Lockdown survey: We drank more, exercised less

Lockdown saw people in the UK eating less fruit and veg, getting less exercise and drinking more alcohol – according to research from the University of East Anglia.

A new study published today shows how lifestyle behaviours changed in the first month of lockdown back in April 2020 – as the nation adhered to new government restrictions designed to stop the spread of the Covid-19 pandemic.

It finds that young people, women and those who are overweight were more likely to adopt unhealthy behaviours. And that some of the people at greatest risk of Covid-19 demonstrated the most unhealthy behaviour changes.

This has important implications as 44 million people in England are already living under Tier 4 restrictions. And it comes after the prime minister Boris Johnson announced on Sunday that even tougher new measures could be needed to help cope with the surge in cases.

At the start of the UK’s first lockdown, UEA researchers launched a project to track people’s lifestyle behaviours to understand the impact of lockdown on the health of the nation.

More than 1,000 participants signed up to a daily survey – with questions on a range of lifestyle behaviours including physical activity, diet, sleep, smoking, drinking, and drug use.

Participants were followed every day for three months in this, the first study of its kind.

The study is led by Dr Felix Naughton, UEA School of Health Sciences, working together as co-lead with Prof Caitlin Notley, from UEA‘s Norwich Medical School.

Prof Notley said: “People around the world had to change their lifestyles very quickly in response to the Covid-19 pandemic.

“We wanted to track people’s health and lifestyle behaviours over the first lockdown period to help answer important questions about the overall impact of social distancing measures on health.

“We have been carefully observing and monitoring reported changes in health behaviours – focusing on things like people’s mental health and wellbeing, whether we are getting enough exercise, whether people are smoking or drinking more alcohol.

“This is important because we know that things like drinking, smoking, poor diet and not doing enough exercise have a big impact on people’s health and are responsible for premature mortality. Health behaviours also affect mental health and the risk of chronic conditions and disease, such as cancer, cardiovascular disease and Type II diabetes.

“And people could also be more likely to have a more severe Covid-19 infection if they are engaging less in healthy behaviours.”

Lockdown began on March 23, and the study began on April 8 – with participants completing a baseline questionnaire. The team collected information on age, gender, ethnicity, weight, height, the number of adults and children in a household, whether people have any pre-existing medical conditions and whether they are in an at-risk group for Covid-19. Employment status and average monthly income were also taken into account.

Participants were asked to share information daily on their smoking habits, alcohol consumption, mental wellbeing, physical activity levels, sleep, and nutrition – as well as whether they are suffering Covid-19 relevant symptoms such as a persistent cough or fever.

Nutrition

Dr Felix Naughton, who led the early analysis reported in this paper, said: “One of the most striking things we found was that people were eating around one portion less fruit and veg every day than they were before the pandemic.”

But encouragingly the study doesn’t show an increase in eating junk food.

“We had expected that people might have been eating more high-calorie sugary foods,” said Dr Naughton. “But actually we didn’t see any change in the amount of high sugar foods people were eating.”

Exercise

Dr Naughton said: “We found that participants were doing significantly less exercise. Our figures show that overall, there was a 20 per cent reduction in days where participants were doing 30 minutes or more moderate to vigorous physical activity.

“But interestingly people did report that they were doing a bit more strength training – with a 15 per cent increase in strength training per week.

“We found that those groups most at risk of covid-19 were undertaking the least activity.

“We know that exercise helps improve immune function and could contribute to an increase in deconditioning and functional decline, particularly among older people – so the fact that those who are most at risk of being severely affected by Covid-19 were doing the least exercise is a worry. We recognise that social distancing and shielding can make exercise more difficult, so finding ways around this is important”

Alcohol, smoking and drugs

The team found that people were drinking more alcohol in total – with women drinking more frequently but men drinking greater quantities per drinking occasion. Both of these are concerning because even relatively small changes in alcohol consumption can have a marked impact on long term health.

Dr Naughton said: “We found that being a key worker, older and male was associated with a greater number of drinks consumed on a typical day’s drinking, and consuming alcohol on a greater number of days was associated with being older and female.”

The study did not show any changes in smoking, vaping or drug taking habits.

Prof Notley said: “Our findings indicate that on average, people’s health behaviours worsened in the early stages of the UK’s Covid-19 pandemic measures. It’s not surprising that restrictions on movement outside the house and difficulty getting groceries in the early days of lockdown may have led to a less healthy lifestyle for many. It is critical now that we reflect on these changes so that we can advise people of how best to protect their health for any future lockdowns.

“If short term changes turn into longer term habits then people’s health could be compromised as a result. Changes may also become more entrenched with more restrictions in place – this is something the team will be tracking through our follow up data collection”

“Overall, it seems to be that worsening unhealthy behaviours were associated with being younger, female and having a higher BMI.

“As younger people in general displayed more unhealthy changes than older people, the net impact on health outcomes of any long-term changes in habit would be greater as younger people have more life years ahead of them.

“Having a higher BMI consistently predicted a worsening of dietary behaviours and a reduction in physical activity.

“The fact that people with higher BMI showed more unhealthy behaviours is concerning because excess body weight is associated with a more severe Covid-19 prognosis.

“Worryingly we also found that some of the people at greatest risk of Covid-19 had demonstrated the most unhealthy behaviour changes,” she added.

The research team will continue the project studying longer term changes using further waves of data collection, and they hope their findings will help inform decision making about current and future pandemic responses.

Limitations

This study began recruiting shortly after the UK lockdown and so it does not include real time data collected from before the pandemic hit the UK for comparison purposes. The team relied on participants recalling their pre-lockdown health behaviours.

‘Health behaviour change during the UK COVID-19 lockdown: findings from the first wave of the C-19 health behaviour and wellbeing daily tracker study’ is published in the British Journal of Health Psychology on January 7, 2021.