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Non-Communicable Diseases Watch
August 2021
Physical Inactivity
During the COVID-19 Pandemic
Key Messages
※ For substantial health benefits, the World Health Organization (WHO) recommends
adults to engage in at least two and a half hours of moderate -intensity physical activity
or one hour and 15 minutes of vigorous-intensity physical activity every week. They
should also limit the amount of time being sedentary and replace sedentary behaviours
with physical activity of any intensity (including light-intensity physical activity).
※ Insufficient physical activity increases individuals’ risk of developing major chronic
non-communicable diseases such as hypertension, heart disease, stroke, type 2 diabetes,
colorectal and breast cancers, as well as shortens life expectancy.
※ Physical inactivity is also a significant risk factor for severe coronavirus disease 2019
(COVID-19) outcomes. Those who were consistently inactive were about 2.3 times, 1.7
times and 2.5 times as likely to be hospitalised, admitted to intensive care unit and die
from COVID-19 compared with those who were consistently meeting physical activity
guidelines respectively. They also had 20% and 32% increased risk of hospitalisation and
death due to COVID-19 than those who were doing some physical activity respectively.
※ Regular physical activity can boost the immune system, increase the potency of vaccina-
tions and defend the body from infectious diseases. During the COVID-19 pandemic,
members of the public are urged to make physical activity a “must do” habit. Even
without going to fitness centres or outdoors, there are ways to overcome the common
barriers to physical activity.
※ To encourage members of the public to stay physically active, the Department of Health
produced and launched various exercise demonstration videos and TV Announcements
in the Public Interest that can be viewed at Change for Health website at
www.change4health.gov.hk/en/resources/av_gallery/index.html.
This publication is produced by the Non-communicable Disease Branch, Centre for Health Protection of the Department of Health
18/F Wu Chung House, 213 Queen’s Road East, Wan Chai, Hong Kong http://www.chp.gov.hk All rights reserved
Non-Communicable Diseases Watch August 2021
Physical Inactivity During the COVID-19 Pandemic
In the wake of the coronavirus disease 2019 and activity in public spaces, also showed
(COVID-19) pandemic, most governments that self-reported level of moderate-to-
across the world implement social distancing vigorous and vigorous physical activity
measures to limit the spread of infections declined by 41.0% and 42.2% compared to
that may affect people’s lives and health- pre-restrictions respectively. Including light
related behaviours, one of which is physical physical activity, 75.5% of participants self -
activity participation. For substantial health reported decreases in overall physical activi-
benefits, the World Health Organization ty during restrictions. 4
(WHO) recommends adults to engage in at
least two and a half hours of moderate - In Hong Kong, a local study in April 2020
intensity physical activity (such as brisk with 631 adults aged 18–35 found that more
walking) or one hour and 15 minutes of than half of the respondents (57.8%) did not
vigorous-intensity physical activity (such as engage in any vigorous physical activity
jogging) every week. They should also limit during the COVID-19 pandemic. Overall,
the amount of time being sedentary and 72.3% of respondents reported that their
replace sedentary behaviours with physical physical activity level had decreased, with
activity of any intensity (including light - an average of 8.6 minutes/day spent on
intensity physical activity such as light moderate-to-vigorous physical activity, 17.1
walking). 1 Although the strictness of social minutes/day on walking, and 9.4 hours/day
distancing measures varied from country to on sedentary activities. Besides, less than
country or even region to region, studies one-third (29.6%) of respondents met the
found significant decreases in physical WHO recommended level of physical
activity level with concurrent increases in activity. 5
sedentary behaviours compared to pre -
pandemic levels. 2 Health Risks of Physical
Inactivity
Effects of COVID-19 Pandemic It is well-documented that insufficient physi-
on Physical Activity cal activity increases individuals ’ risk of
A study of 455 404 unique smart-phone developing major chronic non-communicable
users from 187 countries observed a rapid diseases (NCDs) such as hypertension, heart
decrease in worldwide daily step count disease, stroke, type 2 diabetes, colorectal
shortly after WHO’s declaration of COVID - and breast cancers, as well as shortens life
19 as a global pandemic. Within 10 days of expectancy. 6 , 7 Even brief periods of reduced
the pandemic declaration, there was a 5.5% ambulatory activity can be detrimental to
decrease in mean steps (287 steps); within 30 health. In healthy, nonexercising young men,
days, there was a 27.3% decrease in mean a study showed that reduction in daily steps
steps (1 432 steps). 3 Another multinational from an average of about 10 000 to 1 400
survey, which included over 13 500 persons for a 2-week period could lead to im-
aged 18 or above from 14 countries with paired insulin sensitivity, loss of leg lean
registered cases of COVID -19 and active mass and decreased cardiovascular fitness. 8
governmental restrictions limiting movement
Page 2
Non-Communicable Diseases Watch August 2021
Compared to people who are sufficiently participation in adults included lack of
active, those who are insufficiently active energy or feeling fatigue, lack of motivation,
would have 20% to 30% increased risk of lack of appropriate facilities/equipment or
death. 1 Physical inactivity is also a signifi- space, lack of time and lack of partner. 11
cant risk factor for severe COVID -19 out- As shown in Table 1, however, there are
comes. A study with 48 440 adults in the ways to overcome these barriers even with -
U.S. with confirmed COVID -19 infection out going to fitness centres or outdoors.
