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Contents
 Abstract
 Introduction
 Methods
 Results
 Discussion
 Conclusion
 Acknowledgements
 Psychosocial and Physical Importance
 Consideration for Athletes
 Staying well during Pandemic
 Minimizing Risk to Athletes
 Environmental Considerations
 Sport Stratification by Risk
 Virus Test
 Consideration for Protection
 Conclusion
 Educational Aims
 Direction for Future Research
 Mechanisms of Physical Activity
 Coping Behaviors
 Integrated Conceptual Framework
 Antecedents Factors Hindering
 Physical Activity Types
 Future Research Directions
 Conclusions
 Conflict of Interest
 Monitoring
 Importance of Sport to Health
 Special Populations
 Getting Physical
 Lifestyle Thing
 Sport Effect On Health
 Sport in Socialization
 Pros and Cons of Middle School Sports
 Advantages and Disadvantages of Sport
 Techniques used by Coaches to Improve Sports

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TAbstract
he objective of the study was to determine whether the proportion of athletes with
mental health
diagnoses and
athlete motivations
for playing differ
between team sports
and individual sports.
We conducted a
cross-sectional study
of child and
adolescent athletes
assessed at a sports
injury prevention
center. We compared
self-reported anxiety,
depression, and
reasons for
participating in sports between athletes in individual sports (e.g. gymnastics, running,
diving) and team sports (e.g. soccer, football, hockey). In addition, we categorized
motivation for participating in sports as 1) for fun, with associated benefits of
participation including, motives such as making friends and being part of a team or 2)
for goal-oriented reasons with associated benefits of participation including motives
such as obtaining scholarship or controlling weight. At the time of this analysis, 756
athletes between the ages of 6 and 18 years had undergone a sports injury prevention
evaluation. Most athletes were White (85%) and there was a slight female
predominance (56%). Of the total population, 8% reported suffering from anxiety or
depression. A higher proportion of individual sport athletes reported anxiety or
depression than team sport athletes (13% vs. 7%, p < 0.01). Individual sport athletes
were more likely than athletes in team sports to play their sports for goal-oriented
reasons, as opposed to for fun (30% vs. 21%, p < 0.05). Individual sport athletes are
more likely to report anxiety and depression than team sport athletes. The mental health
benefits of participation in organized sports may vary between individual sport athletes
and those playing team sports.

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Introduction

As the prevalence of
mental health issues
continues to increase
globally, more studies have
focused on physical activity
as a potential protective
mediator for mental health
disorders including anxiety
and depression (Boone and
Lead beater, 2006; Schell
et al., 2011). Having
extensively examined how
exercise improves physical
health, researchers are
now focusing on the
psychological impacts of
physical activity (Emmet
al., 2013; Nixdorf et
al., 2016). Between 2-9% of
children are diagnosed with
major depressive disorder,
while 5-10% of children and
up to 25% of teenagers
suffer from anxiety (Glover
and Fritsch, 2018; asbestos et al., 2016). Presenting adolescents with an opportunity to
socialize, relieve stress, and build confidence, physical activity has been associated
with decreased risk of these illnesses (Adachi and Willoughby, 2014; Boone and Lead
beater, 2006; Findlay and Bowler, 2009; Laban’s et al., 2016; McMahon et al., 2017;
Toseeb et al., 2014). Several studies suggest that physical activity is beneficial to the
mental health of young people, 30-40% of whom will show moderate or severe
depressive symptoms between ages 12 and 19 (Boone and Lead beater, 2006;
Sabastian et al., 2016). Strong et al. (2005) recommend school-age youth should
engage in 60 minutes of exercise per day to increase muscle strength, reduce body fat,

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maintain healthy body weight, promote bone density, improve mood, and decrease
symptoms of depression and anxiety.

Furthermore,
organized sports
participation is
associated with a
decreased risk of
anxiety, depression,
feelings of
hopelessness,
suicidal ideation and
suicide attempts,
illicit drug use, and
the smoking of
tobacco products,
above exercise alone
(Miller et al., 2002;
Miller and
Hoffman, 2009;
Pedersen et
al., 2017). Organized
sports correlate more
positively with adolescent mental health than other forms of physical activity (Esme et
al., 2013). Organized sports have been associated with decreased depressive
symptoms, increased self-esteem, and improved social abilities (Sabastian et al., 2016;
Vella et al., 2017). The social benefits of participating in sports have been linked to
reduced stress and better self-reported overall mental health in young adults (Sabastian
et al., 2016; Vella et al., 2017). A study from 2015 revealed that those who do not
participate in or drop out of organized sports have greater social and emotional
difficulties than those who continue to play (Vella et al., 2015). Non-athletes are also 10-
20% more likely to suffer from mental health issues (Vella et al., 2017). The benefits of
sport and physical activity on metrics of mental health have been well-established.

Not all sports, however, impact mental health in the same way. Kajbafnezhad et al.
(2011) discovered “significant difference between [team sports and individual sports] in
terms of psychological skills and motivation of athletic success” (p. 1904). Playing on a

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team both encourages fitness and allows young people to develop important mental and
social skills (Boone and Lead beater, 2006; Vella et al., 2017). Team sports provide an
opportunity for children to learn to work well with others and effectively contribute to a
group (Sabastian et al., 2016). The resulting sense of support and acceptance likely
plays an integral role in reducing depressive symptoms and leads to healthy
relationships with adults and peers (Eime et al., 2013; Boone and Lead beater, 2006).
Boone and Lead beater (2006) found that positive experiences on teams with coaching,
skill development, and peer support contribute to feelings of social acceptance and
decreased body dissatisfaction and ultimately fewer depressive symptoms among
adolescents.

Individual sports help cultivate other important psychological skills. When athletes
practice alone, they can improve their ability to concentrate and improve mental
strength. While individual sports often provide less social opportunity, they encourage
responsibility and self-reliance. Individual sport athletes may engage in a “higher level of
preparation” because their success depends completely on their own skills and training
(Kajbafnezhad et al., 2011). Yet, this increased sense of accountability can lead to
intense feelings of shame or guilt after losing (Nixdorf et al., 2016). Team sports are
sometimes stressful as a result of competition, team dynamics or coaching issues, but
individual sports may cause greater internal attribution such as shame after failure,
which is linked to depressive symptoms (Boone and Lead beater, 2006; Hanrahan and
Cerin, 2009; Nixdorf et al., 2016). Nixdorf et al. (2016) reports that elite junior athletes
who play individual sports suffer more from depression than those who play team
sports. Sabastian et al. (2016) reveals that youth who engaged in team sports
throughout high school reported fewer depressive symptoms later in life, but the same
did not apply to individual sports. Both team and individual sports have been shown to
support mental and physical health, but, as noted by Vella et al. (2017), “the weight of
evidence suggests that participation in team sports may be more strongly linked to
positive social and psychological outcomes when compared to individual sports” (p.688)

Individual sport athletes can exhibit increased anxiety not only because of the way they
internalize failure, but also their tendency to set intense personal goals for themselves
(Nixdorf et al., 2013). Individual sports for which judges determine success, including
gymnastics, figure skating, and dance, correlate with the highest rates of anxiety in elite
athletes; these athletes feel immense pressure to differentiate themselves from the
competition in the pursuit of perfection and a judge’s approval (Scala et al., 2011).
Team sport athletes also engage in perfectionist behaviors, but perhaps not to the
extent of individual sport athletes (Nixdorf et al., 2013). The current study tests the
hypothesis that team and individual sports have distinct associations with the diagnoses
of anxiety and depression. In addition, we hypothesized that young team sport athletes
are motivated to play for different reasons than individual sport athletes.

