key: cord-0711045-d67lhszd
authors: Yamada, Keiko; Yamaguchi, Satoshi; Sato, Kimihito; Fuji, Takeshi; Ohe, Takashi
title: The COVID-19 outbreak limits physical activities and increases sedentary behavior: a possible secondary public health crisis for the elderly
date: 2020-09-04
journal: J Orthop Sci
DOI: 10.1016/j.jos.2020.08.004
sha: 8c8851cd79205d2282cf5421aeb1fb5c34351dbb
doc_id: 711045
cord_uid: d67lhszd

nan

In February 2020, the Japanese government requested the general population to avoid 2 unnecessary outings, as well as local governments, to close schools nationwide to prevent 3 coronavirus disease 2019 (COVID-19) from rapidly spreading [1] . Although these measures 4 are indispensable to prevent the spread of the highly contagious disease, refraining from 5 outings for prolonged periods could cause unintended negative consequences on health, 6 especially in the elderly, due to reduced physical activity and sedentary behavior at home. 7

In the Great East Japan Earthquakes in 2011, up to 60 % of the elderly in shelters 8

reportedly experienced disuse syndrome one month after the disaster [2] , indicating 9 vulnerability to confinement. Although this may be an extreme example, even moderate 10 restraint on outings could result in decreased physical activity and increased sedentary 11 behaviors, which may contribute to aggravating pre-existing chronic diseases, accelerating 12 frailty or locomotive syndrome,* and increasing long-term morbidity and mortality among 13 the elderly[3]. 14 We conducted an emergent nationwide internet survey among 5,000 people aged over 20 15 years old (including 1,000 people over 60 years old) to assess the physical activities and 16 sedentary behaviors in Japan during February 2020 [4] . The participants were informed and 17 gave consent that data from the study would be released to public or submitted for 18 publication, when they participated in this study. This study was approved by the institutional 19 review board of the authors' affiliated institution. 20

Overall, 48% and 38% of people over the age of 60 had less physical activity and longer 21 sedentary time, respectively, when compared to those over the same period in the previous 22

year (Table1), which percentages were the highest among all age groups both in men and 23 women. Additionally, the instrumental activities of daily living were affected during the 24 COVID-19 outbreak. Overall, 52% and 43% of individuals over the age of 60 with decreased 25 outings reported a lower frequency of shopping and the use of public transportation, 26 respectively. We consider that many more people experienced further decreased physical 27 activitiy and increased sedentary time after this survey in Feburary, since the Japanese 28 government announced a state of emergency and strongly requested the people to self-29 quarantine in April. 30

The COVID-19 pandemic will be expected to last for one or two years [5] , and 31 consequently, the elderly would be most likely to go on self-quarantine for the 32 correspondning period, as this survey indicated. However, it also means that the elderly could 33 be more vulnerable through decreased physical activity and increased sedentary behavior. 34

Moreover, it is expected that once health conditions are impaired in the elderly, recovery to 35 the original health status can be challenging, given the declined intrinsic capacity [6] . 36 Therefore, the government, municipalities, and non-governmental organizations, should 37 cooperate and take necessary measures to avoid this potentially critical public health problem, 38 less physical activity and more sedentary behavior in the elderly during the COVID-19 39 pandemic. Suggestions include promotion with broadcast media, online workout programs, or 40 distributing brochures to encourage at-home physical activities. We would have to create 41 flexible design of the system to promote physical activities at home for the elderly. 42

Countries with a large aging population such as Japan need to tackle this problem to 43 decrease the number of elderly with worsening health status during the pandemic owing to at-44 home confinement. Are there any changes in the frequency of outings in the recent month compared to the same period of last year? Q2. Are there any changes in physical activities in the past month compared to the same period of last year? Q3. Are there any changes in sedentary time in the recent month compared to the same period of last year? P-values are obtained from the chi-square test (<0.05 significant).

Basic policy for 52 countermeasures against COVID-19

The great East Japan earthquake disaster: a 55 compilation of published literature on health needs and relief activities

59 of influence of COVID-19 on physical activities. Press Release from 61 'Locomo Challenge' Promotion Council

COVID-19: The CIDRAP viewpoint

World Health Organization