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Effect On Student's Mental Health Due To Physical Inactivity During

Coronavirus Pandemic: Systematic Review

Article  in  International Journal of Grid and Distributed Computing · January 2021

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 International Journal of Grid and Distributed Computing
Vol. 14, No. 01, (2021), pp.1909 -1923

Effect On Student's Mental Health Due To Physical Inactivity During Coronavirus

Pandemic: Systematic Review
1
Dr. Apoorva Dighe (PT) 2, Dr.Deepali Rathod (PT), 3Dr. Shweta Satish Devare Phadke, 4Dr.
Pranati Tilak

1 Assistant Professor, Department of Neuro-Physiotherapy, TMV’s Lokmanya Medical college of

Physiotherapy, Kharghar, Navi Mumbai, Maharashtra, India.
apoorvadighe@gmail.com Mobile no; 9579350191

2 Assistant Professor, Kinesiotherapy Department, TMV’s Lokmanya Medical college of Physiotherapy,

Kharghar, Navi Mumbai, Maharashtra, India
dr.deepali.pankaj.rathod@gmail.com Mobile no; 9082390287

3. Principal and Professor, TMV’s Lokmanya medical college of Physiotherapy, Kharghar,

Maharashtra,India
Phadkeshweta7@gmail.com Mobile no; 9869157186

4. Campus Director, TMV’s Lokmanya Medical college of Physiotherapy, Kharghar, Maharashtra ,India
drprantitilak@gmail.com

ABSTRACT

The outbreak of COVID-19 is having severely affected mental health worldwide. Many countries are
under lockdown, the economy has halted, and everyone is afraid of its consequences. The entire life of the
population has been changed due to sudden lockdown. Isolation has greatly affected individual lives by
greater reduction in Physical activity, which in turn increased the chance of infection. It also reduced the
immunity and negatively affected the mental health. The aim of this systematic review was to explore the
effect on mental health of students due to physical inactivity in coronavirus pandemic. Literature search
was conducted through electronic databases that included Pub Med, Google Scholar, Science direct and
ERIC for studies performed from year December 2019 to September 2020. Students, Inactivity, Anxiety,
COVID 19 and depression, used as keywords Total 187 articles were identified through database search,
out of which 171 were removed due to duplication or exclusion. Articles that evaluated apart from
anxiety, stress and depression were considered as exclusion. Out of 187 studies, 16 articles fitting in the
inclusion criteria were selected for this systematic review. Literature was search from year 2019 referring
to subject of interest up to 2020.The review concluded strong evidence for Stress, Anxiety and depression
in students during COVID 19 Pandemic having decrease in Physical Activity.

Keywords; Students, Physical Inactivity, Anxiety, Depression, COVID 19

INTRODUCTION:

On 30 January 2020, WHO announced that the COVID-19 outbreak was a Public Health Emergency of
International Concern.1 COVID-19 is an acute respiratory illness caused by a novel human coronavirus
(SARS-CoV-2, called COVID-19 virus), which causing mortality in people more than 60 years of age and

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in people with underlying medical conditions like cardiovascular disorders, diabetes mellitus and cancer.
The novel coronavirus (COVID-19) has resulted in a global health emergency.1 As of 7th August 2020,
the virus has claimed more than 716,000 lives globally and infected more than 19.2 million
people.2Requiring people to practice social distancing and undergoing self-quarantine and or self-isolation
which are public health mitigation strategies and actions many countries have used to such strategies to
control and prevent the widespread of COVID-19. Schools, colleges and many jobs have transitioned to
online due to increasing number of cases. Restaurants, gyms, parks, and other public places used for
social activities and recreation have closed response to COVID-19, leading to significant disruptions and
changes in everyday schedules for work, school, recreation, and social engagement routines.3 Physical
Activity (PA) or exercise routine is compromised due to reduction in movement.
PA showed vitally important in improving the human system and reducing the risk for diseases and health
condition due to present pandemic. Those people who exercise have a lower incidence of coronary
disorders. Studies also prove that there is a strong inverse relation between exercise, obesity and diabetes.
4
There were profound reductions in physical ailments due to different interventions designed to extend
PA. A recent study suggested those who exercise suffer from less depression, anxiety, fatigue, and
cognitive impairments.3
Many studies reported that staying home for extended time might lead to sedentary behaviour's, such as
spending more time on sitting activities, playing games. Watching television, decreasing regular outdoor
activity and exercises results in an increased risk of chronic health conditions.5 The applicability of
lockdown due to COVID-19 not only affects people's mental health but also affects physical health due to
no activity. Previous studies reported that around 35% people were experiencing psychological stress.
Long-term PA may reduce the immune function and affect the physiological system of the body. Also this
may lead to secondary problems like infections, drowsiness, obesity and other psychological issues. 3
Objective of the study was to explore effect of mental health of students due to physical inactivity in
coronavirus pandemic.

