but key points or information should be explained in the paper, including the validity and reliability of the instruments.
Please adjust the location of “Changes in physical activity and sedentary behaviours” on page 3.
Depressive symptoms at Wave 5 and COVID-19 Wave were measured using the 8-item Centre for Epidemiological Studies Depression Scale (CESD-8). (please add citation)
It has been shown to be consistent, reliable, and valid for use within the TILDA cohort³¹ (please specify the reliability and validity scores).
Participants’ height was measured to the nearest 0.01m (Seca 240 Stadiometer, Seca Ltd, Birmingham, UK), weight to the nearest 0.1 kg (Seca 861 Electronic Scales, Seca Ltd, Birmingham, UK).(please clarify whether the data of participants’ height and weight were self-reported or measured by the researcher. When these kinds of measurements have been done? In which wave?)
All statistical analyses could also be performed using the open access R software (R Foundation for Statistical Computing, Vienna, Austria [Team, 2018]).(please clarify the necessity of mentioning this as this research didn’t use R for analysis)
Linear regressions were used to assess the separate associations between changes in physical activities and sedentary behaviours before and after the outbreak of COVID-19 and perceived stress / depressive symptoms levels (continuous) during the COVID-19 Wave .(please edit extra space before full stop)
Please clarify in the article whether participants got compensations for their participation in the research.
Measures of changes in physical activity and sedentary behaviours were missing for 202 participants (n=2,921). Additional missingness on covariates left 2,645 individuals with full data for analysis.(please explain the reasons for “the missing”)
Most participants reported doing about the same amount of exercise at home compared to before COVID-19 Wave (47%)(the use of “most participants” seemed to be not match with 47% proportion)
A large proportion of participants reported increases in home DIY (do it yourself)/gardening (add full stop).
The layout of Table 1 need to be adjusted so that the table will be on the same page.
The author need to edit the detail in the table 2 (Exercising at home)
Please explain the necessity or the reason for implementing model 1-3 in the analysis.
Discussion. These findings are broadly in line with related previous research and support the need to facilitate physical activities, particularly among those who reduced their activity levels due to COVID-19. (please add citation) Similarly, participation in hobbies and reading among those who reduced their engagement in these activities may be beneficial (please add citation)
Conclusion. To conclude, the COVID-19 pandemic has severely, negatively impacted the mental health of older adults in Ireland. (the author may need to soften the tone of the language).

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

I cannot comment. A qualified statistician is required.
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

physical activity, sedentary behaviour

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

Respond to this report

Responses (0)

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Associations between self-reported changes in physical activities and sedentary behaviors and changes in mental health during the coronavirus disease 2019 (COVID-19) pandemic: findings from The Irish Longitudinal Study on Ageing (TILDA)

Abstract

Keywords

Introduction

Methods

Study design

TILDA COVID-19 Study

Changes in physical activity and sedentary behaviours

Perceived stress

Depressive symptoms

Covariates

Analyses

Ethics

Results

Participant characteristics

Table 1. Baseline characteristics of The Irish Longitudinal Study on Ageing (TILDA) participants who took part in the coronavirus disease 2019 (COVID-19) study.

Table 2. Levels of stress and depression at Wave 5 and during the coronavirus disease 2019 (COVID-19) pandemic and self-reported changes in physical activity and sedentary behaviours before and after the outbreak for the study sample.

Association between changes in physical activity and sedentary behaviours and levels of perceived stress during the COVID-19 Wave

The association between changes in physical activity and sedentary behaviours and levels of depressive symptoms during the COVID-19 Wave

Discussion

Conclusion

Data availability

Underlying data

Extended data

Acknowledgements

References

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Associations between self-reported changes in physical activities and sedentary behaviors and changes in mental health during the coronavirus disease 2019 (COVID-19) pandemic: findings from The Irish Longitudinal Study on Ageing (TILDA)

Abstract

Keywords

Introduction

Methods

Study design

TILDA COVID-19 Study

Changes in physical activity and sedentary behaviours

Perceived stress

Depressive symptoms

Covariates

Analyses

Ethics

Results

Participant characteristics

Table 1. Baseline characteristics of The Irish Longitudinal Study on Ageing (TILDA) participants who took part in the coronavirus disease 2019 (COVID-19) study.

Table 2. Levels of stress and depression at Wave 5 and during the coronavirus disease 2019 (COVID-19) pandemic and self-reported changes in physical activity and sedentary behaviours before and after the outbreak for the study sample.

Association between changes in physical activity and sedentary behaviours and levels of perceived stress during the COVID-19 Wave

The association between changes in physical activity and sedentary behaviours and levels of depressive symptoms during the COVID-19 Wave

Discussion

Conclusion

Data availability

Underlying data

Extended data

Acknowledgements

References

Comments on this article Comments (0)

Open Peer Review

Comments on this article Comments (0)

Open Peer Review

Reviewer Status

Reviewer Reports

Comments on this article

Competing Interests Policy

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Are you a HRB-funded researcher?

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