Self-assessed health of adult Australian sport club participants during and after COVID- 19 restrictions: a longitudinal study

doi:10.21203/rs.3.rs-3218874/v1

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Research Article

Self-assessed health of adult Australian sport club participants during and after COVID- 19 restrictions: a longitudinal study

https://doi.org/10.21203/rs.3.rs-3218874/v1

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Background: Internationally, COVID-19 restrictions impacted negatively on participation in sport and physical activity. Participation in community club sport was particularly disrupted with cancelled training and competitions, and this has been shown to impact the health of individuals. We now need to investigate the effects of the lifting of COVID-19 restrictions.

Aim: The aim of this study was to longitudinally investigate the health of Australian adult sports club participants, during and post-COVID-19 restrictions.

Methods: Two waves of an online survey were conducted in mid-2020 and mid-2021. The first wave also captured retrospective pre-COVID19 (2019) data. For each year 2019-2021 each survey respondent was categorized as participating (Yes/No) in club sport. Respondents also assessed their current health (overall, physical and mental) in both 2020 and 2021. The six health assessments were cross-tabulated against three patterns of participation (dropout, dropout and return, continuation), for the survey sample overall and for six demographic subsamples: 42 crosstabulations in all.

Results: A total of 1,037 Australians aged 18 years and above completed both survey waves. Those who continued playing club sport throughout, and to a lesser degree those who returned to club sport in 2021, reported better physical and general health than those who dropped out. This pattern was consistent, for the overall survey sample and for the sub-samples based on gender, age and region of residence, with statistically significantly associations (p<0.05) in 24 of 28 analyses. The pattern of club sport participation was only weakly associated with reported mental health, with only one of 14 associations being statistically significant.

Conclusion: Changes in club sport participation impact general and physical health of adults; continuation or return were associated with better physical and general health than drop-out. There was little evidence of an association between participation in sport and mental health, which is inconsistent with previously reported cross-sectional results; this may be due to a combination of factors, including confounding with the broader effects of the pandemic. In conclusion, it is clear that retention in participation in sport is not just important for sports management policy and strategies; it is also important for the health of individuals.

Participation in sport and physical activity during COVID-19

COVID-19 restrictions negatively impacted participation in physical activity and sport globally (1–4), and contributed to increased sedentary behaviour including screen time (4–6)

In many instances, participation in club and team-based sport declined more than other types of physical activity, such as some individual activities (2, 7, 8). In Australia participation in team sports such as bowls, cricket and netball declined whilst participation in individual-based activities including running, walking, yoga, bushwalking and cycling increased (2, 9). Similarly, in a Korean study, participation in indoor activities such as bodybuilding and swimming decreased whilst outdoor activities including climbing and cycling increased (10). Overall, community sport participation in Australia declined by 27% in 2020 compared to pre-COVID levels (11). I

The impact of COVID-19 on participation in sport and physical activity in general influenced various demographic groups differently. For example, the largest decline in participation in community sport in Australia was for those aged 4–9 years, and the decline was greater for females than males (11). The gender differences reported for participation in sport are similar to those from other studies on leisure-time physical activity which reported greater declines in participation during COVID-19 restrictions for females (12). Further, individuals with lower education and those with financial problems were more likely to decrease participation levels in sport during COVID-19 (8, 13).

Impact on health during COVID-19

There is growing evidence of the many different health (physical, social and mental) benefits of participation in sport, and including for adults (14–16). The great majority of sport and health literature is based on children and youth, with very limited focus on the adult population. However, specifically for adults, the benefits of participation in sport include improved wellbeing and reduced distress and stress (15). These benefits are attributable to the social nature of participation in sport through team and club-based engagement (15). A more recent review confirmed the finding that participation in sport is beneficial for improving mental health and social outcomes for adults (16), and reported that these benefits included higher self-esteem and life satisfaction, lower psychological ill-being such as reduced levels of depression, anxiety and stress, and improved social outcomes including improved self-control, pro-social behaviour and interpersonal communication, and an enhanced sense of belonging (16).

There has been growing concern that the disruption of physical activity and life in general will have negative mental health implications (1, 9). There were consistent reports of decreased wellbeing during the pandemic, when individuals could not pursue the sport and physical activities in a way that would enhance wellbeing (17). Further, there is consistent evidence that individuals who were active through sport during COVID-19 had improved health and wellbeing outcomes compared to non-sporting individuals (9, 18, 19). For example, individuals active through sport reported less likely to report symptoms of anxiety and depression and had improved quality of life scores than non-participants (18). However, most of the research on health outcomes of sport participation in general, and in relation to COVID-19, has been focused on youth, with limited specific reference to adults.