MATERIAL & METHODS:

Identification and selection-

Preferred Reporting items for Systematic reviews and Meta Analyses (PRISMA) was used for conducting
this Systematic review. Pub Med, Science direct, Google Scholar and ERIC databases were used for
literature search. Keywords used were “Students, Physical Inactivity, Anxiety, Depression and COVID
19”. Full texts articles were compiled and evaluated for inclusion.

INCLUSION CRITERIA:

All articles from December 2019 - September 2020 evaluating effect on Mental Health due to Physical
inactivity in school and college going students at the time of COVID pandemic were included. Articles in
only English language were included.

EXCLUSION CRITERIA:

Articles evaluating parameters apart from anxiety, depression and stress were considered as exclusion.

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Literatures on other population group including the working individual and elderly population were
excluded from the study.

Inclusion criteria were applied to title of the article, abstracts and full texts.

STUDY SOURCES:

Literature search was performed referring to subject of interest from year 2019 - 2020, using following
databases- Google scholar, Pub Med, Science Direct and ERIC using different key words. Keywords
included “Students, Physical Inactivity, Anxiety, Depression and COVID 19”.

STUDY SELECTION:

Figure 1; Study strategy and study selection process

Records identified through database searching

Google Scholar PubMed Science Direct ERIC (n= 118)

(n=26) (n=35) (n=8)

(n=187)

Removed Due to Duplication/Exclusion

(n=171)

Total studies included in the review

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(n=16)

DATA COLLECTION PROCESS:

Full text was obtained for each article from above mentioned database. In Total 187 articles were
extracted but due to duplication 171 articles were removed. Finally, 16 articles were included in our
systematic review. Required details were systematically extracted from each study and findings are
summarized based on their principal findings.

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Psychiatric
Count symptoms/ COVID
Type of Study Sampl Age Outcome
Study ry co 19 Status Conclusion
e size group/ measures morbidity Limitation

1.Mental Health and Cohort Study Participants were

Behavior During the Early undergraduate college
Phases of the COVID-19 Compared with prior students, which limits
Student Life
Pandemic: A Longitudinal academic terms, generalizability of the
mobile 200,000
Mobile Smartphone and United individuals in COVID findings to the
smartphone deaths
Ecological Momentary 219 States 19 were depressed and general population.
18-22 sensing app, Depression and
Assessment Study in College Studen of anxious. Variety of
years Ecological & Anxiety 3,000,000
Students ts Americ behavior’s including
Momentary confirmed
a phone usage and
Assessments cases
Jeremy F. Huckins et al. May decreased Physical
(EMAs)
2020 activity was reported.

Survey Based 24.9% of students -

experienced anxiety
2.The psychological impact because of COVID 19
Anxiety pandemic. The mental
of the COVID-19 epidemic 7143 Undergra Generalized
disorders, 49,824 health of college
on college students in China duate Anxiety
Studen China phobia, confirm students significantly
Medical disorder
Wenjun Cao, Ziwei Fang et ts stress and cases affected with public
students scale
al. March 2020. panic. emergency, and they
require attention, help,
and support of the
society, families, and

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colleges.

3. Impact of COVID-19 Survey based, Considering health

pandemic on the mental purposive Results showed that threats, face to face
health of children in sampling Child anxiety large number of interview was not
Bangladesh: A cross- Depression, taken whereas when
387 Depression children was suffering
sectional study 5-15 Bangla anxiety and compared to face to
childre scale and unknown from mental health
years desh sleep face interviews, self-
n behavior disturbances in
Sabina Yeasmin et al. July disturbance reporting has certain
checklist Bangladesh during
2020 limitations.
lockdown period.