between January and October 2020 observed
that those who were consistently inactive People who prefer exercising outdoors
were about 2.3 times, 1.7 times and 2.5 times should maintain an appropriate social dis-
as likely to be hospitalised, admitted to tance with other people as far as possible
intensive care unit and die from COVID -19 and observe good personal hygiene. They
compared with those who were consistently are also urged to take necessary protective
meeting physical activity guidelines (i.e. measures (such as drinking enough water,
having engaged in at least two and a wearing loose and light -coloured clothing,
half hours of moderate-to-vigorous physi- appl ying adequate amount of broad -
cal activity per week) respectively. They also spectrum and water -resistant sunscreen
had 20% and 32% increased risk of hospi - lotion with a sun protection factor of 15
talisation and death due to COVID -19 than or above, avoiding over -exertion and pro-
those who were doing some physical activity longed activities, etc) to reduce the risk of
respectively. 9 dehydration, heat stroke and sunburn when
exercising in very hot weather. It is note-
The Importance of Leading an worthy that COVID -19 vaccines can protect
Active Lifestyle full y vaccinated people against the infec-
tion when exercising. Unless there is
The dual epidemics of chronic NCDs and contraindication, members of the public
COVID-19 accentuate the importance of with stable chronic conditions are urged to
physical activity. Apart from reducing the get vaccinated against COVID -19 to protect
risk of developing various chronic NCDs, 1 oneself, famil y, friends as well as the
regular physical activity can boost the communit y. 1 2 , 1 3 For more information about
immune system, increase the potency of COVID-19 Vaccination Programme, please
vaccinations and defend the body from visit www.covidvaccine. gov.hk/en .
infectious diseases, including acute respire -
tory infections. 1 0 Thus, members of the
public are urged to make physical activity
a “must do” habit. Although remaining
physically active may seem challenging
during social distancing, it is still possible
to exercise and have sufficient physical
activity. During the COVID-19 pandemic,
study found that the most frequently
perceived barriers to physical activity
Page 3
Non-Communicable Diseases Watch August 2021
Table 1: Countermeasures for common barriers to physical activity participation
Barriers Countermeasures
Lack of energy ◇ Schedule physical activity during the time of day when you feel
or feeling tired more energetic
◇ Have regular meals and eat a healthy diet to help boost energy
levels and fight fatigue
◇ Start with small amount of exercise and build it up gradually
with longer duration and greater intensity
Lack of motivation ◇ Use motivational tools, such as workout apps, pedometer or other
or company wearable devices for monitoring the accumulation of daily steps
and supporting us to achieve the daily step count target
◇ Buddy up with friends or family members, text and send each
other an “accomplishment emoji” when completed the daily
workout with another exercise challenge
◇ Join online exercise classes or dance lessons and exercise along
with the instructors and other participants
◇ Play active videogames, yet you should limit the time spent in
front of a screen and be sure to maintain a balance between online
and offline activities in your daily life
Lack of skills, ◇ Select activities that require minimal skills or facilities, such as
facilities or equip- walking
ment, or space ◇ Use bottles containing about 500 ml of water, a 5 kg bag of rice
or a heavy book as weights for bicep workouts; a sturdy stool or
chair for step-up exercise; a towel for resistance training
◇ Opt for home-based exercises that can be performed in limited
space, such as squats, lunges, planks, push-ups or abdominal
crunch sit-ups according to your own capacities
Lack of time ◇ Review your daily schedule and put aside 10, 15 or 20 minutes
two or three times every day for physical activity
◇ Do household chores as a means of exercise. Examples of moder-
ate-intensity home activities include making beds and changing
linens, scrubbing bathroom or bathtub, mopping or sweeping floor
with some efforts 14
◇ Incorporate physical activity, small walks or stand -ups into daily
routines, such as taking stairs instead of elevator or stepping
on the spot while watching television; pacing around while
talking on the phone; standing up while folding laundry, ironing
or performing other sit-down tasks
Page 4Non-Communicable Diseases Watch August 2021
To encourage members of the public to 8. Kro gh-Madsen R, Thyfault JP, Broholm C, et al. A
2-wk reduction of ambulatory activity attenuates
stay physically active, the Department of p erip h eral in su lin sen sitivity. Jou rn al o f Applied
Health produced and launched a number Ph ysio lo gy 2010 ;108 (5 ):1034-104 0.