Recovery of participation post-COVID-19

There is an abundance of literature detailing the changes to sport and physical activity behaviours during COVID-19 restrictions. However, to date there is very little published regarding the period post-COVID-19 restrictions, either about participation patterns or health outcomes for the general population. There are reports that whilst some individuals have returned to pre-COVID participation levels, with a newfound enjoyment for being physically active, others are now less active, with some continuing sedentary behaviours that became habitual during restrictions (20, 21). The financial impact of COVID-19 has also been a significant barrier to many returning to playing sport (6, 22, 23).

There is some evidence that after returning to play sport post-COVID-19 restrictions, adolescent athletes reported significant improvements in mental health and quality of life (24). For children, many seem to be playing outdoors as frequently post COVID-19 compared to pre-pandemic rates, however participation in sport has not returned to pre-COVID-19 levels (25). However, we do not know the trends in sport participation and health outcomes for adults post-COVID-19 restrictions.

The aim of this study was to investigate the health outcomes of Australian adult sports club participants, during and post-COVID-19 restrictions.

This study is part of a broader program of research in Australia which involves the longitudinal measurement of sport and physical activity profiles and physical, mental and social health and wellbeing outcomes that are the result of this participation. This study was conducted in two waves of online surveying during the COVID-19 period (2020 and 2021). The first wave of data collection included retrospective (baseline) data pertaining to pre-COVID-19 participation rates in 2019.

Full details of the program of research can be found elsewhere (2, 9). Briefly, recruitment to the survey was primarily facilitated by several national and state sporting organizations. The target population was people aged 13 years or older who were registered in the 2019 and/or 2020 playing seasons to participate in one or more sports. The sport organizations that sent out the survey invitation to their registered participants represent major sports in Victoria and Australia (26, 27).

The first wave of the longitudinal survey (conducted May-June 2020) included among other themes, questions about:

Demographic characteristics – gender, age, and residential postcode
Types of sports and other recreational physical activities participated in
Frequency and duration of participation, at the time of the survey and during the previous year.

Date of birth was used to determine age in years at the time the survey was completed. Age was then recoded into two age cohorts: adolescents (13–17 years) and adults (18 years and above). Residential postcode correspondence tables (28) were used to assign each postcode to one of two broad geographical zones or regions: Metropolitan, comprising the capital cities of the Australian states; and Non-metropolitan, comprising regional cities, towns and rural areas.

All participants in the first survey were invited to participate in a similar follow-up survey conducted one year later, in May-June 2022, and just over 20% did so. The study is based on the group of adult respondents to both surveys.

Regarding recreational physical activity (RPA), two separate sections of the survey dealt respectively with two ‘settings’: organised club sport involving membership and registration (designated ‘Club sport’), and less structured sport and recreational physical activity (designated ‘Other RPA’). In each section, a list of the most common activities was presented – 16 for club sport and 26 for other RPA (which also included 12 of the 16 club sports). Respondents indicated the activities in which they participated, with provision for adding other activities that were not listed.

Because organized club sport was heavily impacted by COVID-19 restrictions in 2020 and their subsequent easing in 2021, the present study was focused on club sport participation. Each respondent was assigned, for each of the three epochs (designated 2019, 2020, 2021) a dichotomous club sport participation indicator (1 = participated, 0 = did not participate). This set of three indicators provides a ‘broad brush’ snapshot of the overall impact of the imposition of COVID-19 restrictions in 2020 and their subsequent easing in 2021 on levels of engagement in club sport.

The three dichotomous indicators together define a pattern or sequence of participation over the 3-year period. There are eight (2×2×2) possible sequences, of which four involve no participation in 2019. These four patterns were driven by various individual factors rather than COVID-19 restrictions, and each had low counts in some demographic categories, and so participants with these patterns were excluded, reducing the number of patterns to four. The small group of respondents who dropped out of club sport only in the final year of the study (2021) were also excluded because this participation pattern was not related to COVID-19 restrictions per se. Hence the three groups whose 2021 health assessments were compared were designated as follows:

Dropped out: played in 2019 and did not play in 2020 or 2021
Dropped out and returned: played in 2019 and 2021 and did not play in 2020
Continued: played in 2019, 2020 and 2021

The first two of these three 2021 groups constituted a single group in 2020, and only split into two groups in 2021. Hence, the comparisons of 2020 health assessments were made between two groups, designated as follows:

Dropped out: played in 2019 and did not play in 2020
Continued: played in 2019 and 2020.

