The most dominant research topic as of the first wave of the Corona Virus Disease 19 (COVID), has been COVID. Of all the ways that COVID, and especially COVID-related restrictions, affected the population at large, one of the most apparent may be a decline in exercise and physical activity. This has been examined by many studies, including a few review studies. One of the most recent studies included a particularly comprehensive meta-analysis; it confirmed the suspected decline in physical activity in all age groups, in both sexes, and in most countries (3). It is known that insufficient physical activity or exercise results in a decline in health and fitness, and negative detraining effects in athletes have also been well documented.
COVID led to the inaccessibility of common training facilities, such as commercial gyms, recreation centers, and the like for the typical citizen, or campus-based gyms for student-athletes. In many communities, especially earlier on, this type of lockdown was often enforced suddenly and took on a scope as extreme as including home confinement orders. It is difficult to imagine any reader who was not directly affected by such restrictions and who is not already acutely aware of their potential effects. The consequences and possible remedies for those measures should be investigated. One recently published study sought to describe and understand the environment of the COVID stay-at-home (SAH) orders for the American college student-athlete, specifically in the National Collegiate Athletic Association (NCAA) (1). Furthermore, it explored for any differential in impact between sexes or among competitive divisions. It particularly examined the student-athletes’ behaviors and perceptions regarding training, nutrition, and sleep, and also the effect on their mental wellbeing. These shutdowns whose targets included universities and public gyms, varied across the United States, starting in March 2020 and lasting 11–16 weeks.
Snowball sampling was used to circulate a 15-minute anonymous survey throughout the NCAA. This nonprobability method of recruiting study participants (word-of-mouth, email, social media, etc.) is not ideal compared with other more structured or randomized approaches. Unless adjustments are made to direct the process into subsegments of the target population(s) that are lagging in recruitment, the resulting study sample of participants may not be adequate to enable all the desired comparisons among subgroups. The applicability of the study's findings may therefore be limited. A manifestation of this was an inadequate number of respondents from Division II (DII), so comparisons were limited to Divisions I (DI) and III (DIII). Also, the DIII group ended up with a higher proportion of women than that in DI, which made it more difficult in a couple of instances to discern if there was a sex effect or a division effect. There is no apparent indication that the data presented by this study were in any other way biased or skewed by this technique.
Students were eligible to submit the survey, from May 27 to July 25, 2020, if they were at least 18 years old and intending to participate in an NCAA sport during the upcoming academic year. Overall, there was an even split of respondents for in-season and off-season training. Most were living at home with their parents (62%) or with roommates (21%). Nine percent of the participants had themselves experienced a diagnosis or symptoms of COVID.
Student-athletes receiving a training plan from a strength and conditioning (S&C) coach at school was more common in DI (61%) than DIII (45%). This would be expected because of the much higher prevalence of S&C coaches and other resources in DI. It was more common for DIII than for DI student-athletes to get a plan from a sport coach (39 vs 20%) or to design one themselves (49 vs 33%). More women than men got a training plan from a sport coach (36 vs 19%), but this may have been a function of the resultant overrepresentation of women in the DIII group. The data indicated that a considerable percentage of student-athletes received training plans from more than one source.
One of the major issues identified by this study, was the access to equipment and space to execute those training plans. Many more of the DI than the DIII student-athletes were able to train as prescribed (44 vs 27%). Approximately 15% of all student-athletes were not able to perform their program, even with further modifications. It is important to consider that these plans, attempting to accommodate the student-athlete situation, would have already been modified versions of the programs conducted under normal circumstances at school.
Cardiovascular training was the most reported (87%), followed by resistance training (78%), sport-specific drills (57%), and yoga/stretching (49%). Fewer women than men were resistance training (75 vs 88%) and fewer women than men were using dumbbells (59 vs 79%) or barbells (26 vs 54%). Twice as many women as men (25 vs 12%) did not resistance train. This may stem from the women assigning less value on resistance training or may be related to their source of training guidance. There was a smaller proportion of DIII than that of DI student-athletes using dumbbells (53 vs 67%), kettlebells (16 vs 32%), and barbells (20 vs 42%), but these differences were likely influenced by the DIII sample having disproportionately more women. Equal to dumbbells as the most widely used resistance equipment, without any group differences, were resistance bands (61%). Some athletes resorted to a variety of informal methods and the use of risky common household items as implements. Beyond the equipment, the most common resistance training characteristics were a frequency of 2–4 d·wk−1, a duration of >45 minutes, and an intensity that was assessed as hard or somewhat hard.
Only 65% of all respondents believed that their SAH training was less effective than when at school. Nonetheless, mitigating the barriers mentioned above has benefits. These include avoiding detraining effects and minimizing the risk of overuse and traumatic injury. These injuries may come about from a major increase in training volume or intensity upon returning to the sport. To better inform the design of home-training plans for any future SAH, S&C coaches should become more aware of the nature of each athlete's home scenario. This can be performed by collecting detailed data ahead of time on exact equipment availability and factors influencing it. Programs should include the provision of some equipment within those contingency plans, to the extent permitted by their financial resources and the regulations of their sport governing bodies. The development of best practices to address the above challenges, is further justified by the fact that those barriers were consistent with those highlighted by a student-athlete survey administered directly by the NCAA (2). According to that report, a large segment of the respondents cited lack of access in the following categories: travel, facilities, and public gatherings (83%); appropriate facilities (79%); appropriate equipment (72%); training partners (69%); and coaches (50%).
