Change in quality of life, sleep, and physical activity during COVID-19: A longitudinal study of adolescent athletes

J Athl Train. 2023 Feb 24. doi: 10.4085/1062-6050-0529.22. Online ahead of print.


Context: The abrupt cessation of school and sport participation during the COVID-19 pandemic may have negative implications for adolescent mental health.

Objective: (1) To compare mental, physical, and social health and behaviors during pandemic-related stay-at-home mandates with the same measures collected 1-2 years prior. (2) To assess the relationship of physical activity and sleep during the pandemic with anxiety, fatigue, and peer relationship changes between assessment timepoints.

Design: Prospective cohort study, repeated-measures.

Setting: Pediatric sports medicine center.

Participants: High school athletes (n=39; 16.2±0.9 years of age; 64% female).

Main outcome measures: Patient Reported Outcome Measurement System (PROMIS) anxiety, fatigue, and peer relationships short forms and the Pittsburgh Sleep Quality Index (PSQI) were completed at two timepoints (initial assessment: May 2018 or 2019; follow-up assessment: May/June 2020). Physical activity frequency and duration, and frequency of interaction with other individuals (family, peers, sport coaches, etc.), were self-reported at follow-up assessment for the two weeks prior to school/sport closure and the two weeks prior to questionnaire completion.

Results: Higher levels of anxiety (5.5±4.0 vs. 3.6±3.4; p=0.003) and fatigue (5.4±3.7 vs. 2.3±2.5; p<0.001), and worse sleep quality (6.6±2.9 vs. 4.3±2.3; p<0.001) were observed during the pandemic compared to previous assessments. Reductions in physical activity were observed between assessments (exercise duration: 86.4±41.0 vs 53.8±30.0 minutes). Sleep quality, but not physical activity, during the pandemic predicted changes in fatigue (p = 0.03, β = 0.44 [0.06, 0.83]) and peer relationships (p = 0.01, β = -0.65 [-1.16, -0.15]) from initial to follow-up assessment.

Conclusions: Mental and physical health declined during stay-at-home mandates, compared to assessments 1-2 years earlier. Physical activity behaviors and sources of social interaction underwent significant changes following school and sport cessation. Quality sleep may provide some protection against declining adolescent mental health during the pandemic, although this relationship requires further investigation.

Keywords: COVID-19; exercise; pediatric; psychological health; public health.