Three survey items were devoted to self-assessed health. The general health item was a 5-point Likert scale item (poor, fair, good, very good, excellent) derived from the Short-form Health Survey (SF-36) instrument (29). The same format was used for the assessment of physical health and mental health.

Statistical analysis

Responses to the three health items for each year (2020 and 2021) were cross-tabulated against the two (2020) or three (2021) patterns of participation. Chi-square tests of independence were conducted to identify differences in the health profiles of the groups defined by the two/three patterns of participation. These analyses were conducted for the survey sample as a whole, and also for subsamples based on gender, age cohort and region of residence. To ensure that sample sizes in all cells of the cross-tabulations were sufficient for valid and reliable inference, each of the 5-category health items were recoded into three categories (poor/fair, good, very good/excellent). Data analysis was conducted using SPSS Version 27, with statistical significance defined as p < .05.

Of 5,371 respondents who completed the sport and physical activity questions in the Wave 1 survey, 1,138 (21.2%) also completed the Wave 2 follow-up survey, of whom 1,037 were adults (aged 18 years or more). This adult group provided the basis for the present study.

[Insert Table 1 near here]

Table 1
Self-assessment of health by sports club participants: by respondent characteristics, year and participation pattern.
Assessments by Group & Year	Participation pattern						p-value¹
All respondents²	Dropped out³		Continued³
2020	N	%	N	%
General health							0.001
Poor or fair	93	14.6	17	7.6
Good	213	33.3	62	27.6
Very good or excellent	333	52.1	146	64.9
Total	639	100.0	225	100.0
Physical health							< 0.001
Poor or fair	117	18.4	24	10.7
Good	255	40.2	70	31.3
Very good or excellent	263	41.4	130	58.0
Total	635	100.0	224	100.0
Mental health							0.297
Poor or fair	111	17.5	30	13.3
Good	204	32.1	71	31.6
Very good or excellent	321	50.5	124	55.1
Total	636	100.0	225	100.0
All respondents²	Dropped out⁴		Dropped out & returned⁴		Continued⁴
2021	N	%	N	%	N	%
General health							< 0.001
Poor or fair	25	22.3	49	9.7	12	5.5
Good	37	33.0	180	35.6	51	23.4
Very good or excellent	50	44.6	276	54.7	155	71.1
Total	112	100.0	505	100.0	218	100.0
Physical health							< 0.001
Poor or fair	30	26.8	59	11.9	18	8.3
Good	44	39.3	197	39.7	62	28.6
Very good or excellent	38	33.9	240	48.4	137	63.1
Total	112	100.0	496	100.0	217	100.0
Mental health							0.045
Poor or fair	17	15.2	47	9.3	22	10.1
Good	37	33.0	150	29.8	49	22.6
Very good or excellent	58	51.8	306	60.8	146	67.3
Total	112	100.0	503	100.0	217	100.0
Gender⁵: female	Dropped out³		Continued³
2020	N	%	N	%
General health							0.015
Poor or fair	40	15.3	6	6.3
Good	77	29.4	22	22.9
Very good or excellent	145	55.3	68	70.8
Total	262	100.0	96	100.0
Physical health							0.010
Poor or fair	50	19.2	10	10.4
Good	99	37.9	28	29.2
Very good or excellent	112	42.9	58	60.4
Total	261	100.0	96	100.0
Mental health							0.914
Poor or fair	54	20.7	18	18.8
Good	78	29.9	30	31.3
Very good or excellent	129	49.4	48	50.0
Total	261	100.0	96	100.0
Gender⁵: female	Dropped out⁴		Dropped out & returned⁴		Continued⁴
2021	N	%	N	%	N	%
General health							0.001
Poor or fair	11	20.8	14	7.0	4	4.3
Good	15	28.3	63	31.7	19	20.4
Very good or excellent	27	50.9	122	61.3	70	75.3
