COVID-19 is a deadly infectious disease that has caused a total of 318 million cases and 5.5 million deaths as of 14 Jan 2022.1 The first confirmed case of COVID-19 was reported on the literature MedRxiv in Mar 3, 2020.2 To control the spread of COVID-19, a series of preventive measures, such as border restrictions, quarantine and isolation, and social distancing, were implemented by the government. The COVID-19 pandemic and the associated preventive measures resulted in a substantial disruption of daily life, which, in turn, led to reduced physical activity, increased stress and compromised quality of life (QoL). Previous studies reported that the long-term isolation or home-confinement may have negative effects on psychosocial and mental health, especially causing stress, negative emotions, and impaired cognition,3 and immune system and physiological functions suppress from prolonged isolation may increase the risk of exposure to SARS-CoV-2.4 WHO strongly suggested that people stay physically active at home in order to optimize their health status, decrease the negative psychosocial consequences of confinement, and maintain their immune system function during the COVID-19 pandemic.
Shenzhen, adjacent to Hong Kong, jointly forms the most developed international metropolitan circle in the world, with a huge population and economic aggregate. The quality of life of residents is crucial to economic and social development. Especially under the environment of the large-scale SARS-CoV-2 pandemic, how to balance and reduce the impact of the prevention and control policies on the quality of life is a very important proposition. Physical activity is important for healthy aging.5 It is associated with various health-related outcomes, including health status and functional capacity,6 chronic illnesses (e.g., type 2 diabetes mellitus and coronary heart disease),7 cognitive functions (e.g., executive function and memory),8 physical performance of daily activities,9 the risk of falling,10 mortality11 and quality of life.12 Notably, decreased levels of physical activity (PA) in people of different age groups have been reported globally during the COVID-19 pandemic. In a systematic review of 66 studies, Stockwell et al.13 reported that during the COVID-19 pandemic, children, healthy adults and patients across the globe had decreased levels of physical activity and increased sedentary behaviour.
Worldwide, the general public have been facing the fear of being infected, and experiencing stress associated with infringed personal freedoms, disrupted normal living activities and economic turbulence resulting from the imposition of these preventive measures and the COVID-19 pandemic. Krishnamoorthy et al.14 conducted a systematic review and meta-analysis of 50 studies from different countries and found that the prevalence of stress and psychological distress (e.g., post-traumatic stress symptoms and poor sleep quality) among the general population amid the COVID-19 pandemic was 36% and 26%, respectively. The prevalence of stress in the general public was found to be even higher than its prevalence in healthcare workers (33%). Moreover, Goularte et al.15 reported that other psychiatric symptoms, such as anger and somatic symptoms, are remarkably high among the general population.
Quality of life is a socially relevant construct and should be understood through the lens of contemporary social circumstances. The COVID-19 pandemic and its associated preventive strategies are influential worldwide and may induce a vicious cycle of ‘restricted physical activities–chronic stress’.16 This vicious cycle, in turn, may further suppress the immune system and increase the risk of contracting COVID-19. In Shenzhen, the effect of the COVID-19 pandemic on physical activity and stress is largely unknown, especially among the older general population who are vulnerable to infection and at a higher risk of severe complications from COVID-19.17 To date, 2 year after the initial outbreak, there has been no specific investigation of the effects of COVID-19 on physical activity, stress and quality of life among community-dwelling older adults. Thus, the objectives of this study were to investigate the levels of physical activity and stress and quality of life of community-dwelling older adults during the post-COVID-19-pandemic period; determine whether physical activity and stress independently contribute to their quality of life and to quantify the relative contributions of physical activity and stress to their quality of life when sociodemographic variables are also considered.