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Methods
Study design
We conducted a cross-sectional study of athletes who underwent an injury prevention
evaluation (IPE) at a sports injury prevention center affiliated with an academic pediatric
medical center between April 2013 and February 2018. The focus of the center is to
reduce the risk of sport-related injuries and conduct research on injury prevention in
sport. Specifically, each athlete completes an extensive questionnaire detailing sports
participation, previous injury history, training regimen, dietary intake, and sleeping
habits followed by anatomic measurements, performance measures, biomechanical
evaluations, functional movement assessments, and physical fitness screening. At the
end of the evaluation a list of injuries for which the athletes are at highest risk is
generated and a prescription for decreasing the risk of those injuries is given to the
athlete. Athletes are either self-referred, referred by other athletes who have gone
through an IPE, referred in by coaches, or are referred in by physicians who have
treated them for past injuries. All stages of athletes from early amateur through
professional are evaluated. Only participants aged 18 years and younger were included
in these analyses. The institutional review board of Boston Children’s Hospital approved
this study.

Participants were
provided with a list
of the most
common sports
and asked to select
the three organized
sports they
prioritize
participating in
yearly; participants
were allowed to
write in sports not
listed. Individual

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sport was defined as a sport not requiring another person to compete with you (not
including the opponent or events such as relays). Individual sports included swimming,
cross country, gymnastics, tennis, fencing, track and field, boxing, equestrian, dance,
figure skating, long distance running, martial arts, diving, wrestling, and sailing. For the
purposes of this analysis, participants were analyzed as individual sport athletes only
when they participated exclusively in individual sports year-round; any athlete who
participated in a team sport during any season was categorized as a team sport athlete.
Single sport athletes were defined as those who only listed participation in one sport
during the year and measured as a binary yes/no variable.

Reason for playing was coded into thematic categories. Fun reasons for playing
included: to have fun, to make friends, to be part of a team, or enjoyment/love of the
sport. Goal-oriented reasons for playing included: to obtain a school scholarship, to
control weight, to be strong, to be popular, to make parents happy, or to win a
championship. Strenuous and moderate exercise was measured using the Marx Activity
Rating Scale and analyzed categorically by how often a participant engaged in either
level of exercise outside of their usual practice regimens over the course of a week (0
x/week, 1-2x/week, ≥3x/week).

BMI was adjusted by age and gender using ranges recommended by the Center for
Disease Control (CDC, 2017). Anxiety and or depression was defined as clinician
diagnosed, but was self-reported by the participant. Alcohol consumption was defined
as a binary measure where “no” was defined as an athlete who reported never drinking
alcohol and “yes” was defined as an athlete that selected a response option ranging
from less than 1x per month to daily.

Results
There were 756 athletes that underwent an injury prevention evaluation during the study
period. The mean age of participants was 13.5 ± 2.5 years. The mean age was similar
between male and female athletes (13.5 ± 2.6 years, and 13.6 ± 2.6, p = 0.11). Just
over half of the study cohort was comprised of female athletes (Table 1). Nearly three
quarters of participants had a normal BMI and most participants identified as White
(Table 1).

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Discussion
We hypothesized that type of sport, team vs. individual, would be associated with
athletes’ motivations for playing and/or mental health diagnoses. Concerning the
relationship
between sports
and mental health,
current research
suggests that
youth who engage
in sports have
lower levels of self-
reported
diagnoses of
anxiety and
depression than
those reported by
the general
population (Jewett
et al., 2014). In our
study, 8% of
athletes reported suffering from physician-diagnosed anxiety or depression, a statistic

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below the national average. Data from the National Surveys on Drug Use and Health
found prevalence rates of major depressive episodes in adolescents and young adults
to be 11.3% in 2014, up from 8.7% in 2005 (Mojtabai et al., 2016). Therefore, while
depression and anxiety rates seem to be increasing over time in the general adolescent
population, individual and team sports seem to help mediate the presentation of
psychological disorders in adolescents and serve as effective treatment measures
(Vella et al., 2017). The physical benefits of exercise as well as the sense of
accomplishment and self-esteem youth gain by playing sports may contribute to fewer
mental health issues (Eime et al., 2013; Toseeb et al., 2014; Vella et al., 2017). In our
study, a significantly higher proportion of individual sport athletes suffered from anxiety
or depression. While both team and individual sports may be protective factors for these
disorders, a greater proportion of individual sport athletes (13%) reported anxiety or
depression compared to team sport athletes (7%). After adjusting for other covariates,
sport type (individual vs. team) remained associated with a diagnosis of anxiety or
depression, but the findings were no longer statistically significant (OR 1.72; 95%CI 0.9-
3.2).

In regression analysis however, playing an individual sport alone was not a risk factor
for anxiety and dep-recession. As most of our study individual athletes were female, it
raises the question of whether this points to a specific patient population who may be at
increased risk for mental health issues. For example, research has shown that sex
differences in brain structure and function, such as those that promote reproductive
success, are also likely to put women at greater risk of mood and anxiety disorders
(Altima’s et al., 2014). Therefore, it is important to consider how the coupling of gender
and sport type may affect risk for mental health issues.

Sports can provide

relief for symptoms of
mental health issues,
allowing adolescents
to alleviate and
manage their
problems (Toseeb et
al., 2014). This
mechanism of
amelioration may be
most effective through
team sports because
of their added social
component (Boone and Lead beater, 2006; Sabastian et al., 2016). The sense of

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community and the relationships that youth build on teams with peers and adults
promote feelings of comfort and acceptance and may reduce emotional problems and
insecurities (Boone and Lead beater, 2006; Eime et al., 2013; Sabastian et al., 2016).
Although the benefits of individual sports are evident, they may be grounded in the
general effects of physical activity rather than the culture of teamwork in which group
athletes train and compete.

