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COVID-19 has had an impact on physical activity (PA) among older adults; however, it is unclear whether this effect would be long-lasting, and there is a dearth of studies assessing the changes in barriers to performing PA among older adults before and after entering the “postpandemic era.”
The aim of this study was to compare the levels and barriers of PA among a random sample of community-dwelling older adults recruited during (February to April 2022) and after the fifth wave of the COVID-19 outbreak (May to July 2022) in Hong Kong. In addition, we investigated factors associated with a low PA level among participants recruited at different time points.
This study involved two rounds of random telephone surveys. Participants were community-dwelling Chinese-speaking individuals aged 65 years or above and having a Hong Kong ID card. Household telephone numbers were randomly selected from the most updated telephone directories. Experienced interviewers carried out telephone interviews between 6 PM and 10 PM on weekdays and between 2 PM and 9 PM on Saturdays to avoid undersampling of working individuals. We called 3900 and 3840 households in the first and second round, respectively; for each round, 640 and 625 households had an eligible older adult and 395 and 370 completed the telephone survey, respectively.
As compared to participants in the first round, fewer participants indicated a low level of PA in the second round (28.6% vs 45.9%,
The level of PA increased significantly among older adults after Hong Kong entered the “postpandemic era.” Different factors influenced older adults’ PA level during and after the fifth wave of the COVID-19 outbreak. Regular monitoring of the PA level and its associated factors should be conducted to guide health promotion and policy-making.
Hong Kong has a rapidly aging population. By 2030, 22% of Hong Kong residents will be ≥65 years old [
Physical inactivity remains a global phenomenon and increases significantly with age. A systematic review showed that 43.4%-78.0% of older adults across countries could not meet the WHO-recommended PA level [
Several different facilitators and barriers affect the participation of PA among older adults. A systematic review suggested that lack of knowledge, skills, capacities, and support from peers or family members related to PA; perceived cons of PA (causing pain, risk of injury, and fear of falling); and environmental barriers (access to facilities and transportation, bad weather) were the main barriers of performing PA among community-dwelling older adults [
To address the above-mentioned knowledge gaps, we analyzed the data of two rounds of cross-sectional random telephone surveys among community-dwelling older adults in Hong Kong, China. We compared levels and barriers to performing PA between rounds. In addition, we investigated the factors associated with a low PA level among participants of different rounds. We hypothesized that less participants would have a low PA level in the second round of the survey compared to the first round. Associated factors of low PA level were also expected to be different between the two rounds of the survey.
This study was a secondary analysis of two rounds of random telephone surveys investigating COVID-19 vaccination uptake among community-dwelling Chinese-speaking individuals aged 65 years or above in Hong Kong, China [
The COVID-19 situation and its control measures in Hong Kong during the study period.
Inclusion criteria of the participants were: (1) community-dwelling Chinese-speaking individuals aged 65 years or above and (2) having a Hong Kong ID card. The exclusion criterion was not able to communicate effectively with the study interviewers. We used the same data collection methods in both rounds of surveys and reported these details previously [
Ethics approval was obtained from the Survey and Behavioral Research Ethics Committee of the Chinese University of Hong Kong (SBRE-19-187).
The English and Chinese versions of the questionnaires are provided in
The interviewers assessed participants’ PA in the past week using the validated Chinese version of the 7-item International Physical Activity Questionnaire-Short Form (IPAQ-SF) [
Nine items were constructed for this study to assess barriers to performing PA (response categories: 1=disagree, 2=neutral, and 3=agree). They were: (1) do not have time, (2) lack of interest, (3) cannot find people to do PA with, (4) lack of physical capacity to do PA, (5) PA will cause pain and discomfort, (6) lack of space and facility to do PA at home, (7) concern about COVID-19 infection during PA, (8) closure of facilities due to COVID-19 and its control measures, and (9) peers refused to do PA with you due to COVID-19. Responses to these items were dichotomized (“disagree/neutral” vs “agree”) for analysis.
The target sample size for each round of the survey was 400. The sample size planning for the original study was explained in a previous publication [
There were no missing values in either round of survey. The differences in background characteristics between participants in the first and second rounds were assessed using
We called 3900 and 3840 households in the first and second rounds, 640 and 625 households had an eligible older adult, 245 and 255 refused to participate in the study, and 395 and 370 completed the telephone survey, respectively. The response rate was 62% and 59% in the first and second round, respectively. The characteristics of the participants are presented in
Background characteristics of the participants.
