Effects of COVID-19 Pandemic on Behavior, Perception of Threat, Stress and Training Patterns of Olympic and Paralympic Athletes

Objective Analyze the effect of the COVID-19 pandemic and its subsequent connement on Olympic and Paralympic level athletes’ behaviors, perception of threat, stress, state of mind and training patterns. Methods All variables were modulated by gender, academic training, and sport discipline on a population composed of 447 Olympic (25.97 ± 7.46 years) and 64 Paralympic athletes (28.44 ± 10.50 years). Results Most of the athletes recognize that their best athletic performance diminished due to the COVID-19 connement but that will recover after the pandemic and its connements. Almost half of the athletes declared they were more tired than normal and had diculty sleeping, while more than half eat more or less as usual. Paralympic athletes report they felt more capable to cope with personal problems and feeling more frequently that life events where going well and less lonely during the connement than the Olympians. The athletes from team sports disrupted their training routine more signicantly than athletes of individual sports, seeing their athletic performance more affected. Athletes in individual sports felt more capable to cope with personal problems than athletes in team sports. Female athletes were signicantly more tired and reported more diculty sleeping than male. Conclusions The situation caused by COVID-19 has had signicant effects on the behavior, perception of threat, stress and training patterns of Olympic and Paralympic athletes facing the 2020 Tokyo Olympiad. It is necessary that sports institutions to reinforce mechanisms of help to athletes during future situations of connement. athletes. Perception of threat and stress were different between individual versus collective sports and between Olympic and Paralympic athletes.


Introduction
In December 2019, a novel coronavirus emerged in China, which posed an international public health emergency. This virus was named as the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) [1]. On March 11, 2020 the new coronavirus disease 2019 (COVID-19) was described as a pandemic by the World Health Organization (WHO) [2]. This pandemic is now a major global health issue, representing the most serious respiratory virus since the 1918 H1N1 in uenza pandemic [3].
On March 14, the Spanish Government declared a nationwide lockdown ordering people to stay at home [4] and approving the last extension of the state of alarm until June 21 [5]. As of this date, with no vaccine available and no herd immunity, the population must continue to maintain important safety standards for the sake of individual and collective health. On In the middle of the present study, September 13, 2020, there were 28,637,952 con rmed cases and 917,417 deaths worldwide [2] and Spain accumulates 12,113 con rmed cases and 636 deaths per million population. The lack of vaccines and the actual no population immunity due to the herd effect increase the feeling of danger and uncertainty in this health crisis [6].
The actual health crisis is a new threat that put the adaptive mechanisms of the human being, both physiologically and psychologically, through its paces.
The human being is a highly adaptative organism, for this reason we developed in our evolution different physiological and psychological defence mechanism that allow us to overcome different eliciting contextual scenarios, but some of these phylogenetic defence system could produce non adaptative behaviour in current society and specially in exceptional situations [6]. In the current global home con nement situation due to the COVID-19 pandemic, most individuals are exposed to an unprecedented stressful situation of unknown duration, being a focus of stress, anxiety, fear and depression or disrupt sleep due to a negative appraisal of the situation and self-protection behaviours [7,8].
In this line, one of the populations that could suffer more the con nement are athletes, especially professional ones. The Olympic and Paralympic athletes suffer an eliciting situation, since they have been preparing the Tokyo Olympiad for 4 years and their postponement is a more added stressor. This setback and the threat of the Coronavirus can cause the athlete to lose concentration, motivation and the desire to continue preparing for the Olympiad with the same energy as he did up until then. the perception of threat of this virus, the psychological pro le of the athlete, as well as their psychological skills [9,10], All this information would be fundamental to understand their stress response and to de ne professional interventions on these athletes so that they continue to prepare for the Olympiad at the highest level. Other factors as social support, academic level, gender or cultural differences could also modulate the behaviors in eliciting situations [11], making the knowledge of theses parameters and their relationships important factors in actual moments.
The con nement situation caused by COVID-19 has had signi cant effects on the perception of personal and professional threat of Olympic and Paralympic athletes facing the 2021 Tokyo Olympiad [12]. In the same vein, the study carried by Clemente-Suarez, Fuentes-Garcia, de la Vega, & Martinez-Patiño [10] with Olympic out with Olympic and Paralympic athletes during con nement showed how they perceived how con nement negatively affects their workouts, even if it does not affect their performance, both approving the suspension of the Tokyo Olympics. Paralympic athletes perceived higher negative impact in their training and performance by the con nement than Olympic ones. Neuroticism and psychological in exibility presented the greatest negative feelings and the perception that quarantine would negatively affect their sports performance. Faced with this same con nement situation generated by COVID-19, the study carried out by Fuentes-Garcia, Martinez-Patiño, Villafaina, & Clemente-Suarez [13] on a sample of 450 chess players showed that a sample of accustomed chess players a long training durations, tournaments, and games, leading to mental, emotional, and physical stress, characteristics that could provide chess players a certain advantage in facing quarantine situations, showed that the amateur players presented a signi cantly higher level of social alarm than professional and high-performance players; while chess players with a higher academic level might have adapted their psychological pro le to t con nement situations and the worrying levels of physical inactivity.
Then, the aim of this research was to analyse the effect of age, gender, academic training, participation, sport specialty and high options to participate in the Tokyo 2021 in the individual perceptions about COVID-19 crisis, psychological pro le and training patterns.