Total	53	100.0	199	100.0	93	100.0
Physical health							< 0.001
Poor or fair	13	24.5	21	10.7	6	6.5
Good	22	41.5	69	35.2	20	21.7
Very good or excellent	18	34.0	106	54.1	66	71.7
Total	53	100.0	196	100.0	92	100.0
Mental health							0.380
Poor or fair	8	15.1	18	9.1	6	6.5
Good	16	30.2	55	27.8	23	24.7
Very good or excellent	29	54.7	125	63.1	64	68.8
Total	53	100.0	198	100.0	93	100.0
Gender⁵: male	Dropped out³		Continued³
2020	N	%	N	%
General health							0.082
Poor or fair	53	14.1	11	8.5
Good	135	35.9	40	31.0
Very good or excellent	188	50.0	78	60.5
Total	376	100.0	129	100.0
Physical health							0.006
Poor or fair	67	18.0	14	10.9
Good	156	41.8	42	32.8
Very good or excellent	150	40.2	72	56.3
Total	373	100.0	128	100.0
Mental health							0.159
Poor or fair	57	15.2	12	9.3
Good	126	33.7	41	31.8
Very good or excellent	191	51.1	76	58.9
Total	374	100.0	129	100.0
Gender⁵: male	Dropped out⁴		Dropped out & returned⁴		Continued⁴
2021	N	%	N	%	N	%
General health							< 0.001
Poor or fair	14	23.7	35	11.5	8	6.4
Good	22	37.3	117	38.4	32	25.6
Very good or excellent	23	39.0	153	50.2	85	68.0
Total	59	100.0	305	100.0	125	100.0
Physical health							0.001
Poor or fair	17	28.8	38	12.7	12	9.6
Good	22	37.3	128	42.8	42	33.6
Very good or excellent	20	33.9	133	44.5	71	56.8
Total	59	100.0	299	100.0	125	100.0
Mental health							0.089
Poor or fair	9	15.3	29	9.5	16	12.9
Good	21	35.6	95	31.3	26	21.0
Very good or excellent	29	49.2	180	59.2	82	66.1
Total	59	100.0	304	100.0	124	100.0
Age: 18–59 years	Dropped out³		Continued³
2020	N	%	N	%
General health							0.123
Poor or fair	46	20.3	14	13.7
Good	72	31.7	27	26.5
Very good or excellent	109	48.0	61	59.8
Total	227	100.0	102	100.0
Physical health							0.014
Poor or fair	50	22.1	16	15.7
Good	91	40.3	30	29.4
Very good or excellent	85	37.6	56	54.9
Total	226	100.0	102	100.0
Mental health							0.429
Poor or fair	65	28.6	25	24.5
Good	81	35.7	33	32.4
Very good or excellent	81	35.7	44	43.1
Total	227	100.0	102	100.0
Age: 18–59 years	Dropped out⁴		Dropped out & returned⁴		Continued⁴
2021	N	%	N	%	N	%
General health							0.002
Poor or fair	12	20.3	22	13.9	7	7.2
Good	19	32.2	57	36.1	19	19.6
Very good or excellent	28	47.5	79	50.0	71	73.2
Total	59	100.0	158	100.0	97	100.0
Physical health							0.001
Poor or fair	13	22.0	25	16.0	8	8.3
Good	27	45.8	61	39.1	25	26.0
Very good or excellent	19	32.2	70	44.9	63	65.6
Total	59	100.0	156	100.0	96	100.0
Mental health							0.334
Poor or fair	11	18.6	25	15.8	18	18.8
Good	22	37.3	58	36.7	24	25.0
Very good or excellent	26	44.1	75	47.5	54	56.3
Total	59	100.0	158	100.0	96	100.0
Age: 60 + years	Dropped out³		Continued³
2020	N	%	N	%
General health							0.002
Poor or fair	47	11.4	3	2.4
Good	141	34.2	35	28.5
Very good or excellent	224	54.4	85	69.1
Total	412	100.0	123	100.0
Physical health							0.001
Poor or fair	67	16.4	8	6.6
Good	164	40.1	40	32.8
Very good or excellent	178	43.5	74	60.7
Total	409	100.0	122	100.0
Mental health							0.057
Poor or fair	46	11.2	5	4.1
Good	123	30.1	38	30.9
Very good or excellent	240	58.7	80	65.0
Total	409	100.0	123	100.0
Age: 60 + years	Dropped out⁴		Dropped out & returned⁴		Continued⁴
2021	N	%	N	%	N	%
General health							< 0.001
Poor or fair	13	24.5	27	7.8	5	4.1
Good	18	34.0	123	35.4	32	26.4
Very good or excellent	22	41.5	197	56.8	84	69.4
Total	53	100.0	347	100.0	121	100.0
Physical health							< 0.001
Poor or fair	17	32.1	34	10.0	10	8.3
Good	17	32.1	136	40.0	37	30.6
Very good or excellent	19	35.8	170	50.0	74	61.2