A higher proportion of adolescent individual sport athletes also reported training year
round in a sport and playing only one sport year round. This type of consistent attention
to one sport may suggest a challenging investment in a single activity and make single-
sport athletes more vulnerable to anxiety and depression (Scala et al., 2011). We also
found that team sport athletes are more likely to work out strenuously three or more
times per week, outside of regular practices; having a potentially more balanced
schedule and equal distribution of energy among multiple activities could contribute to
lower rates of anxiety and depression. Individual athletes could be more likely to suffer
from mental health problems, in part, because they may feel increased pressure to
perform. Dedicating all of their energy to succeeding in a single athletic pursuit, they
may be overly focused on the outcomes and experience greater internal attribution after
failure (Nixdorf et al., 2016). Whereas team sport athletes can depend on the support of
their teammates, individual sport athletes rely on only their own preparation and skill
level to achieve success (Kajbafnezhad et al., 2011; Nixdorf et al., 2016). Competing
alone, individual sport athletes can not only experience loneliness, but also, if they do
not succeed in accomplishing their goals, may experience the weight of failure alone
(Nixdorf et al., 2016). While we did not collect data on the pattern of motivation over the
course of the athlete’s career, it can be hypothesized that this increased pressure on
individual athletes may also result in a change of their intrinsic motivation from pleasure
or enjoyment to goal-oriented reasons such as outperforming others.

This study further identifies a major difference between team and individual sports
related to what factors motivate adolescents to play each type of sport (Deco and
Ryan, 2000). Given the critical role of motivation in determining behavior and effort, a
closer look at what
drives athletes to
pursue success in
their sport has the
potential to be quite
informative. The
achievement goal
theory and self-
determination theory
are the most

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common in determining what motivates athletes, and common links are found between
the two (Ntoumanis, 2001). Achievement goal theory consists of two goal orientations:
task, which is the need to perform well, and ego, which is driven by the desire to
outperform others. Self-determination theory, on the other hand, “is based on the
gratification of the three basic psychological needs for competence, autonomy and
relatedness” (Georgios’s et al., 2001, p. 2). Theories provide interesting context when
examining athletes in performing “for fun” or for goal-oriented reasons.”

A greater percentage
of individual-sport
athletes reported
playing sports for goal-
oriented reasons, as
opposed to for fun. The
social component of
team sports may play a
part in this outcome, as
team engagement
presents more
opportunities for fun
than the solo training
that many individual
sports require. While team sports involve a community and network of players,
individual sports focus more directly on one player’s singular track to success. In
addition, the possible relationship between individual sports and internal attribution
could explain the tendency for individual sport athletes to be goal-oriented. Players who
internalize and dread failure would be more likely to hyper-focus on results, enduring
the sport in order to attain success, instead of enjoying it (Sterling et al., 2014). The
nature of scoring for individual sports could also contribute to why athletes are goal-
oriented. In sports including running, swimming, and gymnastics, success is usually
quantified by a time or number of points (Scala et al., 2011). As a result, individual sport
athletes can easily track their success and set concrete, numerical goals in attempt to
achieve it (Scala et al., 2011). While goal-oriented motivation is still intrinsically driven,
such intense focus on outcome has the potential to strip the athlete of enjoyment in
training and competition.

The reach of this study is potentially restricted by a few factors, and underscores the
need for further study. The participants involved were not randomly selected, as they
are all patients at a sports injury prevention center. The sample is also predominantly
White athletes < 18 years old. The narrow representation of this group suggests that the
results may be limited in their generalizability. Moreover, while we asked participants if

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they were diagnosed with anxiety or depression, the responses were ultimately self-
reported and not confirmed by medical records or independent professional evaluation.
In addition, the questionnaire’s joint assessment of depression and anxiety in only one
question does not provide a comprehensive mental health evaluation; it neither
distinguishes between disorders that athletes are reporting nor gauges the severity of
their symptoms.

Prospective studies examining the effect of team and individual sports on adolescent
mental health in a longitudinal manner might further reveal both the immediate and
long-term impacts of sport participation on mental health. In addition, to reflect a realistic
sample of the adolescent population, studies should include participants who represent
a diversity of races and ages.

Conclusion
Among young athletes, anxiety and depression are more common in those who play
individual sports than those who play team sports. In addition, adolescent individual-
sport athletes are more likely to play their sport for goal-oriented reasons, instead of for
fun when compared to their counterparts participating in team sports. Researchers
should continue to investigate how children’s motivation for participating in sports may
relate to or explain why team sports mediate psychological problems more effectively
than individual sports. It is possible that the social opportunities associated with team
sports promote fun and stress relief, while training for individual sports is lonelier and
can lead to less healthy goal setting and internal attribution after failure.

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Acknowledgements
Dr. William Meehan III research is funded, in part, by philanthropic support from the
National Hockey League Alumni Association through the Corey C. Griffin Pro-Am
Tournament. The remaining authors do not have any funding sources to disclose.
Financial disclosures: Dr. Meehan receives royalties from 1) ABC-Clio publishing for the
sale of his books, Kids, Sports, and Concussion: A guide for coaches and parents,
and Concussions; 2) Springer International for the book Head and Neck Injuries in
Young Athlete and 3) Wolters Kluwer for working as an author for Up-to-date. Dr.
Meehan’s research is funded, in part, by philanthropic support from the National Hockey
League Alumni Association through the Corey C. Griffin Pro-Am Tournament and the
National Football League. No other authors have any financial disclosures or conflicts of
interest. This study complied with the laws of the country of the authors’ affiliation.

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Psychosocial and physical importance of maintaining
sports in a pandemic
Mental health
Isolation can challenge an athlete’s ability to maintain performance levels, healthy
nutrition and quality sleep. Athletes, used to a high caloric intake, may maintain the
same eating programs despite less exercise and evolving mood-related drivers of
comfort eating occurring with boredom and stress. Reduced sleep quality has been
linked to loneliness. This may decrease an athlete’s ability to recover and train.
Returning to training and competition after poor sleep quality can hinder performance.
Healthy sleep practices may be reinforced through the use of apps for the psychological
and physical health of the athlete.

Isolation inhibits abilities to form relationships as a result of cancelled social events,

classes, and sporting competitions. Whilst people can remain in contact through social
media platforms, there are fewer opportunities to develop deeper friendships. Not
surprisingly, reliance on online communication has been linked to greater rates of
loneliness and depression in the general population.

There are fears about contracting and transmitting COVID-19 among athletes especially
in older female athletes, those engaged in team sports, and those from lower
socioeconomic backgrounds. Athletes may have reservations about returning to group
training and competition without adequate health and safety provisions in place as
discussed later in this article.

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Physical health
A lack of regular physical activity is associated with an increase in body fat and
muscular atrophy, resulting in a reduced muscular contractile capacity. Aerobic capacity
[VO2 max] declines markedly in elite athletes with major injuries, as seen in professional
soccer players for up to 6 months after anterior cruciate ligament tears requiring
surgery. Some of the adaptations observed from regimented physical activity occurring
in training, and graded programs for recovery from injury, include increases in blood and
blood plasma volume,
cardiac output and
stroke volume during
maximal efforts, and
muscular hypertrophy.
Deconditioning will
reverse these training
induced adaptations.
The decline in athletic
performance can be
limited with the
adaptation of home-
based workouts or
outdoor aerobic
activities, where
permitted. Undertaking
consistent physical
activity to limit
deconditioning will be beneficial before returning to training and competition.