Characteristics | Round 1 (n=395), n (%) | Round 2 (n=370), n (%) | |||||||
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.98 | |||||||
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65-69 | 197 (49.9) | 182 (49.2) |
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70-74 | 132 (33.4) | 125 (33.8) |
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75 or above | 66 (16.7) | 63 (17.0) |
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.88 | |||||||
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Male | 157 (39.7) | 145 (39.2) |
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Female | 238 (60.3) | 225 (60.8) |
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.79 | |||||||
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Currently single | 97 (24.6) | 94 (25.4) |
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Married or cohabiting | 298 (75.4) | 276 (74.6) |
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.94 | |||||||
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Primary or below | 167 (42.3) | 157 (42.4) |
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Secondary | 188 (47.6) | 173 (46.8) |
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Tertiary or above | 40 (10.1) | 40 (10.8) |
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.88 | |||||||
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Unemployed/retired/homemaker | 339 (85.8) | 319 (86.2) |
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Full-time/part-time | 56 (14.2) | 51 (13.8) |
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.99 | |||||||
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<20,000 (2580) | 292 (74.3) | 273 (74.2) |
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≥20,000 (2580) | 53 (13.5) | 49 (13.3) |
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Refuse to disclose | 48 (12.2) | 46 (12.5) |
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.88 | |||||||
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No | 364 (92.2) | 342 (92.4) |
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Yes | 31 (7.8) | 28 (7.6) |
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.75 | |||||||
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No | 328 (83.0) | 304 (82.2) |
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Yes | 67 (17.0) | 66 (17.8) |
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Hypertension | 188 (47.6) | 173 (46.8) | .82 | ||||
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Chronic cardiovascular diseases | 43 (10.9) | 40 (10.8) | .97 | ||||
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Chronic lung diseases | 8 (2.0) | 6 (1.6) | .68 | ||||
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Chronic liver diseases | 8 (2.0) | 8 (2.2) | .90 | ||||
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Chronic kidney diseases | 2 (0.5) | 2 (0.5) | .95 | ||||
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Diabetes mellitus | 76 (19.2) | 70 (18.9) | .91 | ||||
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Any of above |
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<.001 | |||||||
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No | 353 (89.4) | 276 (74.6) |
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Yes | 42 (10.6) | 94 (25.4) |
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<.001 | |||||||
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0 | 32 (8.1) | 16 (4.3) |
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1 | 52 (13.2) | 13 (3.5) |
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2 | 186 (47.1) | 123 (33.2) |
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3 | 125 (31.6) | 205 (55.4) |
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4 | 0 (0.0) | 13 (3.5) |
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The changes in PA are presented in
Physical activity and barriers to performing physical activity.
Variables | Round 1 (n=395) | Round 2 (n=370) | ||||||||||
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Unadjusted | Adjusted | ||||||||
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<.001 | <.001a | |||||||||
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Low | 170 (45.9) | 106 (28.6) |
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Moderate | 147 (39.7) | 161 (43.5) |
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High | 53 (14.3) | 103 (27.8) |
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METb-minutes/week, median (IQR) | 840.0 (371.3-1834.3) | 1707.5 (716.6-3395.0) | <.001 | <.001c | |||||||
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Minutes of moderate-intensity or vigorous-intensity physical activity (MVPA) per week, median (IQR) | 105 (0-315) | 240 (67.5-600) | <.001 | <.001c | |||||||
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.18 | .08d | |||||||||
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Disagree/neutral | 368 (93.2) | 353 (95.4) |
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Agree | 27 (6.8) | 17 (4.6) |
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.08 | .12d | |||||||||
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Disagree/neutral | 342 (86.6) | 303 (81.9) |
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Agree | 53 (13.4) | 67 (18.1) |
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.73 | .29d | |||||||||
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Disagree/neutral | 287 (72.7) | 273 (73.8) |
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Agree | 108 (27.3) | 97 (26.2) |
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.58 | .47d | |||||||||
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Disagree/neutral | 355 (89.9) | 328 (88.6) |
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Agree | 40 (10.1) | 42 (11.4) |
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.98 | .83d | |||||||||
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Disagree/neutral | 335 (84.8) | 314 (84.9) |
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Agree | 60 (15.2) | 56 (15.1) |
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.04 | .02d | |||||||||
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Disagree/neutral | 274 (69.4) | 281 (75.9) |
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Agree | 121 (30.6) | 89 (24.1) |
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<.001 | <.001d | |||||||||
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Disagree/neutral | 118 (29.9) | 189 (51.1) |
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Agree | 277 (70.1) | 181 (48.9) |
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.26 | .046d | |||||||||
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Disagree/neutral | 232 (58.7) | 232 (62.7) |
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Agree | 163 (41.3) | 138 (37.3) |
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.10 | .01d | |||||||||
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Disagree/neutral | 238 (60.3) | 244 (65.9) |
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Agree | 157 (39.7) | 126 (34.1) |
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a
bMET: metabolic equivalent of tasks.