9. Sallis R, Youn g DR, Tarto f SY, et al. Ph ysical in activ-
of exercise demonstration videos and TV ity is associated with a higher risk for severe COV ID-
Announcements in the Public Interest that 19 o utco mes: a stud y in 48 440 adult p atients. British
Jou rn al o f Spo rts Medicin e 20 21; Apr 13:bjsports-2021
can be viewed at Change for Health website -104080.
at www.change4health.gov.hk/en/resources/ 10. Ch astin SFM, Ab arao gu U, Bo urgo is JG, et al. Effects
av_gallery/index.html. Together, let’s keep o f regu lar p h ysical activity o n the immu n e system,
vaccin ation and risk o f commu n ity-acquired infectious
healthy, get vaccinated and fight the virus! d isease in th e gen eral popu lation: systematic review
and meta-analysis. Sports Medicine 2021:1 -14.
11. Farah BQ, do Prado WL, Malik N, et al. Barriers to
ph ysical activity du rin g th e COV ID-19 pandemic in
adu lts: a cro ss-sectional study. Sport Sciences for
Health 2021 :1-7.
12. S c i e n t i fi c C o m m i t t e e o n E m e r g i n g a n d Z o o n o t i c
Diseases and Scientific Committee on Vaccine
Preventable Diseases. Consensus Interim Recom-
m e n d a t i o n s o n t h e U s e o f C O V I D- 1 9 V a c c i n e s
in Hong Kong (As of 9 June 2021). Hong Kong
S AR : C e n t r e fo r H e a l t h P r o t e c t i o n , D e p a r t m e n t o f
H e a l t h , J u n e 2 0 2 1 . A v a i l a b l e a t w w w . c h p . go v. h k / e n /
s t a t i c / 2 4 0 0 5 . h t m l.
13. A Concise Guide for Individuals with Chronic
D i s e a s e s : C a n I H a v e C O V I D- 1 9 V a c c i n a t i o n . H o n g
References K o n g S A R : D e p a r t m e n t o f H e a l t h . A va i l a b l e a t
w w w . c o v i d v a c c i n e . g o v . h k / p d f/ Gu i d a n c e _ E x a mp l e s _
1. Physical Activity. Geneva: Wo rld Health Organization, o f_ C h r o n i c _ D i s e a s e s _ e n . p d f .
26 November 2020. Available at www. who.int/news - 14. Ain swo rth BE, Haskell WL, Herrmann SD, et al.
room/fact -sheets/detail/physical -activity. Th e Co mp endiu m o f Physical Activities Tracking
2. Stockwell S, Trott M, Tully M, et al. Changes in Gu id e. Availab le at https://sites.go o gle.com/site/
physical activity and sedentary behaviours from before co mp en diu mo fph ysicalactivities/ho me .
to during the COVID-19 pandemic lockdown: a
systematic review. BMJ Open Sport & Exercise
Medicine 2021;7(e000960):doi:10.1136/bmjsem -2020-
000960.
