CURATIO – Original Article 1

Abstract

Introduction: In an effort to mitigate the spread of the COVID-19 pandemic, the government implemented various measures, including home confinement. These measures had unintended consequences on the lifestyle of Sri Lankan university athletes.

Objectives: This study aims to elucidate the effects of the COVID-19 pandemic lockdown on the physical activity and mental well-being of Sri Lankan university athletes.

Methods: An analytical cross-sectional study was conducted among athletes from all government universities in Sri Lanka. Athletes engaged in board games and those studying at private universities were excluded. A stratified sampling method was employed for data collection. A self-administered questionnaire with the International Physical Activity Questionnaire – Short Form and the Short Warwick- Edinburgh Mental Well-Being Scale were utilised in the data collection. Data was analysed using SPSS software version 15.0, with a p-value of less than 0.05 considered significant.

Results: Data was collected from 199 participants representing 13 local universities. The lockdown negatively affected all intensities of physical activity levels (vigorous, moderate activity & walking) with a reduction in the total MET score by 2091.03. The mean total mental score before confinement was 23.08, which decreased to 20.82 during the COVID- 19 lockdown (Δ 2.266), highlighting a decline in the mental state of athletes.

Conclusions: While isolation is a necessary measure to protect public health, the results indicate that it adversely impacts the physical activity and mental well-being of athletes. This may lead to detrimental consequences for the athletes’ long-term careers. The data gathered would be beneficial for future recommendations during similar extended restrictions.

Keywords: COVID-19 lockdown, Sri Lanka, University athletes, Physical activity, mental wellbeing

Introduction

COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an infectious disease resulting from a newly discovered enveloped RNA virus [1]. Initially, it posed a potentially fatal threat and emerged as a significant global public health concern. The World Health Organisation declared this serious disease a pandemic on 11th March 2020[2]. In response to this global health emergency, numerous countries implemented lockdowns and travel restrictions to mitigate the spread of COVID-19. While these measures effectively reduced the transmission rate of the infection, they also imposed a burden on public health by adversely affecting physical and mental well-being.

Sri Lankan universities offer a range of sports amenities, such as indoor and outdoor fields, swimming pools, sports equipment, and coaching resources to promote the mental and physical wellbeing of student-athletes. Moreover, several interuniversity sporting events, like the Sri Lanka University Games (SLUG), are organised to nurture and support talent across various sports. In 2019, a total of 6,127 athletes from 13 state universities in Sri Lanka participated in the Sri Lankan university games, underscoring the engagement of university students in athletics[3].

Sri Lankan universities and schools were first closed to prevent the spread of the COVID-19 virus on March 12^th, 2020.[4] Subsequently, online teaching programs were introduced in educational institutions to bridge the gap in education. However, athletes from these institutions encountered significant challenges in maintaining their training regimens at home.

Research done in these fields has shown that even a four-week cessation of training can lead to numerous physiological changes in athletes’ bodies, resulting in reduced athletic performance and an increased risk of injury upon returning to sport[5]. Sports and exercise play a crucial role in maintaining mental health by reducing anxiety and impact athletes’ psychological well being[6].

Although the effects of COVID-19 on sports have been extensively studied in developed countries, no such inquiry has been conducted in the Sri Lankan university sporting context. Government bodies and university authorities have prioritized educational activities during the lockdown period, but have not given sufficient attention to the field of sports.

Our study mainly aims to assess the changes in physical activity and mental state during the COVID-19 pandemic lockdown among Sri Lankan university athletes. Even though the lockdown phase has concluded, the insights gained will be beneficial for future recommendations during similar extended restrictions.

Methods

This study used an analytical cross sectional design to assess changes in physical activity levels and mental well-being among university athletes during the COVID-19 confinement period. The research was conducted from September and October 2021 and included athletes from 13 Sri Lankan government universities. Participants were selected based on their involvement in university sports, while individuals from private universities and those participating exclusively in board games were excluded from the study.

The sample size was determined using the Lem show formula, with the expected proportion of affected athletes 86.3%[7] and 15% non-response, which yielded a minimum required number of 190 participants. A stratified sampling technique was used to distribute this sample proportionately among the 13 universities, based on athlete participation in the 2019 Sri Lankan University Games. Data collection was facilitated via an online survey using Google Forms, which was distributed across the target universities. Once the required sample size was achieved, further responses were not accepted.

A self-administered, structured questionnaire was used as the primary data collection instrument. The main version of the questionnaire was in English, with translations available in Sinhala and Tamil to accommodate participants’ language preferences. The questionnaire consisted of four sections. Section 1 included an overview of the study’s objectives, inclusion and exclusion criteria, and an informed consent declaration, which participants had to acknowledge before proceeding.

Section 2 gathered socio-demographic information, including gender, ethnicity, and financial status of the participant’s family.

Section 3 assessed physical activity levels using the International Physical Activity Questionnaire – Short Form (IPAQ-SF), a validated tool designed to evaluate the frequency and duration of physical activity in adults aged 15 to 69 years. Participants were asked to report the number of days per week and the amount of time per day they engaged in walking, moderate-intensity, and vigorous-intensity physical activities. Using this data, a weekly total physical activity score (measured in MET-minutes/week) was calculated. This was done by multiplying the minutes they spend by the number of days they put in by a factor specific to each form of physical activity. MET values were assigned as follows: vigorous activity = 8.0 METs, moderate activity = 4.0 METs, and walking = 3.3 METs. The final MET score for each individual was obtained by summing up the MET values for all activity types.

Section 4 evaluated participants’ mental well-being using the Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS). This tool comprises seven items assessing aspects of mental health. Participants responded based on their experiences over the preceding two weeks. Responses were rated on a 5-point Likert scale, and total raw scores were converted into metric scores using a standard conversion table. Scores ranged from 7 to 35, with higher scores indicating better mental well-being.

All the questions that were asked in the research tools, used in sections 3 and 4, were presented in a differential format that should be answered directly in sequence regarding “before” and “during” confinement conditions. This differential response format allowed for paired comparisons.

All data were analysed using IBM SPSS Statistics software version 15.0. Changes in physical activity and mental well-being scores before and during the confinement period were assessed using paired sample t-tests. A p-value of less than 0.05 was considered statistically significant. Ethical clearance was obtained from the Ethics Review Committee of the Faculty of Medical Sciences, University of Sri Jayewardenepura.

Results

Data were collected from 199 athletes distributed across 13 universities in Sri Lanka. Among the participants, 121 (60.8%) were male, with the majority being Sinhalese (n=140; 70.4%), followed by Tamils (n=54; 27.1%), Muslims (n=4; 2%), and Burghers (n=1; 0.5%). A significant proportion of participants reported an average monthly income exceeding Rs 100,000 (n=65; 32.8%). The University of Ruhuna had the highest representation with 25 participants (12.6%), whereas the University of Wayamba had the least with 4 participants (2%). Of the total participants, 108 (54.3%) were engaged in outdoor sports, while 91 (45.7%) participated in indoor sports. (Table 1)

Table 1: Frequency distribution of the socio-demographic factors of the study sample