This study assessed behavioral and demographic correlates of exercise during a COVID-19 lockdown in three cities in Ghana. The study found that individuals aged 25-34 years were less likely to exercise than those aged 18-24 years. That is, the younger group of city residents were more likely to exercise during the lockdown. This result is consistent with studies [15–17] indicating that older adults are less active and less frequently exercise owing to their physiological limitations. Empirical evidence has also consistently shown that younger adults are more active [26, 27]. Studies [18–20] have revealed that younger adults, compared with adults aged 65 years or more, were more active during a COVID-19 lockdown. Since access to the built environment and community services were limited during the lockdown, residents may have utilized domestic resources (including online exercise lessons) to exercise. This reasoning is premised around studies [28, 29] that have indicated that access to online exercise classes and the utilization of indoor spaces for exercise increased significantly during the lockdown.
Those who had a chronic disease status were 19 times more likely to exercise during the lockdown compared to those without any chronic disease. This result confirms some previous studies [5, 27, 30, 31] focused on the general population in developed and developing countries. In their cross-sectional study, for instance, Asiamah et al. [5] found that older adults with one or more chronic diseases were more likely to exercise than those without any of these diseases. This result could be the effect of two advantages people with clinically diagnosed chronic diseases have. Firstly, such individuals often receive special medical care that includes lifestyle counselling [27, 30]. Compared with people without chronic disease, individuals with non-infectious diseases are more mindful and aware of the risks of disease and mortality accompanied by sedentary behavior and would, as a result, better adhere to standard physical activity recommendations [5, 30, 31]. People with long-term health conditions are more likely to exercise because they have better access to exercise counseling and are more conscious of their health [5]. The import of these explanations is that having limited access to the built environment and services owing to a lockdown would not necessarily discourage physical activity in people with chronic conditions. In other words, people would be compelled by their ill-health to use indoor facilities to exercise in a pandemic context where access to the built environment is limited.
Residents who were not employed were about 13 times more likely to exercise than those who were employed. This result counteracts some studies [32–34] that have assessed the association between employment status and physical activity as well as sedentary behavior. In the US, for example, Van Domelen and colleagues [33] found that, compared with people who were not working, individuals who were employed (including those working in sedentary sectors) had a higher level of physical activity. In Sweden, Macassa et al. [32] found that individuals working full-time were more likely to exercise than those who were not employed. Given this disagreeing evidence in the literature, it could be argued that the lockdown made it impossible for working residents to perform physical activities. Another scenario may be that most employees were working at home during the lockdown [35], so they may not have had enough time to exercise.
Individuals who lost 30 to 60 minutes of moderate physical activity time were 0.14 times less likely to exercise compared with those who did not lose moderate physical activity time. This result implies that the lockdown necessitated social isolation and therefore took away the time residents spent on walking and other moderate free-living physical activities. Furthermore, residents who had never smoked were about 4 times more likely to exercise than those who smoked. While the literature shows mixed results on this relationship [36], our result may suggest that non-smokers better understood the health benefits of exercise and, therefore, more frequently exercised during the lockdown than smokers. As reported by some commentators [5, 37], a smoking status may connote that an individual knows nothing or little about the consequences of unhealthy behaviors such as exercise and is unwilling to make sacrifices to maintain health, an idea that explains why smokers were less likely to exercise during the lockdown.
Residents who experienced domestic violence or faced a higher risk of it were about 0.03 less likely to exercise than those who did not. This result may be due to victims of domestic violence lacking the emotional, psychological, and physical strength to exercise during the lockdown. These residents may have been forcefully denied resources and the freedom to exercise at home. In the long-term, the physical and mental health of victims of domestic violence may significantly deteriorate due to the joint impact of a lack of exercise and trauma. Our results suggest that public education before a lockdown may be necessary, at least in developing countries where many people lack formal education [38] and may not understand the dynamics and consequences of taking to some behaviors in response to the lockdown. Public education is a way to conscientize people to avoid potentially harmful behaviors and adapt to the lockdown with new health-supporting behaviors. Finally, this study contributed to knowledge by indicating segments of the population (e.g., smokers, workers) that face the risk of sedentariness during a lockdown. This information can enable stakeholders to design public education programs targeting specific groups.
This study, however, has some limitations. By utilizing a non-powered sample in this study, our results may not be generalizable to other cities. In harmony with previous studies [39, 40], most of our sample is made up of highly educated people, which means that residents who were uneducated or poorly educated were underrepresented in the study. As a result, studies that employ representative samples and more resilient designs (e.g., randomized controlled interventions) are needed in the future. Older adults were underrepresented in the study possibly because older adults in Ghana hardly use the internet and social media platforms [40]. With most older adults in Ghana having poor English skills [39, 40], our reliance on a survey administered solely in English could have prevented some older adults from participating. Our results are ideally applicable to educated populations aged 18 to 55 years. Since Africa’s population is generally young [40], this study, despite the above limitations, provides lessons applicable to Africa, sets the foundation for future studies, and can help stakeholders to identify younger segments of the population that face a higher risk of sedentary behavior during a lockdown. If so, this study would not only encourage public education before a lockdown but would also indicate the focus of viral public education programs, particularly in Africa and related developing countries.