Social dynamics
Physical activity and sport at all levels of competition provides an opportunity for social
interactions among athletes, coaches and families. The social interactions at these
training or sporting fixtures can provide an outlet for emotional stresses. The Covid-19
pandemic has greatly affected young people globally with forced isolation and varying
degrees of restriction, resulting in the rescheduling and cancellation of many sporting
competitions and social sporting events which may have lasting impacts on
psychosocial functioning.

Considerations for athletes and their teams

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The team’s organization must provide a safe environment for its members to train and
compete It involves an awareness of symptoms of Covid-19 infection, wearing masks,
physical distancing, not sharing drink bottles, foods and utensils, towels, clothing,
protective sports gear and hand hygiene remain essential at training and when
competing. Screening of temperatures and questioning about contact with potentially
infectious cases at Covid-19 “hot spots” within the community are helpful. The use of
Quick Response [QR] codes [two-dimensional bar-codes] via mobile phones apps is
proving useful for tracing peoples’ movements, enabling efficient contact tracing which
has been the hallmark of successful virus suppression/eradication strategies in
countries such as Australia.

Athletes should maintain their own labelled sporting equipment and clothing. Where
training involves gym work, this needs to allow for physical distancing protocols.
Segregation of travel and accommodation for team members attending training and
competition is essential to minimize the risk of acquiring Covid-19. The UK government
has provided useful guidelines for phased return to sport involving the screening of
coaching staff, spectators and providing practical advice for travel logistics.

Staying well during the pandemic

An athlete needs to remain active and adjust their training to maintain fitness and
wellbeing when communal training and competition are restricted. Non-contact activity
such as conditioning work, skill development, wearing of cloth masks and drills where
physical distance can be maintained in training should be prioritized. Athletes need to
adhere to government restrictions when training, but should be actively supported in
continuing to exercise, continue their educational requirements, set realistic goals for
training and realign expectations for participation in competition in line with the impact of
Covid-19 on their sport within their
community.

Likely or proven Covid-19

infection in athletes
Athletes with symptoms consistent with
Covid-19 should seek testing and obtain
medical review if needed. They should
undertake appropriate quarantine and contact tracing to minimize the spread of the
infection to others. Diagnosis may involve a positive polymerase chain reaction [PCR]
for Covid-19 on a nasal or ore-nasal swab or, less commonly, serological testing for the
presence of antibodies. A negative test does not exclude infection and so athletes with
persisting symptoms should be retested. When a positive test is obtained, it should be
repeated before returning to training to confirm that the athlete is no longer infectious.

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However, not all athletes will have access to reliable and expedited testing. Many
diagnoses may be considered on clinical grounds and treated similarly. Basic
management should include maintaining hydration, adequate and appropriate diet,
isolation within the household, separate toilet, bathing and laundry facilities for clothes
and bedding where possible as well as ample rest. If symptoms persist beyond a week,
further medical assessment should be sought.

Minimizing the risk to athletes

Environmental considerations
For training and competition to proceed, a safe sporting environment for participants,
coaches and observers is needed. Until herd immunity is achieved through widespread
vaccine uptake and previous infection, limitations on sporting participation will continue.
Appreciating that young people may be asymptomatic or minimally symptomatic yet
infectious, the basic tenants of social distancing, masking, and appropriate hand
hygiene must be followed to minimize the risk of disease transmission. The sporting
environment must allow observers safe entry to and egress from sporting facilities as
well as limits on the numbers of observers congregating within the allocated viewing
spaces. Risks of disease transmission will vary with the facility and the sport in
question. An indoor
sporting complex
(Basketball arena
or indoor swimming
pool) with many
tiers of tightly
arranged seats
poses a different
level of risk
compared to an
open-air stadium
with dispersed team
seating and limited
observers.
Swimming poses
additional risks as
there are usually
additional indoor
facilities such as
changing and

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shower rooms, locker rooms, office(s), and rest areas in the same building. Although the
direct risk of infection from contaminated water is very low, swimmers cannot wear a
cloth face mask while in the water and some may be uncomfortable using a full-face
snorkel mask as an alternative.

Sports stratification by risk

The risk of acquiring Covid-19 can be stratified into low, medium and higher risk based
on the sport undertaken is presented, based on a recent article Furthermore, risk may
vary among players depending upon their position and associated risk factors. As an
example, the linemen in American football and Japanese sumo are deliberately very
overweight or obese, a known risk factor for severe disease, and are expected to have
close contact with opposing players. The football quarterback, on the other hand, tends
to be thin, agile, and protected from direct contact by the offensive line.

Virus testing to decrease exposure risk

It is recommended that all players be tested just before the start of the sports season
and at regular intervals based on risk and testing availability. The PCR test is specific
and fairly sensitive if an adequate nasal swab specimen is obtained, but this test is
generally more expensive than antibody-based tests and the results can take up to
several days to receive. Moreover, if an athlete has been very recently exposed then
tests may not be accurate. Athletes should be tested by using a certified lab and should
be retested whenever there is a possible exposure (e.g. after a competition) and
periodically between competitions. Athletes must be tested whenever they have
symptoms but recognizing the risk of a false negative test (especially for antibody tests),
they must stay home from practice and competition until they are symptom free.

Considerations for protection

Protecting the athletes and spectators within the facility
When it comes to protecting the environment around athletes, two considerations
should be kept in mind; preventing the virus from getting into a facility and preventing
the spread of the virus if the virus should find a way in. Common methods of quickly
screening for the virus are temperature checks and questionnaires that ask about
possible exposure and symptoms. These methods can be beneficial and rapid.
However, they rely entirely on the trustworthiness of the attendee. There is also the
disadvantage that there can be false positives (not specific) and false negatives (not
sensitive). Reasons for poor specificity include warm weather, other infections, or

20 | P a g e
symptoms such as allergic rhinitis and coughing. Reasons for poor sensitivity include
asymptomatic coronavirus infection and symptom denial.

While the PCR tests are specific, disadvantages of these tests include intrusiveness
towards the subjects, delayed results, and most importantly inaccurate negative test
results (poor
sensitivity).
Accuracy of the
results is
between 50%
and 90%,
leaving
potentially half
of tested
subjects with
false negative
results. A
method that
can be used for
accurate, quick
results in the
future is
“sniffer” dogs
that have been
trained to identify volatile organic compounds (VOCs) specific to coronavirus infection in
human breath and body odor’s. While impractical to use sniffer dogs at sporting venues,
a similar method uses an electronic nose, originally developed by NASA for monitoring
air quality inside space crafts, with technology that can detect VOCs from breath even in
those who are asymptomatic. Early prototypes are cost effective and provide a
promising method of rapid, on-the-spot screening.

