The COVID-19 pandemic has disrupted global health systems and services  and upended economies across the world . It has so far led to at least 21 million cases and 755,786 deaths worldwide in far less than its first year . The global response to COVID-19 includes a race to roll out testing, trace contacts, quarantine and isolate individuals, slow the movement of people, reduce person-to-person interactions, develop a vaccine, find effective medical interventions, and bolster public health and healthcare systems. Yet the consequences of COVID-19, especially in the longer-term, are just beginning to bear out . The United States has been impacted especially hard by this pandemic, with over 167,000 deaths and well over 5.2 million cases of COVID-19 as of mid-August – and counting . While U.S. federal efforts include tracking the disease, boosting research, overseeing vaccine development, and attempting to stimulate the economy , responses of U.S. state and local governments have varied and include efforts to restrict the movement and gathering of people as well as closing and tightly controlling re-opening of businesses and organizations, including academic institutions .
Not surprisingly to health professionals, COVID-19 is affecting populations disproportionately . For example, Gupta and colleagues determined that some of the main risk factors for mortality related to COVID-19 for critically-ill patients include pre-existing medical conditions such as coronary heart disease, cancer, acute organ disfunction, and obesity as well as older age, being male, and admission to a hospital with fewer intensive care unit beds . These inequities, however, run deeper than just pre-existing health conditions. Some of the most impacted communities in the U.S. have been racial and ethnic minorities, particularly African Americans, Hispanics, American Indians, Alaskan Natives, and Pacific Islanders [8,10]. COVID-19 has highlighted existing social and economic disparities, which are typically attributed to pre-existing health conditions and disparities in housing and employment [8,10]. In addition, our understanding of how COVID-19 impacts vulnerable populations is just beginning to unfold. For instance, COVID-19 may create barriers for individuals with opioid use disorder to access medications and services, and perhaps lead to increases in opioid overdoses .
As the pandemic continues, an important sub-population that deserves study, though typically healthy and robust, are college students. College students have escaped neither COVID-19 infections nor its other consequences. In a March to May 2020 survey of over 18,000 U.S. students across 14 campuses, few students reported confirmed (0.6%), probable (1.7%), and possible (13%) cases of COVID-19 . However, outbreaks among college students have occurred .
Furthermore, the impacts of COVID-19 on the health and well-being of college students go well beyond contracting the disease. About two-thirds of students recently surveyed reported that they were “very/extremely concerned” about the pandemic’s duration, that individuals they cared about would contract COVID-19, and increased financial stress . They also reported increases in anxiety and depression, and academic performance suffering due to mental health concerns . These results are consistent with findings by Huckins and colleagues, who found that U.S. college students exhibited greater anxiety and depression and increased sedentary behavior in the first few months of the COVID-19 pandemic . Because of the major stressors associated with COVID-19, such as the imposition of unfamiliar public health measures, potential financial losses, and the reality of life in a pandemic, there will likely be an uptick in psychiatric illness in the general population . Since college students are already a high-risk population for depression, suicide, and suicide ideation [16, 17, 18, 19, 20, 21], they warrant study at this time.
Even before the start to this pandemic, depression was a major problem among college students. For those who pursue higher education, the inherent demands of academic performance, adjustments to independent living, and financial stress can intensify negative affects . Aggregated data from a 2013 meta-analysis  indicate that approximately 35.0% of students experience moderate to severe depression while in universities. Comparatively, the National Institute of Mental Health reports that approximately 7.1% of American adults had a major depressive episode in the last year (ages 18 to 25 - 13.1%; ages 26 to 49 - 7.7%; ages 50+ - 4.7%) . In a diverse college environment, demographic factors, including sex [24, 25], sexual orientation [26, 27] and race and ethnicity [24, 28, 29] can exacerbate symptoms. Birth-sex designation and sexual orientation are also associated with reported depression [24, 25, 26]. Male college students are more likely to self-silence symptoms of depression compared to females , and female college students routinely report higher levels of depression and stress than males but are more likely to seek help . Students in a sexual gender minority (SGM) also report higher levels of depression [26, 30]. Research studies [31, 32, 33] and literature reviews [34, 35, 36] indicate that depression is two to four times more prevalent in SGM populations and bisexual individuals are the most vulnerable to depression and depression-related suicide [34, 36]. Race and ethnicity are also associated with increased levels of reported depression in some cases [28, 29, 37]. Asian-American college students report significantly higher rates of depression than Caucasian American students , which is concerning because Asian-Americans are more likely to quell depressive symptoms than other ethnic groups . African American students, with equivalent socioeconomic status to their peers, experience higher levels of depression . Hispanic students also have been found to have higher rates of depression at predominantly Caucasian  and ethnically diverse universities [37, 38].
Physical activity can be a powerful counterforce against depression. The general benefits of physical activity for adults are well documented and include improved mental health and brain health. Other benefits include weight management; reduced risk of developing cardiovascular disease, Type 2 diabetes, and certain cancers; improved bone and muscle health; and reduced risk of all-cause mortality . However, a systematic review of the literature suggests that over half of undergraduate students in the U.S. and Canada do not meet physical activity guidelines . A fall 2019 survey of over 38,000 U.S. college students found that 67.6% of respondents met guidelines for aerobic activity but only 40.3% met both aerobic activity and strength training standards [41, 42]. Since college students are overburdened with depression, and physical activity can both prevent depression and reduce its symptoms [43, 44], it is critical to study how depression and physical activity among college students are changing during the COVID-19 crisis.
In light of the COVID-19 pandemic and the lingering and inter-related issues of physical activity and depression among college students, the purpose of this study was to: (1) determine if there was a change in participants’ physical activity minutes prior to versus after stay-at-home orders were issued in the State of Nevada, (2) determine if there was a change in depression scores prior to versus after stay-at-home orders, and (3) understand predictors of depression score and physical activity changes among college students.