3. Tison GH, Avram R, Kuhar P, et al. Worldwide effect
of COVID-19 on physical activity: A descriptive
study. Annals of Internal Medicine 2020;173(9):
767-770.
4. Wilke J, Mohr L, Tenforde AS, et al. A pandemic
within the pandemic? Physical activity levels
substantially decreased in countries affected by
COV ID-19. International Journal of Environmental
Research and Public Health 2021;18(5).
5. Zheng C, Huang WY, Sheridan S, et al. COV ID -19
pandemic brings a sedentary lifestyle in young
adults: A cross-sectional and longitudinal study.
International Journal of Environmental Research and
Public Health 2020;17(17).
6. Booth FW, Roberts CK, Thyfault JP, et al. Role of
inactivity in chronic diseases: Evolutionary insight
and pathophysiological mechanisms. Physiological
Reviews 2017;97(4):1351 -1402.
7. Lee IM, Shiroma EJ, Lobelo F, et al. Effect of physi-
cal inactivity on major non -communicable diseases
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Page 5Non-Communicable Diseases Watch August 2021
To p r eve nt o b e s it y a n d chr o n ic d i se as es a m o n g T he Le i s ure a nd C ul t ura l Ser v ice s Dep a rt m en t
me mb er s o f t he p ub l ic and e nco ur a ge t h e m t o d o (LC SD ) l a u nc hed a n e w p h as e o f “O n li n e I nt er ac -
p h ys i cal ac ti v it y a t ho m e a mi d t he C OVI D - 1 9 p an - ti ve Sp o r t s T rai ni n g P ro gra m me s ”.
d e mic, t h e D ep ar t me n t o f H eal t h h as p r o d uc ed a
ser ie s o f Ho me E x er c is e Vid eo s a nd l a u nc hed o n T he “O nl i ne I n ter act i ve Sp o r t s T rai n i n g P ro -
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Wo r ko u t – Di sco v er t h e Ol y mp ic s ”, t h e fa mi l y o f
th r ee h a ve f u n i n t he C ha n ’ s Fa mi l y O l y mp i c s a t T he y i n cl ud e aero b ic d a nc e, fit ne s s e x erc is e, b o d y
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wh i le d o i n g p h ys i ca l a c ti vi ti e s a t ho me . I n “Yo ut h
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– Take up t he C h al le n ge s ”
firs t - ser v ed b a si s s tar ti n g fro m 8 :3 0 a m o n t he fi rst
d a y o f e nro l me n t t hro u g h Le is u re Li n k I nter ne t
B o o ki n g s er vi ce ( lei s ure li n k .lc sd . go v . h k). T h e
co ur s e fee i s $ 2 0 . P l ea se vi s it t he LC SD we b s it e
“Fa mi l y Wo r ko ut
– Di sco v er t h e O l y mp ic s ” ( www. l csd . go v. h k/ e n/ v i sa v is) o r ca ll 2 4 1 4 5 5 5 5
fo r d eta il s.
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gra m me s ” are p art o f th e i nter ac ti ve " vi s - a - v is
“Yo ut h Wo r ko u t +0 1 " ser ie s u nd er t he LC SD Ed uta i n me n t C ha n ne l
– Se l fi e I mp o s sib le ”
( www. l csd . go v. h k/ e n/ed ut ai n me n t - c ha n ne l. h t ml)
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sto p o nl i ne p lat fo r m co v eri n g i n fo r ma t i ve a nd
“Yo ut h Wo r ko u t lear n i n g ma ter ia ls .
– Tr ave l Fa nt as ie s ”
Editor-in-Chief
Non-Communicable Diseases (NCD) WATCH is dedicated to
Dr Rita HO
promote public’s awareness of and disseminate health information
Members
about non-communicable diseases and related issues, and the
importance of their prevention and control. It is also an indication of Dr Patrick CHONG Dr Ruby LEE
our commitments in responsive risk communication and to address Dr Thomas CHUNG Dr WK LI
the growing non-communicable disease threats to the health of our Dr Cecilia FAN Dr YC LO
community. The Editorial Board welcomes your views and comments. Dr Raymond HO Dr Lilian WAN
Please send all comments and/or questions to so_dp3@dh.gov.hk. Mr Kenneth LAM
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