Total	53	100.0	340	100.0	121	100.0
Mental health							0.135
Poor or fair	6	11.3	22	6.4	4	3.3
Good	15	28.3	92	26.7	25	20.7
Very good or excellent	32	60.4	231	67.0	92	76.0
Total	53	100.0	345	100.0	121	100.0
Region: Metropolitan	Dropped out³		Continued³
2020	N	%	N	%
General health							0.016
Poor or fair	53	13.6	11	7.6
Good	133	34.2	39	26.9
Very good or excellent	203	52.2	95	65.5
Total	389	100.0	145	100.0
Physical health							0.001
Poor or fair	62	16.1	14	9.7
Good	159	41.3	42	29.2
Very good or excellent	164	42.6	88	61.1
Total	385	100.0	144	100.0
Mental health							0.265
Poor or fair	72	18.6	21	14.5
Good	131	33.9	44	30.3
Very good or excellent	184	47.5	80	55.2
Total	387	100.0	145	100.0
Region: Metropolitan	Dropped out⁴		Dropped out & returned⁴		Continued⁴
2021	N	%	N	%	N	%
General health							< 0.001
Poor or fair	18	25.7	27	8.7	10	7.0
Good	21	30.0	110	35.6	33	23.1
Very good or excellent	31	44.3	172	55.7	100	69.9
Total	70	100.0	309	100.0	143	100.0
Physical health							< 0.001
Poor or fair	20	28.6	30	10.0	13	9.2
Good	26	37.1	119	39.5	42	29.6
Very good or excellent	24	34.3	152	50.5	87	61.3
Total	70	100.0	301	100.0	142	100.0
Mental health							0.083
Poor or fair	13	18.6	28	9.1	16	11.3
Good	22	31.4	91	29.6	33	23.2
Very good or excellent	35	50.0	188	61.2	93	65.5
Total	70	100.0	307	100.0	142	100.0
Region: Non-metropolitan	Dropped out³		Continued³
2020	N	%	N	%
General health							0.079
Poor or fair	40	16.1	6	7.5
Good	80	32.3	23	28.8
Very good or excellent	128	51.6	51	63.8
Total	248	100.0	80	100.0
Physical health							0.060
Poor or fair	55	22.2	10	12.5
Good	96	38.7	28	35.0
Very good or excellent	97	39.1	42	52.5
Total	248	100.0	80	100.0
Mental health							0.530
Poor or fair	39	15.8	9	11.3
Good	72	29.1	27	33.8
Very good or excellent	136	55.1	44	55.0
Total	247	100.0	80	100.0
Region: Non-metropolitan	Dropped out⁴		Dropped out & returned⁴		Continued⁴
2021	N	%	N	%	N	%
General health							0.007
Poor or fair	7	16.7	22	11.3	2	2.7
Good	16	38.1	70	36.1	18	24.0
Very good or excellent	19	45.2	102	52.6	55	73.3
Total	42	100.0	194	100.0	75	100.0
Physical health							0.002
Poor or fair	10	23.8	29	15.0	5	6.7
Good	18	42.9	78	40.4	20	26.7
Very good or excellent	14	33.3	86	44.6	50	66.7
Total	42	100.0	193	100.0	75	100.0
Mental health							0.437
Poor or fair	4	9.5	18	9.3	6	8.0
Good	15	35.7	59	30.4	16	21.3
Very good or excellent	23	54.8	117	60.3	53	70.7
Total	42	100.0	194	100.0	75	100.0
¹ Chi-square test of independence
² All adults who responded to both 2020 and 2021 surveys and who answered each health self-assessment question.
³ 2020 - Dropped out: played in 2019, did not play in 2020. Continued: played in 2019 and 2020.
⁴ 2021 - Dropped out: played in 2019, did not play in 2020 or 2021. Dropped out and returned: played in 2019, did not play in 2020, played in 2021. Continued: played in 2019, 2020 and 2021.
⁵ Two respondents who reported their gender as ’other’ were excluded from the gender breakdowns because the small sample size provided inadequate statistical power to enable reliable conclusions to be drawn about this population.
* Statistically significant p-values (< 0.05) are indicated by boldface type. Points of greatest difference between statistically significantly different response profiles for the different participation categories are also indicated by the use of boldface type for the higher/highest percentage for a particular response.