Web Based Small sample size,

open E survey Only Physiotherapy
professionals were
4. Impact of coronavirus Reduction in self-report included. Only one
disease -19 lockdown on Physical inactivity and outcome measure was
physical activity and energy energy expenditure used.
expenditure among 143 Undergra International
levels were seen among
physiotherapy professionals Physio duate, Physical
Energy students during COVID
and students using E-survey therap Interns Haryan activity Ques 1991,562
Expenditur 19 lockdown.
sent through Whatsapp y and a, India tionnaire Sho cases,
e
Facebook and Instagram Studen Postgradu rt form
messengers ts ate (IPAQ-SF

Adarsh K Srivastav et. al

July 2020

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Age countr Psychiatric COVID 19

group y symptoms/ Status
Study Type of Study Sampl Outcome co Conclusion Limitation
e size measure morbidity

Self-reported
inventory like
5.COVID-19 pandemic and Epworth
lockdown: cause of sleep sleepiness scale,
disruption, depression, 325 Mental health and
somatic pain, and increased Online UG The Centre for Sleep 67,152 physical wellbeing
screen exposure of office questionnaire and 22.1±1.66 epidemiological Deprivation Confirmed were imbalanced as
survey India -
workers and students of India PG yrs. studies depression , cases, 2206 screen exposure
studen scale, Nordick Depression deaths increased and sleep
Piya Majumdar et al. June ts questionnaire, schedule altered.
2020 Discomfort rating
scale

6.Closure of Universities Online survey The health and safety -

Factors causing
Due to Coronavirus Disease of students and staff
Depression and
2019 (COVID-19): Impact 72,435 should be the top
anxiety- shift to
on Education and Mental Universit patients, priority. Proper
West face to face online Anxiety &
Health of Students and _ y more than counseling services
Indies classes, travel Depression
Academic Staff Students 33,997 should be available to
restrictions,
deaths support the mental
Pradeep Sahu et al., April online assessment
health and well-being
2020 system.
of students.

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7.Covid-19: U3A students’ Phenomenolog I) means of 1) Students of a

report on the impacts of ical interview spreading Degree of concern for single U3A
social isolation on physical based information on spread of virus. were included.
qualitative Covid-19 Sleep
and mental health and access Therefore, it was 2) It was a
study disorders,
to information about the ii) impacts of observed that the daily descriptive
loss of
virus during the pandemic isolation and and successive cross-sectional
35 _ Brazil appetite and Unknown
social distancing consumption of study it was not
Marcelo de Maio reduced
on mental health images about the possible to
Nascimento et al. July 2020 functional
and ,impact of deceased was causing explore causal
capacity
isolation and moments of anxiety links between
social distancing and distress the facts
on physical health

Online Survey Increase in sleep

8.Changes in sleep pattern, Italian version of
difficulty was more for
sense of time and digital Pittsburg Sleep
809 Sleep people with higher
media use during COVID-19 Quality Index
univer quality, 8342 level of depression,
lockdown in Italy 18-25 (PSQI),digital _
sity Italy Stress, confirmed anxiety and stress
years media use time in
Nicola Cellini et al. April studen Depression cases symptoms, and
hrs., Depression
2020 ts and Anxiety associated with the
Anxiety Stress
feeling of elongation
Scale (DASS-21)
of time.

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9. The impact of physical Online Survey Anxiety,

Depressed The reduction of total
activity on psychological
health during Covid-19 mood, physical activity had a
Less than
pandemic in Italy positive 207428 profoundly negative _
21 yrs.
2974 Italy IPAQ-SF well-being, total no. Of impact on
(346
Grazia Maugeri et al., June self-control, cases. psychological health
students)
2020 general and well-being of
health, and population
vitality

10.Student mental health in Letter to editor

the midst of the COVID-19
pandemic: A call for further Long-term negative
Anxiety,
research and immediate implications for
College Increased
solutions _ Canada _ _ student education and
Students Stress
mental health due to
Nicholas Grubic et al. May levels
COVID 19
2020

11.COVID-19 and Anxiety: Short Review

A Review of Psychological
Impacts of Infectious Disease COVID 19 has _
Depression,
Outbreaks 10 Medicine caused psychological
Iran _ stress and Unknown
studies students impacts including
Mohammad Ali Fardin et al. anxiety
anxiety.
March 2020