c
d
The changes in barriers to performing PA are also presented in
In univariate analysis, participants who completed the primary COVID-19 vaccination series and/or booster dose were less likely to have a low PA level in both rounds (
Associations between background characteristics and low physical activity level.
Characteristics | Round 1 (n=395) | Round 2 (n=370) | ||||
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ORa (95% CI) | OR (95% CI) | ||||
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65-69 (reference) | 1.0 | —b | 1.0 | — | |
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70-74 | 1.40 (0.90-2.19) | .14 | 0.96 (0.57-1.62) | .88 | |
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75 or above | 1.32 (0.75-2.31) | .33 | 1.96 (1.08-3.58) | .03 | |
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Male (reference) | 1.0 | — | 1.0 | — | |
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Female | 0.86 (0.58-1.29) | .48 | 0.98 (0.62-1.55) | .92 | |
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Currently single (reference) | 1.0 | — | 1.0 | — | |
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Married or cohabiting | 1.13 (0.71-1.79) | .61 | 1.55 (0.89-2.68) | .12 | |
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Primary or below (reference) | 1.0 | — | 1.0 | — | |
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Secondary | 0.86 (0.57-1.31) | .48 | 1.26 (0.78-2.04) | .36 | |
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Tertiary or above | 0.80 (0.40-1.61) | .54 | 1.58 (0.75-3.31) | .23 | |
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Unemployed/retired/homemaker (reference) | 1.0 | — | 1.0 | — | |
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Full-time/part-time | 0.74 (0.42-1.32) | .31 | 1.16 (0.61-2.21) | .64 | |
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<20,000 (2580) (reference) | 1.0 | — | 1.0 | — | |
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≥20,000 (2580) | 0.86 (0.47-1.54) | .60 | 0.86 (0.43-1.70) | .66 | |
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Refuse to disclose | 0.67 (0.36-1.26) | .21 | 0.66 (0.31-1.39) | .27 | |
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No (reference) | 1.0 | — | 1.0 | — | |
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Yes | 0.64 (0.30-1.36) | .24 | 0.39 (0.13-1.16) | .09 | |
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No (reference) | 1.0 | — | 1.0 | — | |
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Yes | 1.11 (0.66-1.88) | .69 | 0.92 (0.51-1.67) | .79 | |
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No (reference) | 1.0 | — | 1.0 | — | |
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Yes | 0.87 (0.58-1.30) | .49 | 1.13 (0.71-1.79) | .62 | |
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No (reference) | 1.0 | — | 1.0 | — | |
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Yes | 0.99 (0.52-1.87) | .96 | 1.23 (0.74-2.05) | .42 | |
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0-1 (reference) | 1.0 | — | 1.0 | — | |
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2 | 0.59 (0.35-0.99) | .048 | 0.43 (0.19-0.99) | .049 | |
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3-4 | 0.50 (0.29-0.88) | .02 | 0.48 (0.22-1.05) | .07 |
aOR: odds ratio.
bNot applicable.
cCSSA: Comprehensive Social Security Assistance.
Associations between perceived barriers to performing physical activity and low physical activity level.