Table 1 includes results of all the cross-tabulations and chi-square tests conducted. These involved seven groupings of respondents – the whole sample, and six subsamples based on gender (female, male), age (18–59 years, 60 years and above) and region of residence (metropolitan, non-metropolitan). For each grouping, three health self-assessments (general, physical, mental) made on each of two occasions (2020, 2021) were cross-tabulated with the pattern of club sport participation across the three years 201–2021. There are 42 (7×3×2) such cross-tabulations.

Statistically significant relationships were found between self-assessed health status and the participation pattern in 25 of the 42 cases: 11 of 14 regarding general health, 13 of 14 regarding physical health, and 1 of 14 regarding mental health, and from another perspective, 10 of the 21 assessments made in 2020 and 15 of the 21 assessments made in 2021.

Mental health was not strongly associated with patterns of sport club participation, and it accounted for 13 of the 17 (42 − 25) null results. The remaining four null results all involved 2020 health assessments: general health of males, general health of 18–59 year-olds, and general and physical health of non-metropolitan residents. All 14 results regarding 2021 general and physical health assessments were statistically significant, as were 10 of the 14 results regarding 2020 general and physical health assessments: 4 of 7 regarding general health, and 6 of 7 regarding physical health.

Turning to the detail of the counts and percentages in Table 1, the distribution of the health assessments is skewed towards the high end in every group in every cross-tabulation throughout the table. However, overlaid on this generally positive picture are consistent differences in the profiles of responses of the groups. Statistically significant p-values (< 0.05) are indicated by boldface type. Points of greatest difference between statistically significantly different response profiles for the different participation categories are also indicated by the use of boldface type for the higher/highest percentage for a particular response. An examination of these boldface percentages reveals a consistent pattern in the associations between the health assessments and the participation patterns. In every instance, the “dropped out” group has the highest percentage of respondents reporting “poor or fair” health, and the “continued” group has the highest percentage of respondents reporting “very good or excellent” health. The percentage reporting the intermediate health category “good” is less differentiated between the groups in most instances. Where substantial differences occur, the group with the highest percentage of “good” responses is either the “dropped out” group, or in the 2021 analyses, the “dropped out and returned” group. Broadly the general pattern can be described as the more participation over the three years, the more likely are reports of better general and physical health, or conversely, the more the disruption or prevention of participation in 2020 and 2021, the more likely are reports of worse general and physical health. The same pattern is evident for mental health throughout Table 1, but the association is consistently weaker, and is only statistically significant in one analysis - for the overall sample in 2021.

To our knowledge, this is the first study to report the health outcomes of adult sport participants during and post-COVID-19 restrictions. Given this, there is limited comparable literature with which to compare results in this discussion.

First, it is apparent that the distribution of all three health assessments in all sport club participation categories and across all demographic groups were skewed towards the high end. This is not surprising considering that the study sample consisted predominantly of individuals who participated pre-COVID-19 in leisure time physically activity. However, overlaid on this generally positive picture were differences in the profiles of responses of the various categories and groups.

Participation in club sport for adults has been shown cross-sectionally to be associated with a range of positive health and wellbeing outcomes specific to the team and club based (social) nature of sport, when compared to other individual activities (15, 16). However, as these authors have pointed out, further experimental and longitudinal evidence is required to understand the mechanisms responsible for the sport effect on mental health (16).

The present study has demonstrated longitudinally that the self-assessed general and physical health of adults were impacted by their change in sport behaviours during and post-COVID-19 restrictions in a manner consistent with these positive associations. Those who continued playing club sport throughout, and to a lesser degree those who returned to club sport in 2021, reported better general and physical health than those who dropped out.