Methods
This study was performed online using the surveymonkey internet platform (https://www.surveymonkey.com/). A correlational design with incidental sampling for convenience was used. During lockout, this methodology was the most appropriate for obtaining information.

Participants
In the present study were analyzed 511 Olympic and Paralympic athletes classi ed or in process to the Olympic Games in Tokyo 2021 (M = 26.28 years; SD =

Procedure
Due to the COVID-19 crisis and the limitation of free movement, an intentional opinion-type sampling type was used. The call to participate in the study was made through a link sent by the federations of the different sports [14]. The questionnaire was sent to 871 athletes: 678 Olympic athletes, answering 447 (66%), and 193 Paralympic athletes, answering 64 (34%). Athletes who completed the online survey gave their passive consent to participate at the time of participating in the research. This study was completely voluntary, and no personal data was requested through which the participants could be identi ed.
Data collection lasted for 21 days (from September 2 to September 22, 2020).
Firstly, they lled the informed consent and then completed the following items:

Personal Information
Age, gender, weight and height, Psychological pro le, by the following questionnaires Questionnaire on Perception of Threat from COVID-19. It is a 5-item questionnaire with a Likert-type scale from 0 =¨It absolutely does not affect me" to 10 = It gravely affects my life". The test provides an overall score on the representation of the illness. The higher the score is, the greater the perception of the illness as a threat (for example, "How much are you worried about being infected by the coronavirus (COVID-19)?" or "How much does infection by the coronavirus (COVID-19) affect you emotionally?" (That is, does it make you feel furious, afraid, angry or depressed?)". Perception Questionnaire (IPQ) for COVID-19 (Perez-Fuentes et al., 2020), Perceived Stress by Psychometric Properties of a European Spanish Version of the Perceived Stress Scale (PSS). It is a 10-item questionnaire with a Likert-type scale from 0 =¨Never" to 4 = "Very often". The test is designed to measure the degree to which situations in one's life are appraised as stressful (for example, In the past month, how often have you been affected by an unexpected event?" or "In the past month, how often have you felt lack of control over important events in your life? (Remor, 2013).