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12.Depression and anxiety Cross sectional

among university students web based
during the COVID-19 survey
6.91
pandemic in Bangladesh: A 15% had moderately
million _
web-based cross-sectional Universit Bangla Depression severe depression,
476 _ infected,
survey y students desh and anxiety where as 18.1% severe
0.4 million
anxiety.
Md. Akhtarul Islam et al. infected
Aug 2020

Long lasting pandemic Sample size

Interview relatively small
13.Effects of COVID-19 on and onerous measures
Survey Study compared to
College Students’ Mental United such as lockdown and
states stay-at-home orders, typical survey-
Health in the United States: Universit Perceived Stress Stress and only studies.
Interview Survey Study 195 of _ the COVID-19
y students Scale-10 (PSS) Anxiety
Americ pandemic brings Cannot be
Changwon Son et al. Sept a negative impacts on generalized to
2020 students mental health other college
students

1) Future
Depression and
follow-up
14.Depression and anxiety anxiety did not much
studies to assess
among Iranian medical differ in Iranian
the long-term
students during COVID-19 500 students before
Beck anxiety Depression 2 million psychological
pandemic studen - Iran COVID 19 Somatic
Cross sectional inventory and anxiety confirmed consequences of
ts symptoms of
Amin Nakhostin-Ansari et al. survey based COVID-19 on
depression are more
July 2020 medical
common during this
students.
pandemic
2) Future works

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to assess the
psychological
consequences of
COVID-19 in
different regions
of Iran.

15. A repeated cross- Repeated cross

Results demonstrate a
sectional survey assessing sectional
significant increase in
university students' stress, survey-based
depression, anxiety, and study Depression depression levels as
7228
suicidality in the early stages anxiety stress pandemic was
univer Stress,
of the COVID-19 pandemic scales, Depressive progressing. Female
sity 18-24 yrs. UK depression unknown _
symptom students scored
in Poland studen and anxiety
inventory significantly higher
ts
Agata Debowska et al. subscale than male students on
September 2020 depression, anxiety,
and stress

The preliminary The

findings were measurement
16. Assessment of Mental suggesting the errors in mental
Depression,
health of Chinese Primary association between health outcomes
anxious,
School students and after enforced social and unmeasured
Self-pre- Suicidal
school closing and Opening Questionnaire isolation imposed by confounders, as
1241 8-12 yrs. China validated thoughts, unknown
during the COVID 19. survey disease containment well as the
Questionnaire non-
measures with future limited
suicidal
Lei Zhang, MS et al., mental health representativene
self-injury
September 2020 problems among ss of the
children and sample.
adolescents

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Table 1 : Description of articles included in systematic review.

RESULTS;

The aim of our study was to explore the effect on mental health of students due to physical inactivity in
the coronavirus pandemic. The initial search resulted in 187 articles, out of which 171 articles were
removed due to duplication/exclusion. Articles evaluating other parameters apart from anxiety, depression
and stress were considered as exclusion. 16 Articles were included in the study.
The articles included various students from age group 5-25 years. Most studies were Cross-sectional web-
based E- surveys. In a cross-sectional study, Wenjun Cao et al. (2) evaluated psychological impacts,
depression, stress, and anxiety at the beginning of the COVID-19 outbreak in
undergraduate medical students. The results showed about 24.9% of college students have experienced
anxiety because of this COVID-19 outbreak, and mental health was affected in these students with
increase in medical emergencies. Xu et al. (3) figured out that depression, anxiety and sleep disturbances
were prevalent among children in large proportions during COVID-19 lockdown. Adarsh Kumar
Srivastav (4) explored the impacts of COVID 19 lockdown on physical activity among Physiotherapy
students using web-based survey, which reported reduced physical activity and energy expenditure among
these students.
Piya Majumdar et al. (5) figured out that mental health and physical well-being were imbalanced as
screen exposure increased and sleep schedule altered. Studies (7), (8), (9) showed the reduction of total
Physical activity had a profoundly negative effect on psychological health and well-being of
population. Md. Akhtarul Islam (12) did the study on university students, that showed that 15% had
moderately severe depression, whereas 18.1% had severe anxiety. Changwon Son et al (13) in his study
concluded that COVID-19 pandemic had negative impacts on student's mental health. In contrast, Amin
Nakhostin-Ansari et al. (14), did the study on medical students, and came to conclusion that depression
and anxiety did not significantly differ among Iranian medical students before and after the COVID-19
outbreak, but somatic symptoms of depression are more common during this pandemic.