If SARS-CoV-2 finds its way into sporting facilities or events, precautions should be
taken to prevent further spread. This includes sanitizing equipment after use,
decreasing equipment sharing among athletes, washing hands frequently, wearing
masks, and social distancing. Athletes should try to change into their gear before
attending practice or a game to limit exposure in a locker room. If the use of locker
rooms is necessary, capacity should be limited and entrances and exits should be
staggered as respiratory aerosols can carry the virus and remain in air for hours.

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An important way to improve safety is to ensure that ventilation techniques are being
effectively used in indoor facilities. There are two main types of ventilation that have
been tested for effectiveness in removing infectious aerosols: mixing ventilation and
displacement ventilation. In buildings with mixing ventilation systems, clean air from
outside is supplied at a high velocity, typically from ceiling level, to dilute the stagnant
air with potential aerosol
virus. The mixed air is
then extracted from the
room through a vent
near the ceiling. This
ventilation system with
very frequent air
exchanges is used on
commercial aircrafts.
Displacement
ventilation systems
introduce clean air at
the floor level of the
room at a low velocity
and this is lifted and
extracted through ducts
at the top of the room
by buoyancy forces.
This positive pressure
ventilation is the
preferred system to
decrease viral load as it limits recirculation of contaminated aerosol concentrations that
could occur using the mixing ventilation method. It is worth noting that only high flow
systems should be used, as it is generally more difficult to reduce recirculation of
infected air with weaker ventilation systems.

Ultraviolet-C [UVC] radiation can be used in sports settings. UVC is an effective

disinfectant for air, water, and nonporous materials. Evidence suggests that this
radiation can sterilize a surface layer of SARS-CoV-2. There are limited data about the
dosage, duration, and wavelength that can best deactivate the virus. UVC is limited
however, as it requires direct exposure to kill, meaning surfaces must be cleaned of any
dust or dirt before use. UVC is ineffective for virus in crevices where direct exposure is
difficult to achieve. There are also health concerns as exposure to UVC radiation can
lead to degradation of some plastics and polymers, as well as skin burns and eye
injuries [35]. The safest way to implement UVC radiation is to disinfect the air above
occupants’ heads by using wall mounted and ceiling suspended UVC air ducts.

22 | P a g e
Protecting the athlete
Depending on the sport, the
most effective preventative
measure is wearing a face
mask. Although use is
encouraged by the CDC,
some sports organizations,
recreational, collegiate, and
professional alike have
abandoned masks. This is
likely due to discomfort to the
face as well as respiratory
discomfort. In a comparison
study between a surgical
mask and an N95 respirator,
physiological factors such as
blood pressure, heart rate,
oxygen saturation, and time to
exhaustion differed minimally
from the mask less control
group. The only significant
deviation was end-tidal carbon
dioxide (ETCO2) levels rose
significantly with the N95
respirator as workload
increased. While insignificant
for milder workout loads,
strenuous and heavy workouts
resulted in higher ETCO2 for
both surgical masks and N95
respirators and may lead to
mild hypercapnia. However,
increased levels of carbon dioxide may improve respiratory adaptation, thus over time
reducing the rate of fatigue for respiratory muscles. N95 respirators and other form
fitting masks are the safest option for protecting athletes from the spread of Covid-19.
However, it is impractical for all athletes to have access to N95 respirators due to the

23 | P a g e
cost. Face masks can be used by recreational and school athletes where other
preventative measures are unavailable.

Gaiters are a face covering option that is frequently used by coaches in professional
sports. One study suggested that gaiters are the least effective form of face coverings
when it comes to preventing the release of respiratory particles from the nose and
mouth. This study even showed that the gaiter releases more particles than the
maskless control group, possibly due to the fabric “splicing” large aerosols into higher
quantities of smaller aerosols.

For sports requiring helmets, face shields are an effective approach for protection of
athletes with their durability, ease of cleaning, and prevention of autoinoculation from
touching of one’s face. Simulation studies suggest that face shields reduce viral
exposure by 96% when within 18 inches [45 cm] of a cough. American football offensive
and defensive
linemen play most of
the game within
inches of each
other’s faces with
heavy breathing
involved, and face
shields attached to
the helmets could be
the solution to
limiting this
exposure. Since
many players already
wear visors that
cover their eyes, it is
reasonable to
assume that a full-
face shield wouldn’t
be much of an
inconvenience.

Another option for

athletes is antimicrobial masks that have positively charged ions that inhibit virus
attachment. Popular materials for these masks include copper and silver, which can kill
virus within hours of contact. However, there isn’t enough evidence to suggest that
these work when metal strands are embedded in a cloth mask. There is also the risk of
false confidence for those wearing antimicrobial masks and users may be less inclined
to wash the masks frequently enough, decreasing effectiveness. Additionally, the CDC

24 | P a g e
advises that any mask with an exhalation valve be avoided because of the vents in the
valve allow virus particles to escape.

The ideal mask for an athlete is lightweight, effective, and affordable. It is important to
consider various materials that can be used as well as multiple layers to increase
effectiveness. Wet layers of fabric introduce the risk of respiratory droplets traveling
through the mask to the wearer’s face. Since sweating occurs during most sports, at
least one water repellent layer could be made from non-woven polypropylene or
polyester and polyamide. It is also important that the mask form a tight seal on the face
to prevent aerosols escaping from the mask. A line of nylon with the mask is a useful
way to create a better seal between the mask and face, preventing viral particles from
escaping.

In aerobic activities such as running and biking, studies suggest that the need for masks
is more important, due to aerosol droplets spreading up to 5 meters at a walking pace
and 10 meters at a jogging pace. The Tour de France bike race required masks for all
contestants, proving that it is possible to hold top-tier sports events with athlete masks.
For sports in which masks can be a breathing hazard, such as competitive swimming or
diving, athletes should be advised to
socially distance themselves and
wear a mask until the time when they
enter the water. There is no evidence
to suggest that SARS-CoV-2 can be
spread through the water in
swimming pools. Full face snorkel
masks have also been considered as
these reduce the expelling of viral
particles into the air or water from the
swimmers, and while these snorkel
masks may be acceptable for practice
sessions; they cannot be used in
competition.

While professional sports have

experienced the benefits of an isolated “bubble” setting, it is impractical to implement
the same strategies with amateur athletes. As an alternative, it is essential to take the
preventative measures as discussed before. In instances where mask-wearing is not
feasible, the American College of Sports Medicine emphasizes continuous testing as
frequently as resources allow and contact tracing. Secure facemasks worn over both
the nose and mouth should be required for staff members, team coaches, and sidelined
players. In situations where athletes participate in two sports or two different teams in
the same sport, they should choose just one to limit exposure, a strategy implemented

25 | P a g e
by the Finnish Ice Hockey Association. A further consideration includes the risks to
sports officials such as referees, especially if they are older and more vulnerable. This
has been highlighted in a recent article in the Washington Post citing COVID-19
fatalities linked to youth outbreaks in sporting teams, prompting calls for more frequent
[weekly or biweekly] screening of athletes.