Academic and training patterns information
What is your level of education? Academic training (High school, Professional training, University training), At this moment, are you ranked or do you have high options to participate in the Tokyo 2021 Olympic or Paralympic? (Yes, No).
What is your primary sport? Choose Olympics or Paralympics (___).
On a scale from 1-4, how much do you think that your athletic performance was affected by the con nement?
How many hours per week did you train, on average, before COVID-19 con nement? (___) How many hours per week did you train, on average, during COVID-19 con nement? (___) Did your personal best athletic performance diminish due to the COVID-19 con nement? (Yes, No).
Do you foresee recovering your athletic performance after the COVID-19 pandemic? (Yes, No).
Individual information, and perceptions and harmful behavioral about COVID-19 crisis.
On a scale from 0-10, how do you evaluate the magnitude of the COVID-19 pandemic today? 0 meaning that you think it is not serious at all and 10 meaning that you think it is extremely serious.
On a scale from 1-4, were you more stressed (feeling pressured, tense or overwhelmed) than usual because of the con nement? (1 = "Not at all" to 4 = "Extremely affected").
On a scale from 1-4, how much were you worried about reducing your athletic capability because of the con nement? (1 = "Not at all" to 4 = "Extremely affected").
On a scale from 1-4, how worried were you about not being able to participate to sports competitions because of the con nement? (1 = "Not at all" to 4 = "Extremely affected").
On a scale from 1-4, how worried were you about your nancial situation during the con nement?
On a scale from 1-4, how lonely did you feel during the con nement? (1 = "Not at all" to 4 = "Extremely affected").
On a scale from 1-4, how much did you miss interacting with other athletes during the con nement? (1 = "Not at all" to 4 = "Extremely affected").
Have you been infected by COVID-19? (Yes, No), Did you feel more tired than usual during the con nement? (Yes, No).
Did you have di culty sleeping during the con nement? (Yes, No).
Did your food intake/eating change during the con nement? (Eat More than usual, Eat Less than usual, Eat the same as before, no change).
Did you increase your use of tobacco during the con nement? (Yes, No).
Did you increase your alcoholic intake during the con nement? (Yes, No).
Did you take Psychotropic medications for mental health during the con nement (for example; anxiety, depression, panic)? (Yes, No). Before the data analyses, the normal distribution of the dependent variables was tested with the Kolmogorov-Smirnov test. All test results were statistically signi cant (p < .05 for all tests). Consequently, nonparametric tests were used. Wilcoxon signed-rank test to compare two related samples was used. Group differences in the dependent variables were tested with the nonparametric Mann-Whitney U test with the Bonferroni correction, which is recommended for smaller samples and might be less sensitive to sample size differences between the groups [15]. To measure the effect size of differences between variables we rely on the following thresholds: small (| r | = 0.1), medium (| r | = 0.3), large (| r | = 0.5), and very large (| r | = 0.7) [16].
The Chi-Square tests were performed (X 2 ) to analyse the ordinal categorical variables related to the Individual, sport and perceptions information about COVID-19 crisis.
Additionally, for psychological pro le and perceived stress variables a bivariate correlation analysis between all these variables was performed using Spearman's correlation thresholds correlation. Table 1 showed the descriptive data such as the number of subjects (N), Mean (M) and Standard deviation (SD) of the age, anthropometric dimensions, training patterns, individual perceptions about COVID-19 crisis and psychological pro le. Regarding the gender, the U Mann-Whitney test reveal that female compared to male group affected more emotionally by COVID-19 (e.g. angry, fearful, upset or depressed) (Z = 2.571, p < .010, effect size [r] = 0.11, small). Women also perceive that they have been more affected than men by an unexpected event in the last month (Z = 2. When applying the U Mann-Whitney no signi cant differences were observed in any variable analyzed between those athletes ranked or with high options to participate in the Tokyo 2021 and those who had low options.  Finally, a correlational analysis of perception of threat, stress and training patterns variables about COVID-19 crisis is shown in Table 3.