Nutrition did not seem to be affected as much by the SAH. A greater fraction of the women, compared with the fraction of men, believed that their food intake had decreased and had also become healthier during the COVID restrictions. Of those who were already consuming certain supplements prelockdown, a greater portion of the men than of the women stopped their use of protein powder (23 vs 15%) and/or creatine (15 vs 5%). There was no impact reported regarding the consumption of Omega-3/fish oil, multivitamins, and vitamins C and D.
Regarding sleep, the percentage of participants who indicated >9 hours per night, increased from pre-SAH to during SAH (3 vs 12%), whereas those who indicated <7 hours decreased with SAH (9 vs 30%). Coupled with this shift toward a longer duration, there was a shift to more student-athletes having sleep disturbances overall (25%) compared with pre-SAH (6%; no sex- or division-difference in this baseline). There were no differences between competitive divisions in this increase in sleep disturbances overall. However, there was a greater increase in the number of women specifically experiencing a lack of sleep onset within 30 minutes of going to bed (37 vs 24%) and difficulty sleeping due to anxiety/racing thoughts (31 vs 16%). There were no differences in the increased reporting of waking up during the night/prematurely or of sleep aid usage.
Regarding mental health, even though the occurrence of using a provider did not change during SAH, there was an increase in respondents reporting psychological changes during SAH. When viewing the below patterns in the women's group, it is important to comprehend them in relation to the patterns seen in DIII (again because of the sample numbers). This caution is founded on the NCAA-commissioned survey, which showed that the reporting of mental health concerns during that COVID SAH increased similarly for men and women (by 25–150% of pre-SAH rates, depending on the specific question). Compared with the men, the occurrence of feeling concerned, stressed, tense, and unfocused, rose more in the women. Likewise, there was a greater rise in DIII than in DI, in feeling indecisive, stressed, tense, unfocused, and unhappy. In contrast, in DI, there was a greater rise in feeling calm, happy, and relaxed. Also, the motivation to train decreased more in the women (59 vs 40%) and also decreased more in DIII than in DI (60 vs 46%). The authors proposed that this may have resulted from some DIII programs having had already announced for that fall semester, a suspension of sports and in-person classes. With regard to some overall concerns regarding the training disruption, women more frequently reported concerns about fitness (77 vs 57%), sport-specific training (75 vs 55%), staying healthy (84 vs 68%), and mental health (62 vs 36%). The only such difference between divisions was about scholarships (35% in DI vs 21% in DIII). More of the men reported enjoying their SAH training (62 vs 49%), whereas more of the women (42 vs 28%) were at the other end, reporting not enjoying it at all or not really enjoy it. SAH training was perceived to raise stress, more so among the women than among the men (44 vs 26%). It would be safe to agree that this was likely linked to the concomitant lack of proper equipment and S&C guidance. Coaches should impart on athletes that SAH training is beneficial even if less effective. Both sexes did in fact attribute an increased feeling of overall wellbeing to their training during SAH. Best practices for the future should also account for the need to help student-athletes access stress and anxiety management resources during SAH and upon their return to school. This should decrease the occurrence of mental health issues, which can also in turn reduce the risk of physical injury.
One of the key conclusions for the S&C coach during the COVID-containment restrictions, should be the importance of the equipment/training program improvisation issue. The situation was probably further compounded by the inadequate availability of good-quality inexpensive and convenient home training equipment on the market. This was because of explosive demand and labor/supply chain problems, which could be less likely in the future. It will be interesting and important to know how ready the profession is to mitigate similar circumstances in the future. If there is a better physiological outcome for the athletes, it may also contribute to an improved mental health outcome. With SAH having obviously been a global phenomenon, lessons learned are of course not limited to American colleges, but have implications in a variety of population segments throughout the world.
In closing, it may be interesting to revisit the initial comment about selecting a COVID-related topic. Has COVID indeed been the most dominant research topic? Using an incognito Google Scholar search (March 17, 2022) for all of 2021, excluding citations, the term “COVID” returned 420,000 results. This surpassed terms one may expect to be the most common because of their ubiquitous and generic nature: “medicine” (261,000); “medical” (291,000); “human” (311,000); and “health” (373,000); among many more attempts. “COVID” was even comparable with the extremely general terms of “study” (362,000) and “data” (438,000). This provides some simple indirect data, albeit not thoroughly scientific, supporting the prevalence of COVID in the literature.
1. Chandler AJ, Arent MA, Cintineo HP, et al. The impacts of COVID-19 on collegiate student-athlete training, health, and well-being. Transl J ACSM 6: e000173, 2021.
2. National Collegiate Athletic Association Research. Student-athlete COVID-19 well-being survey. May, 2020. Available at: https://ncaaorg.s3.amazonaws.com/research/other/2020/2020RES_NCAASACOVID-19SurveyPPT.pdf
. Accessed March 3, 2022.
3. Wunsch K, Kienberger K, Niessner C. Changes in physical activity patterns due to the covid-19 pandemic: A systematic review and meta-analysis. Int J Environ Res Public Health 19: 2250, 2022.