Perceived barriersa | Round 1 (n=395) | Round 2 (n=370) | |||
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AORb (95% CI) | AOR (95% CI) | |||
Do not have time | 4.19 (1.54-11.40) | .01 | 0.99 (0.33-2.92) | .98 | |
Lack of interest | 1.06 (0.59-1.90) | .85 | 0.91 (0.50-1.66) | .75 | |
Cannot find people to do physical activity together | 1.07 (0.68-1.67) | .78 | 1.80 (1.03-3.16) | .04 | |
Lack of physical capacity to do physical activity | 3.34 (1.61-6.94) | .001 | 2.92 (1.48-5.76) | .002 | |
Physical activity will cause pain and discomfort | 2.04 (1.15-3.61) | .02 | 2.82 (1.55-5.16) | .001 | |
Lack of space and facility to do physical activity at home | 0.74 (0.48-1.14) | .17 | 2.03 (1.11-3.72) | .02 | |
Concern about COVID-19 infection when doing physical activity | 1.73 (1.10-2.72) | .02 | 0.75 (0.48-1.19) | .23 | |
Closure of facilities due to COVID-19 and its control measures | 0.97 (0.66-1.48) | .95 | 1.12 (0.69-1.80) | .65 | |
Peers refused to do physical activity with you due to COVID-19 | 1.45 (0.96-2.19) | .08 | 0.78 (0.48-1.29) | .33 |
aResponses were categorized into disagree/neutral (reference category) and agree.
bAOR: adjusted odds ratio; adjusted for significant background characteristics listed in
This was one of the first studies to track changes in the levels and barriers to performing PA among older adults before and after entering the “postpandemic era.” One of the strengths of this study is that it was based on a random and population-based sample. In response to the fifth wave of the COVID-19 outbreak, the Hong Kong government closed all sports centers and venues, and advised older adults to stay at home and limit their outdoor activities due to their vulnerability to COVID-19 [
As compared to those in the first round, participants in the second round reported a much higher completion rate of the primary COVID-19 vaccine series (94% vs 78.7%) and the booster dose (58.9% vs 31.6%). Completing the primary COVID-19 series and/or the booster dose was associated with a higher PA level in both rounds. An increase in COVID-19 vaccination coverage might contribute to the increasing PA level in the second round. Vaccinated older adults might feel they are protected against COVID-19 and hence have fewer concerns to resume outdoor activities (eg, PA). Promoting COVID-19 vaccination and the booster dose might be useful strategies to improve PA among older adults in the future.
Our findings suggested some different barriers to performing PA applied to older adults in Hong Kong before and after the fifth wave of the outbreak. First, a higher proportion of older adults agreed that they did not have time for PA in the first round compared to those in the second round. Those who lacked time for PA were more likely to report a low PA level in the first round, but not in the second round. In Hong Kong, grandparents are the main caregivers of children [
Some similar barriers have hindered older adults to perform PA both before and after the fifth wave of the COVID-19 outbreak. In this study, concern about PA capacity and that PA would cause pain and discomfort were associated with a lower PA level. These concerns were also barriers to performing PA in this group before the time of COVID-19 [
In contrast to our hypothesis, the closure of facilities due to COVID-19 and its control measures were not significantly associated with the PA level in the first or the second round. A previous study suggested that older adults in Hong Kong changed their mode of PA to cope with the COVID-19 control measures. For example, older adults reduced swimming or going to the gym for exercise, but increased stretching, brisk walking, or other activities that rely less on access to sports facilities [
This study had some limitations. First, it was a major limitation that we did not assess the functional limitations of the participants. In Hong Kong, 16.3% of community-dwelling older adults had a functional limitation [
The level of PA increased significantly after the drop of daily confirmed COVID-19 cases and the relaxation of COVID-19 control measures among older adults in Hong Kong. Different factors influenced older adults’ PA level during and after the fifth wave of the COVID-19 outbreak. Barriers to performing PA, such as perceived lack of space and a facility to perform PA at home, concerns about COVID-19 infection during PA, closure of facilities, and refusals made by peers to perform PA reduced significantly over time. Regular monitoring of the PA level and its associated factors should be conducted to guide health promotion and policy-making. Sport scientists should introduce suitable options for older adults with inadequate physical capacity or having functional limitations. In the “postpandemic era,” reactivating peer support groups and promoting home-based PA may increase the PA level among older adults. Health authorities should be aware of the negative impact of school closure on PA among older adults. If school closure has to be implemented in future waves of a COVID-19 outbreak, introducing PA options suitable for older adults to perform with their grandchildren may be helpful to alleviate its negative influence.
STROBE checklist for cross-sectional study.
The English and Chinese versions of the questionnaires used in the telephone survey.
Changes in physical activity among subgroups of participants.
adjusted odds ratio
International Physical Activity Questionnaire-Short Form
metabolic equivalent of tasks
moderate-to-vigorous physical activity
physical activity
World Health Organization
Part of this study was funded by the Health and Medical Research Fund, Food and Health Bureau, Hong Kong Special Administrative Region (project reference 19181152).
The data sets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.
None declared.