Discussion
The aim of the present research was to analyze the effect of age (25 or Less, or 26 or more), gender (male or female), academic training (high school, professional training or university training), participation (Olympic and Paralympic), sport specialty (individual or collective) and high options to participate in the Tokyo 2021 (ranked or with serious options or without serious options) in the individual perceptions about COVID-19 crisis and psychological pro le (perception of threat and stress). We found differences in various parameters between the athletes analyzed.
The present situation generated by COVID-19, supposes that people have to adapt to special care to which they are not accustomed and, even, as happened in Spain for more than three months, at the con nement, increased somatization of anxiety, resulting from the perception of lack of control in adapting to contextual demands, existing empirical evidence that emerging adults are at high risk for depression and anxiety related to the psychosocial effects of the Although the Olympic games are the most important sport event for athletes, and much of then depend on this event for their sports scholarships and sponsorships, there was a high agreement on the suspension of the Tokyo Olympics and the con nement of high-performance athletes (62.5% in favor, 14.6% against and 22.9% neutral), results that are in the same line as the study carried out during con nement by Clemente-Suarez, Fuentes-Garcia, de la Vega, & Martinez-Patiño [10] also with Olympic and Paralympic athletes. Probably, although the majority of athletes recognize that their best athletic performance diminish due to the COVID-19 con nement (78.2% Yes and 21.8% No), with athletes under 26 years of age more negative than group aged 26 and over athletes, on the other hand, the majority of athletes also believe that their athletic performance will recover after the pandemic (93.6% Yes and 6.4% No). In this sense, the athletes of collective sports disrupted the training routine by COVID-19 more signi cantly than athletes of individual sports, seeing their athletic performance more affected than in individual sports by the con nement, probably due to the added di culty of having to meet with more companions in order to train.
The immune landscape in patients with COVID − 19 is considerably different between the sexes, and these differences may underlie heightened disease vulnerability in men (Takahashi, et al., 2020). 64.8% of the athletes were tested for COVID − 19: 44.8% with nasal swab and 20% with antibody (blood) test.
6.8% declare that they were infected by Covid-19. It should be noted that individual sports athletes underwent a signi cantly higher number of tests than individual sports athletes and that women presented a signi cantly higher number of infections than men. These results are not in line with different studies, which have shown that the incidence of coronavirus disease 2019 is higher in males than in females worldwide even though these levels may be in uenced by social reasons depending on each country, culture and the speci c context in which people nd themselves [19].
During con nement, 48.7% of the athletes declared they were more tired than normal, 47.9% had di culty sleeping, 62.9% eat more (31.7%) or less (31.3%) as usual, 4% increased their tobacco consumption, 9.8% increased their alcohol consumption and 2% took psychotropic medications for mental health. Thus these results are in line with other studies in which it has been shown that most individuals are exposed to an unprecedented stressful situation of unknown duration, being a focus of stress, anxiety, fear and depression and also disrupt sleep due to a negative appraisal of the situation and self-protection behaviors [7,8]. For all the above, it would be important to teach athletes to manage sleep problems as best as possible during home con nement can limit stress. In relation to the above, during the con nement, the results of our study show that female athletes were signi cantly more tired than men, with more di culty sleeping and more tobacco consumption. In relation to the above, the study carried out by Sal et al. [20] in Italy evaluated through survey sleep quality, insomnia and depression symptoms, perceived stress, and anxiety, showing the female gender the worst condition for all the examined dimensions in both the assessments. Nevertheless, at the follow-up women reported a reduction in insomnia and depression severity symptoms, perceived stress, and anxiety. On the other hand, male participants showed a worsening of sleep quality, insomnia symptoms, and perceived stress. Consequently, the gender prevalence gap of clinical conditions such as insomnia and depression was largely reduced under lockdown, showing women seemed greater long-term resilience during the lockdown, meanwhile, the male gender emerges as the most vulnerable category to the extension of the restraining measures.
On the other hand, the group high school evaluated the gravity of the COVID-19 pandemic as less serious than the athletes in the groups professional training and university training, probably due to less knowledge of the consequences of the situation. The group with university training more worried in which the group with high school in the nancial situation, probably because many of the athletes in the latter group are still studying and are more concerned about their training than about work, and, conversely, the group with high school missed more than the group with university training interacting with other athletes during the con nement probably because many of them, being younger, are still giving great importance to forging social relationships.
Regarding the Olympic or Paralympic participation the Paralympic felt more capable to cope with the personal problems, also more frequently than life events are going well and less lonely during the con nement than Olympic athletes. All of the above, probably, by the very fact that disability, in general, and sport for people with disabilities, in particular, somehow prepares these people to better cope with adversity [21].
Something similar could happen regarding the sport specialty, the athletes in individual sports felt more capable of cope with personal problems than athletes in collective sports, where studies such as Sepulveda-Paez, Diaz-Karmelic, & Ferrer-Urbina [22] show that the relationship between coping strategies and precompetitive anxiety is different between individual sport (swimming) and collective sport (waterpolo), and in this sense, individual sports athletes may be more prepared to face con nement situations.
Faced with all the problems generated by the COVID − 19 previously exposed, 50.3% of the athletes report that they received guidance from the Sports Federation, with women perceiving this help to a signi cantly greater extent than men. In part these results could be supported by the fact that women would demand more information from their coach since, also according to our study, that female compared to male group affected more emotionally by Covid-19, more affected by an unexpected event in the last month, feeling less control over important events in the life, more nervous / anxious or stressed, less capable to cope with the personal problems, less capable to face the responsibilities, less control of all aspects of the life, more angry / upset due to events that occurred that were out of control, greater feeling that problems pile up that can not overcome them. In fact, women disrupted the training routine by COVID-19 more than men, feeling also women more stressed (pressured, tense or overwhelmed) than usual because of the con nement, more worried about reducing the athletic capability because of the con nement and more lonely during the con nement than men. These results are in the same line as those of the study carried out by Fuentes-Garcia, Martinez-Patiño, Villafaina, & Clemente-Suarez [13] with chess players, whose results also showed that women reported a higher level of care to avoid infection than men, and the study of Clemente-Suarez, Fuentes-Garcia, de la Vega, & Martinez-Patiño [10] also with Olympic and Paralympic athletes, in which that neuroticism and psychological in exibility was greater in female compared to male group. This is consistent with a previous study [14] in the Spanish population where men and women signi cantly differed in compliance with safety measures, exercising proper care to wash hands, and in keeping at least 1.5 m distance from others in public.
On the other hand, in terms of the help received by the coach, 61.8 of athletes perceived that they received help from their coach, with this help being perceived to a greater extent by athletes 25 years of age or younger than those of 26 years of age or older. In this sense, studies such as the one by Navon-Eyal & Taubman-Ben-Ari [23] have shown that people tended to report di culties in regulating emotion are younger, with more maladaptive, reckless and careless behaviors; angry, hostile and anxious. Thus, it is necessary to reinforce the mechanisms of help and advice from sports institutions to athletes in the face of the pandemic. The rest of the items (9, 10, 12 and 13: Capable to cope with personal problems, Feel that the events are going well, Able to manage the problems, and Feel in control of all aspects) of the Questionnaire on Perception of Threat from COVID − 19 correlate negatively in most cases strongly with each other and also with the ve items of the Questionnaire on Perception of Threat from COVID-19 (1 to 5). Highlight the positive correlation between the item that deals with the athlete's ability to control the problems in his life (12) and the item that deals with the athlete's feeling of controlling the di culties of his life (13) with the item in question. to the ability of the athlete to cope with personal problems (9) and with the item that refers to the frequency with which the athlete has felt that things are going well (10) and with the item that refers to the disability of the athlete to face the responsibilities (11).