Many sports leagues,

amateur and professional
alike, require some form
of long-distance travel.
Appropriate precautions
must be taken such as
disinfecting between trips,
mask-wearing, and social
distancing on the bus;
athletes should not share
seats. Weather-
permitting, windows
should remain open to
ensure airflow. For
airplane travel, current
screening requires a
negative COVID-19 test
within 48 h of boarding or
a validated vaccination
passport. Mitigation
measures should be
ensured such as maximizing use of masks with exceptions for eating, minimizing
movement about the cabin, disinfection of contact surfaces, promoting staggered
entrances and exits from the plane, and frequent hand sanitizing. These mitigations
combined with the mixing ventilation system used on commercial airlines, should make
air travel a safer means of transportation for athletes.

Conclusion
Covid-19 completely disrupted athletic sporting training and competition. Even as
communities emerge from the restrictive consequences of the pandemic, the ability to
return to athletic competition will take years and the rules and etiquette of competition
will likely be forever altered.

26 | P a g e
Educational Aims
The reader will be able to appreciate that:

 • Protecting athletes from COVID-19 infection is challenging when training and

competing.
 • The mental health of athletes is vulnerable as a consequence of COVID-19
restrictions.
 • Following COVID-19 infection of any severity, health assessments and graded
reintroduction to training and competition are advised.
 • Implementing effective simple strategies to mitigate against the risk of acquiring
COVID-19 at a community level is crucial for ongoing participation in organized
sport.

Directions for future research

 • Understanding the long-term

effects of COVID-19,
especially cardiorespiratory, in
young athletes.
 • Developing sports gear that
is comfortable to wear,
reasonably priced, but
effective in preventing
respiratory virus infection and
transmission.

The Mechanisms of Physical Activity and Mental Health

27 | P a g e
Scholars have suggested
various mechanisms that
could potentially explain the
positive effect of physical
activity on mental health
(Anderson and Shiva
Kumar, 2013; Stubbs et
al., 2017). Studies have
revealed a variety of
potential physiological
mechanisms. For instance, it
is well-acknowledged that, in
addition to the improvement
of physical health
(Warburton et al., 2006),
exercise may reduce stress
hormones in the body, such
as cortisol and adrenaline,
and increases the levels of endorphins, which make people feel happy, optimistic and
relaxed (Harber and Sutton, 1984). Moreover, exercise increases BDNF, which may
help relieve the anxiety symptoms (Asmundson et al., 2013).

From the psychological perspective, there are three potential mechanisms. First, regular
exercise increases the exposure to anxiety-related sensations, which helps to reduce
anxiety sensitivity, resulting in a better mental health condition (Smits et al., 2008).
Second, exercise may help build a sense of self-efficacy, improve self-image and
confidence, which enhance the sense of control over stressful situations (Petruzzello et
al., 1991). Third, exercise provides a distraction from stressors to enjoy the moment of
physical activity, thus effectively reduce anxiety (Petruzzello et al., 1991).

Coping Behaviors
Coping behaviors in this
article refer to what people
do in response to the
stressful situation during
COVID-19 (Cypryańska and
Nezlek, 2020), and
engaging in various types of
physical activities is
considered as a coping

28 | P a g e
strategy to mitigate the negative effect on mental health and enhance well-being
(Faulkner et al., 2020). According to the stress coping framework proposed by Lazarus
and Folkman (1984), when people recognize the existence of a threat, they will be
involved in either emotion-focused or problem-focused coping. Engaging in physical is a
problem-focused, active coping, as people attempt to lessen the impact of pandemic-
related stress. Studies have shown that fear and anxiety may trigger coping behaviors
(Teasdale et al., 2012; Jin et al., 2020), which include following the public authority's
preventive guidelines, such as wearing a facemask, washing hands, social distancing,
and active engagement in physical exercises (Harper et al., 2020; Winter et al., 2020).

Lockdown during the pandemic has greatly reduced the outdoor activity time, and the
outdoor activity space has been compressed, and people take home-based exercise as
a coping strategy to promote psychological well-being (Faulkner et al., 2020; Vancini et
al., 2021). The beneficial effects of home-based physical activities on mental health may
be higher than other activities, such as religious activities, puzzles, and board games
(Puyat et al., 2020; Gupta et al., 2021). Studies have focused on home-based physical
exercise models that can be carried out by the general population to promote mental
health from different
perspectives.

Home-based exercise
provides a safe
alternative to public
gyms and individual
group fitness classes
(Gupta et al., 2021).
Studies have
reported on the
positive effects of
family-based exercise
programs on the
anxiety, mood, social
and emotional health
of elderly cancer
patients (Loh et
al., 2019). Home
exercise can include
aerobic activities
such as dancing
(Gupta et al., 2021),
balance and flexibility

29 | P a g e
training, such as yoga (Rinsing et al., 2020), muscle strength exercise, such as
weightlifting (Gupta et al., 2021) endurance training and others (de Almeida et
al., 2020). For example, as one of the common ways of indoor physical exercise, yoga
exercise during the epidemic can reduce the perceived stress (Bussing et al., 2012),
enhance emotional control and improve self-efficacy (Wang and Szabo, 2020), self-
confidence and overall quality of life. Yoga is considered a non-pharmacological active
intervention for mental problems (such as stress, fear) and mental disorders. It can be
used alone or in combination with other interventions (Rinsing et al., 2020), and it is one
of the important measures to prevent or control mental health problems during the
epidemic.

Exergies that use electronic products for human-computer interaction (such as

simulated swimming, boating, cycling, running, and walking) may also help maintain
and/or improve physical and mental health during the pandemic (Vienna and de
Lira, 2020). These active video games use visual and auditory stimuli to allow
individuals to perform physical activity through interaction with motion and motion
sensors (Ivanna and de Lira, 2020). Studies have shown that exergies have a positive
effect on improving mood disorders (Byrne and Kim, 2019). Healthy young women
performing a 20-min exergue Zumba fitness training at moderate intensity can reduce
the level of anxiety (Vilna et al., 2017).

Go to:

An Integrated Conceptual Framework

The control measures to limit the spread of the pandemic, such as lockdown,
quarantine, self-isolation, social distancing, and wearing of masks have restricted both
indoor and outdoor sports and fitness activities (Giustino et al., 2020; Schuch et
al., 2020). Under the influence of various factors such as the general lack of time and
space and the increase in family roles (Lum and Simpson, 2021), the types of physical
activities that people can participate in have changed (Gupta et al., 2021). People's
engagement in exercise has also changed (Faulkner et al., 2021). Generally, there are
three key observations on the impact of the COVID-19 pandemic on physical exercise:
(a) the pandemic triggers people's participation in physical activity; (b) the pandemic
control measures inhibit physical activity, and (c) physical exercise helps improve the
mental health and immune system (Constandt et al., 2020; Cheval et al., 2021;

30 | P a g e
Maltagliati et al., 2021).