In September 2020(15), Agata Debowska et al did a study on Stress, Anxiety, Depression and suicidal
thoughts in university students, and the results demonstrated a significant increase in depression levels as
the pandemic was progressing. It was found that female students scored significantly higher than male
students on depression, anxiety and stress.

In March and May 2020, two review articles were published on student’s mental health during the
COVID-19 pandemic. These articles concluded that long term negative implications were found on the
student’s education and mental health due to COVD 19.

DISCUSSION:

The Objective of this systematic review was to explore the effect on mental health of students due to
physical inactivity in the Covid-19 pandemic. Sixteen articles were found specifically evaluating mental
health among studies aged between 5-25 years. Mental health is an important part of any country and
ignored particularly in low and middle-income countries5. Majority of the study showed the pandemic and
subsequent lockdown resulted in social distancing and isolation showed a detrimental effect on mental
well-being, with increased reliance on digital use presumably to escape the isolation.4

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Studies have suggested that public health emergencies in physical inactivity can have many psychological
effects on college students, which can be expressed as fear, anxiety and worry. Covid-19 Anxiety and
Stress in college students might have been related to the effect of the pandemic on their studies and future
employment. On the other hand, gradually increasing distances between people resulting from the
quarantine may have caused the students anxiety. It is known that anxiety disorders are more likely to
occur and worsen in the absence of interpersonal communication. 2
The education level of children’s parents, place of living, neighbors/relatives infected with Covid-19, The
education level of parents of children, place of living, relatives/neighbors infected with Covid-19, parents
travelling to office for work, parent’s job insecurity, the smoking habit of parents, children watching TV
for long hours, children playing games, abnormal behavior of parents with children,(calling dumb, threat,
scream, hit the child), and parent’s knowledge about child abuse were significantly associated with
children mental status.6 Majority of the studies indicated college student's anxiety regarding the epidemic
was associated with their place of residence, parents income source, whether living with parents or if a
relative or acquaintance being infected with Covid-19.2
Physical activity consists of task, environmental and individual factors. It is believed that social isolation
due to lockdown affects health behaviors through their impact on social support for choice of behavior. In
the study by Adarsh et al, it was concluded that more vigorous physical activity was performed by
physiotherapy students before lockdown and decrease in this activity was noted during COVID
lockdown. The results of this study also showed that approximately 50% of physical activity was reduced
in the students, so there might be chance of reduced immunity level since decrease in physical activity can
lead to decrease in immunity. Also, individuals who stayed at home or are lonely are found to be less
active. Social isolation was significantly associated with physical activity so individuals who are socially
isolated are less physically active and also are more likely to report multiple health risk behaviors
including mental health issues .3
Some studies showed no difference in the gender with the affection of mental health, while some studies
concluded females are more prone than males on the scores of anxiety, stress and depression.15It has been
indicated that, the increasing number of patients and suspected cases, have elicited worry in the students
about being infected in this pandemic, which results in increased anxiety. 2Furthermore, the significant
shortage of masks and disinfectants, the overwhelming and sensational news headlines, and erroneous
news reports have also added to anxiety and fear. As stated by a task force of the European CBT-I
Academy, during total lockdown individuals' sleep habits are challenged by several factors (i.e., reduced
exposure to sunlight, reduced physical activity and psychological distress.19

FUTURE SCOPE:

Considering that the lockdown is likely to continue for some weeks, and they continue to be at home and
attending their education online, there is a pressing need to monitor the psychophysiological well-being of
students. There is a need to gather research data to develop evidence-driven strategies to reduce adverse
psychological impacts caused by these unprecedented changes in people's daily lives. There is also a need
to follow up on the long-term psychological consequences of COVID-19 on different age group students,
depending upon the categorization of their branch.

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CONCLUSION:

The present systematic review article suggests strong evidence for Stress, anxiety and depression in
students during COVID-19 pandemic with significant decrease in physical activity A significant reduction
of self-reporting Physical activity was also seen, in turn affecting the energy expenditure levels.

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