Study limitation and future research lines
One of the limitations of the study is not having controlled different physiological variables directly, by means of, for example, hormone controls. Another limitation is not having carried out a longitudinal study to observe the evolution of the athletes' perception. These two aspects, on the other hand, are di cult to carry out due to the great di culty of accessing a large sample of elite athletes. Future research must seek it would be interesting to analyze the impact of COVID-19 crisis in different performance level athletes.

Practical applications
Considering the results obtained, which re ect, on the one hand, adaptive problems in athletes and, on the other hand, not the su cient level of support from the institutes against Covid-19, it would be advisable to carry it out on the part of the competent institutions a program to give psychological support to Olympic and Paralympic athletes in which they are taught to face in a way the different psychological problems caused by COVID − 19.

Conclusions
The situation caused by COVID-19 has had signi cant effects on the harmful behavioral, perception of threat, stress and training patterns of Olympic and Paralympic athletes facing the 2021 Tokyo Olympiad. These athletes perceived how the pandemic negatively affects their workouts and their best athletic performance, even if it does not affect the recovery of their performance when the pandemic ends. The athletes of collective sports disrupted the training routine and their athletic performance more signi cantly than athletes of individual sports, nding half of the athletes more tired than normal and with di culty sleeping. The Paralympic felt more capable to cope with the personal problems during the con nement than Olympic athletes and the athletes in individual sports felt more capable of cope with personal problems than athletes in collective sports. Only slightly more than half of the athletes received guidance from the Sports Federation. Female compared to male group affected more psychologically in numerous variables and disrupted the training routine by COVID-19 more than men.

Declarations
Ethics Approval, Consent to Participate Before participation, experimental procedures were explained to all the participants who gave their voluntary written informed consent to participate in accordance with the Declaration of Helsinki. All the procedures were approved by the Commission of Bioethics and Biosecurity of the University of Extremadura (Spain) (approval number: 57/2020).
The inclusion criteria used for the present research was that athletes were selectable by the corresponding sports federation with options to represent it in Tokyo 2021 Olympic or Paralympic Games.

Consent for Publication
Not applicable.

Availability of Data and Material
De-identi ed raw data are available upon request.

Competing Interests
None Funding This study was supported were supported by the Research Project "Investigation of the effect of COVID-19 pandemic on the stress level and mental health of