First, while the pandemic has brought a global disaster, it has triggered a new
movement of people engaging in high-quality physical exercise. The information of
physical activity benefits has effectively reached more people, which has become an
opportunity for the education and development of the physical exercise system (Li and
Liu, 2020). Government departments, sports companies, schools, families, opinion
leaders, and ordinary citizens have been involved in the discussion of the benefits of
sports and other physical activities (Faulkner et al., 2020; Li and Liu, 2020). The lack of
exercise at home and the common awareness of improving immunity during the
pandemic have prompted a large number of people to pay more attention to sports and
exercise (Zhong et al., 2020). The pandemic has also greatly changed people's
traditional views that sports and exercise must rely on professional venues, facilities and
mentoring and that these activities can be carried out at home and with family members
(Zhong et al., 2020).

Second, there are many difficulties and challenges for people to engage in physical
exercise because of the Covid-related restrictions. The pandemic and its infection
control measures have restricted people's participation in collective sports. Reduced
physical activity during the pandemic has triggered more mental health problems (Gupta
et al., 2021). Moreover, the economic and financial distress resulted from the pandemic
may distract people from engaging in physical exercise (Salameh et al., 2020). Physical
education faces new major challenges: students' home exercise may not reach the level
required, online sports games lack physical and face-to-face social interaction Yuan (Li
and Yuan, 2020). In colleges and universities, this situation is not optimistic. The
attitude toward exercise is not positive enough; there is a significant gap between girls
and boys in terms of physical exercise; the level of physical self-esteem of girls is

31 | P a g e
relatively low (Li and Yuan, 2020).

Third, despite the challenges, studies on physical exercise during the pandemic confirm
the positive impact of physical exercise on mental health and the immune system.
Regular physical exercise during the pandemic can relieve psychological stress,
improve the public's mental state, and effectively enhance the immune systems (Lou
and Yan, 2020; Vancini et al., 2021). Scholars have called for active physical exercise
to improve physical fitness, relieve stress, and promote physical and mental health
(Constandt et al., 2020; Cheval et al., 2021; Maltagliati et al., 2021).

32 | P a g e
We synthesize the major thinking and findings in the extant literature in a conceptual
model as presented in Figure 1, which depicts the relationships between measures to
control the spread of COVID-19, physical activities and the deterioration of mental
health, and the major mediating and moderating factors.

Antecedents: Factors Hindering Physical Activity

Physical activity during the pandemic can reduce psychological pressure, promote
physical and mental health, and improve the quality of life (Lum and Simpson, 2021).
Both planned and unplanned physical activities are important explanatory variables for
mental health, whether it is before or during the lockdown (Bird et al., 2021). We first

33 | P a g e
explore the factors that hinder routine sports or activities during the COVID-19
lockdown.

Existing Health Status

Lack of physical exercise during the pandemic is likely to cause physical health
problems. Sedentary behavior and
physical inactivity often cause chronic
and high-level inflammation (Zbinden-
Foncea et al., 2020), which may
make people more susceptible to the
most severe form of COVID-19
(Vancini et al., 2021). Studies have
shown that people with
immunosuppression and chronic low-
grade inflammation (especially the elderly) tend to have more severe forms of disease
and higher mortality when infected with the COVID-19 virus (Yang et al., 2020).
Therefore, moderate physical exercise is particularly helpful, as it can improve immunity
and provide immune protection (Vancini et al., 2021). Unfortunately, existing poor health
conditions may hinder physical activity (Lum and Simpson, 2021), thereby further
increase the risk of infection. The level of severity of the illness to be high if infected,
causing even more serious health problems.

Quarantine, Self-Isolation, and Lockdown

The lack of facilities
and time constraints
caused by quarantine,
self-isolation and
lockdown are important
factors hindering the
development of sports
and other activities
(Lum and
Simpson, 2021). Along
with the lengthening of
the pandemic lockdown
cycle, non-physical exercises such as positive thinking exercises, meditation and art,
and light physical activities such as walking became more likely to be engaged in, while
heavy physical activities such as cycling, hiking and jogging were substantially less
likely to be engaged in Gupta et al. (2021). Motivation to exercise for some people may

34 | P a g e
be weakened because of quarantine, self-isolation or lockdown (Maugeri et al., 2020). It
is reported that the total physical activity of the population is significantly reduced during
periods of quarantine, self-isolation and lockdown, with profound negative effects on
people's mental health and well-being (Maugeri et al., 2020).

Social Distancing
Maintaining social distance is an important intervention to
combat the spread of the virus because of the high
infectivity and pathogenicity of COVID-19 (Brooks et
al., 2020). However, the social distancing measure itself is
not conducive to mental health (Salary et al., 2020),
because of the reduced level of face-to-face physical
activity and group physical activity (Moreira-Neto et
al., 2021). The inhibited social interaction brought by social
distancing may exacerbate the psychological distress
brought by the pandemic (Carvalho Aguiar Melo and de
Sousa Soars, 2020).

Physical Activity Type, Intensity, and Frequency

The restricted collective activities during the pandemic have triggered mental health
problems (Gupta et al., 2021), which heighten the importance of physical activity
through alternative forms of exercise (Antunes and Frontini, 2021), especially, home-
based exercise has been very popular as a coping strategy in such difficult times.

Types of Physical Activity

Nearly all types of physical activity are helpful and both physical exercise training and
relaxation training can buffer the negative effects of stress on general health and mental
health (Klaperski and Fuchs, 2021). Participation in physical activities at home such as
yoga, dancing to music, exergames and other home-based exercises have been shown
to alleviate a wide range of mental illness symptoms, improve anxiety, mood, social and
emotional health (Chtourou et al., 2020; Puyat et al., 2020). Yoga, an ancient exercise
focusing on both body and mind, is found to be very effective for improving mental well-
being, through both psychological reappraisal and autonomic stress coping behaviors
(Kinser et al., 2012). Wang and Szabo (2020) suggest that nearly all types of yoga are
beneficial for the relief of stress. Exergames, which are exercises based on video
games, appeal to the younger population to exercise at home, while the internet may
further enable social interaction with friends remotely (Viana and de Lira, 2020).

35 | P a g e
Frequency of Physical Activity
The frequency of physical activity may not have the same degree of positive impact on
mental health during the COVID-19 pandemic, while more physical activity is likely to be
associated with higher levels of mental health (Maugeri et al., 2020). The number of
participants participating in exercise is a moderator of the relationship between stress
and overall health, and physical health alone cannot moderate the relationship between
stress and mental health (Klaperski and Fuchs, 2021). People who become inactive
have higher levels of loneliness, sadness and anxiety compared to those who are
consistently active in physical activity (Werneck et al., 2021). Those who participated in
at least one physical activity had significantly lower depression, anxiety, and
psychological distress scores, compared to those who did not participate in physical
activity (Gupta et al., 2021). People who did not exercise for a long time had a higher
chance of experiencing loneliness and sadness (Werneck et al., 2021).

