COVID-19 and the relationship with lifestyle factors

In 2020, the COVID-19 pandemic has changed ordinary life in many ways.(1) In the Netherlands, like many other countries, social distancing has become the ‘new normal. By contrast, over the last decades, physical inactivity has been a growing concern for public health. This has raised serious public health concerns because of the association between overweight and obesity and increased risk of a wide range of chronic diseases, including cardiovascular diseases, type 2 diabetes mellitus (T2DM), and all-cause mortality.(2-6) It is well established that physical activity (PA) has many positive health benefits, including increased life expectancy and reduced chances of being diagnosed with cardiovascular diseases (CVD). (7-9) In addition, physical inactivity has large economic consequences, including health care costs and productivity loss. (10,11) Worldwide, PA guidelines and policies have been established to promote PA, but with limited effect, and physical inactivity has also been identified as a ‘pandemic’ by the World Health Organization (WHO). (12-14) In this context, all data convincingly indicates the PI pandemic will persist long after we recover from the COVID-19 pandemic - the health and economic impacts of the PI pandemic, for which no end is in sight, will continue to be severe. It is important to note that the aforementioned statistics focus on PI in the context of not meeting recommended PA guidelines (e.g., 150 min or more of moderate intensity PA per week).(15) 
Many opportunities to be physically active have been suspended, including the closure of voluntary sports clubs, fitness centers and school-based physical education as well as facilities to be physically active, such as swimming pools. On the one hand these mostly governmental (and sometimes voluntary) measures have improved social distancing practice and thus protected the spread of COVID-19. On the other hand this severe diminishment of PA possibilities (the supply side) has seen severe drops in PA and sport participation as well as social isolation. As these effects are all associated with increased health risks, including mortality risks .(3,5) So in the short run, the COVID-19 pandemic and the subsequent policy actions have had a negative impact on the PA pandemic, in making the world move even less than before. This raises many questions, to which there are no readily available answers in the current state of knowledge. What are the short term and lasting effects of a pandemic, such as COVID-19, on PA? Who have changed their PA behavior for worse (i.e. decreased the amount of PA) or for the better (the pandemic has also lead to increases in PA among a significant part of the population)? Have socioeconomic inequalities in PA and subsequently health played a role in the changed behavior? And, perhaps even more importantly, what are the effects of COVID-19 for different socioeconomic groups? What can be learned from the crisis and how can the negative effects be overturned or at least be minimized and the positive effects be conserved? 
Although the importance of PA in ‘normal’ circumstances is already beyond dispute, it is also important to note that physical inactivity may accelerate the effects of future pandemics. (16-18) accelerated PI patterns and sedentary behaviors may worsen the impact of future pandemics. Not surprisingly, individuals infected with COVID-19 are much more likely to be hospitalized and have poorer health outcomes if underlying medical conditions, such as one or more chronic disease diagnoses, are present.(19). 
One of the positive side-effects of the COVID-19 crisis is that it moves the importance of a preventive lifestyle up on the political agenda. The need for stronger public efforts to get people physically moving again after COVID-19 has been recognized more than ever. To go from recognition to action, research about the PA behavior is needed to be able to apply this more knowledge is needed. A good starting point could be to focus on the groups changed their behavior as a result of the COVID-19 pandemic. One reason is that is much harder to get long-term inactive persons active than persons who have recently stopped or decreased their PA (i.e. before the COVID-19 pandemic). Secondly, insights about the mechanisms (who, why, how) that changed PA in the COVID-19 pandemic may be also valuable to changes in behavior after the COVID-19 crisis, in a new (future) crisis or in general. That knowledge is much needed for all efforts to improve PA for the health and well-being of society and future generations.