In the present study, although the pattern of mental health responses across the participation categories exhibited the same general trend as for general and physical health, the trend was much weaker and consequently very little conclusive evidence was found of an association between self-assessed mental health and the longitudinal pattern of participation in club sport. This is not consistent with the strong associations reported in previously published systematic reviews, mainly of cross-sectional studies (15, 16). We suggest three possible factors that might contribute to this discrepancy. First, in previously published cross-sectional studies, sport participants have generally been compared with non-participants, whereas in the present study all groups compared played sport in the first year of the study period. The positive benefits of sport club participation to mental health may be more persistent and slower to change than the more obvious and immediately perceived impacts of non-participation on physical health. Second, in the perceptions of respondents, the term ‘mental health’ may suggest a narrower and more clinical concept than wellbeing. If so, much of the broader mental health benefits of sport club participation may be reflected in self-assessed general heath rather than self-assessed mental health. Third, the effects of restrictions on sport club participation may be confounded with COVID-19 effects on other determinants of mental health such as isolation, general social restrictions and financial stress, irrespective of participation behaviours.

There is increasing research attention to retention in sport participation, which is mainly focused on children and youth (30–33). However, to date the literature has not investigated the links between participation status, i.e. retained versus dropped-out, and health outcomes. To our knowledge, this is the first study to investigate sport participation status and health outcomes longitudinally. The recent literature advocating for a strategic and policy focus on retention in sport participation is largely based upon a sport management focus of maintaining and increasing participation in sport, rather than from a health perspective (30, 33). However, as Eime et al. point out, sport participation, including retention and drop-out, is important to inform policy and strategic developments for both sport management and public health (33).

In any survey-based study, the extent to which the survey sample is representative of the population from which the sample is drawn, or of related populations with different contextual characteristics, is an issue which must be considered when interpreting the study findings. In the present study, the risk of selection bias, including self-selection or response bias, occurred at two stages. The first survey sample was a convenience sample, predominantly of Australian sports participants recruited with the assistance of Australian national and state sporting organisations (NSOs and SSOs) of several popular sports. This sample was supplemented by recruitment through social media, which resulted in an additional smaller sample of participants in only informal sport or other physical activity settings (34). Recruitment for the first survey was thus multi-facetted, and mostly facilitated by third parties, making it impossible to ascertain a response rate. The follow-up survey sample was a self-selected subset of the first sample. Recruitment for the follow-up survey was conducted directly by the research team, with a response rate of 21.2%. Given these limitations, caution should be exercised in generalising the results of the study. Notwithstanding that, on the other side of the ledger, the sample obtained was large, and because respondents provided information about the multiple sports and other physical activities that they engaged in, there was comprehensive representation of the sporting codes and other types of recreational physical activity that are available in Australia.

This study has demonstrated that changes in club sport participation longitudinally impact health outcomes amongst adults. For this particular cohort of adults, the changes in club sport participation patterns, which were heavily impacted by COVID-19 restrictions and infections, impacted their health outcomes. Those who continued to play club sport and, to a lesser extent those who returned to playing club sport, reported better physical and general health than those who dropped out. This study did not find a significant association between participation in sport and mental health, which is not consistent with cross-sectional results previously reported in the literature, and which it is conjectured may be due to a combination of factors including confounding with the broader effects of the pandemic. In conclusion, retention in participation in sport is not just important for sports management policy and strategies; it is also important for the health of individuals.

Recreational physical activity (RPA)

(2, 9)

All experiment protocol for involving humans was in accordance to guidelines of national, international and institutional standards.

Ethics approval and consent to participate

Flinders University and Victoria University human research ethics committees approved this study. Informed consent was obtained from participants.

Consent for publication

Not applicable.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Competing interests

The authors declare that they have no competing interests.

Funding

There was no research funding awarded for this study.

Authors' contributions

The design of the study methodology and survey was conducted by RE, JH, and MC. RE conceptualised the paper. MC and JH conducted the analysis and produced the results. All authors have contributed to the preparation of the manuscript. All authors have read and approved the final manuscript.

Acknowledgements

We would like to thank the sporting organisations that assisted with the distribution of the survey, and to also thank all survey participants.

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No competing interests reported.

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Self-assessed health of adult Australian sport club participants during and after COVID- 19 restrictions: a longitudinal study

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Abstract

Introduction

Participation in sport and physical activity during COVID-19

Impact on health during COVID-19

Recovery of participation post-COVID-19

Methods

Statistical analysis

Results

Discussion

Limitations

Conclusion

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1