Physical Activity Intensity

The impact of physical activity intensity on mental health varies. Individuals who
engaged in more active exercise behaviors during the pandemic reported better mental
health and well-being (Faulkner et
al., 2021). However, the step
counting program alone was not
associated with mental health scores
(Bird et al., 2021). For those
participants who participated in
moderate to vigorous exercise (≥30
min) or vigorous exercise (≥15 min)
daily, the level of anxiety and
depression and the concurrent
occurrence of depressive and anxiety
were almost lower (Schuch et
al., 2020). Physical exercise should
be adjusted according to the health
level of the participants and that a
progressive intensity and a training
volume model should be adopted (Chtourou et al., 2020).

36 | P a g e
Moderators

Gender, Age, and Country Differences

Gender
There is a gender difference in exercise behaviors during the COVID-19 pandemic. It
was found that women's exercise behaviors became more active during the COVID-19
pandemic (Faulkner et al., 2021). In general, there is a general reduction in exercise
behavior caused, the reduction was greater for the male than the female group
(Giustino et al., 2020).

Age
The COVID-19 pandemic may have different effects on exercise behaviors by different
age groups. It was found that the exercise behavior of young people between 18 and 29
years old became more passive (Faulkner et al., 2021). In order to overcome the impact
of COVID-19 on mental health, exercise intensity should be tailored for different ages.
Adults must accumulate at least 75 min of high-intensity activities and 150 min of
moderate-intensity activities each week. Children and adolescents who actively play at
home or around the family can reduce the amount of training by 30% (Chtourou et
al., 2020).

Country
Faulkner et al. (2021) compared the differences in exercise behaviors in the United
Kingdom, Ireland, New Zealand, and Australia and their impact on mental health and
well-being, and found that physical activity in different countries did not very much, but
the level of mental health seems higher in New Zealand than in the other countries in
their survey (Faulkner et al., 2021).

37 | P a g e
Contextual Variables
The major contextual variables include exercise monitoring (or supervising and
mentoring), support from family and friends, and the place of residence.

Monitoring
Ideally, a physical activity program should be evidence-based, self-sustaining, feasible,
acceptable, appropriate, and not dependent on remote or face-to-face supervision
(Rinsing et al., 2020). However, compared with self-directed exercise, supervised health
care is more likely to stimulate exercise, thereby reducing self-reported depressive
symptoms (Moreira-Neto et al., 2021). However, the pandemic restrictions make face-
to-face supervision infeasible, and remote supervision has become a viable alternative
(Moreira-Neto et al., 2021). Even home-based exercise requires mentoring programs
such as smartphone applications and wearable sensors for monitoring (Chtourou et
al., 2020) to help optimize activities, to achieve the desired benefits and minimize the
potential risks that occur when certain activities are excessive or incorrectly performed
(Puyat et al., 2020).

Support from Family or Friends

Support from family and friends are important for the engagement of physical activity
during the outbreak. Women, especially those going through menopause, can increase
their physical activity levels by making plans, setting goals, and exercising with friends
or family (Lum and Simpson, 2021). Moreover, parental support may help children
maintain or increase their physical activity levels during a pandemic (Komodo and
Kurita, 2021).

The Place of Residence

The location of residence had an impact on the practice of physical activity during the
epidemic. Studies have shown that the decline in physical activity during the pandemic
was smaller among children living in detached houses, houses with more space, rural
areas, and those with more family members
(Yomoda and Kurita, 2021).

Future Research Directions

Physical activity plays an important role in
maintaining and/or improving mental health.
Future studies will generate more insights
through the collection of data from large
sample sizes, the use of cross-cultural

38 | P a g e
contexts with adequate control for confounding factors, randomized controlled trials, and
the adoption of more robust and thorough statistical analyses. Cross-cultural,
multicenter studies using the same intervention and clearly defined components
(currently missing) should be encouraged to explore the feasibility of physical activity as
an effective intervention to maintain and improve mental health.

Physical Activities in Times of Pandemic

Further research is needed to understand how to maintain physical activity during a
major public health crisis. For example, given the various pandemic restriction
measures, what physical activities are more conducive to people's physical and mental
health? Which physical activities do people prefer to engage in to promote physical and
mental health? How can the pandemic be used as an opportunity to further increase the
awareness of the importance of physical activity? Physical exercise is often seen as a
form of stress management, but causal evidence on the stress-buffering potential of
exercise remains very limited (Klaperski and Fuchs, 2021). Additional research is
needed to further explore the stress-buffering potential of physical exercise.

39 | P a g e
Mediating and Moderating Effects
Future studies could further explore the mediating and moderating effects between
physical activity and mental health in the context of major public health events.

Demographic Variables
Future research could focus on different gender and age groups to explore the
motivations that motivate these groups to participate in physical activity during the
pandemic and the magnitude of the moderating effects of gender and age in the
relationship between physical activity and mental health. Moreover, the effects of
different income levels and different racial/ethnic or cultural differences could be
explored. Research can target specific groups (such as men, young people) that are

40 | P a g e
most vulnerable to the negative effects of restriction measures (Faulkner et al., 2021),
and explore instrumental measures to encourage physical exercise.

Country Context
Future research could compare the impacts of public health restrictions on exercise
behaviors, and subsequently, mental health in different countries, especially those with
different national cultures and income levels. Online supervised exercise has been
proven to help improve mental health during the pandemic, however, it is not possible
for some low- and middle-income countries to widely adopt this mode of exercise due to
the lack of proper resources, especially internet access (Rinsing et al., 2020).
Therefore, further research is required to explore alternative measures to increase the
level of physical exercise in different country contexts.

Modes of Exercise
The type of physical
activity may moderate
the relationship between
exercise and mental
health outcomes (Gupta
et al., 2021). The amount
of time required and the
levels of intensity vary
across the types of
exercise, future research
should compare the
stress-buffering effects of different exercise types and the effects of alternative stress-
modifying interventions to determine which interventions are most effective for different
groups of people under different contexts (Klaperski and Fuchs, 2021). Future research
may explore how suitable home-based exercise programs such as yoga (Rinsing et
al., 2020), non-pharmacological interventions such as home-based aerobics should be
used in conjunction to address mental health issues during a pandemic. The
effectiveness of physical activity in comparison with other leisure activities could also be
examined.

Exercise Monitoring/Mentoring Modes

Some studies have found that supervised exercise is more motivating than self-directed
exercise, thereby reducing depressive symptoms (Moreira-Neto et al., 2021). However,
little is known about the motivation for the different modes of exercise. Therefore, future

41 | P a g e
studies may examine motivation as a moderating factor to explain people's engagement
in certain modes of exercise and the subsequent effects on mental health.

Measures for Promoting Physical

Activities
The extant literature is rather silent on
strategies or concrete measures to encourage
various physical activities during times of
health crisis such as COVID-19. Yarimkaya
and Esentürk (2020) recommended several
strategies that families could adopt to help
children with autism spectrum disorders
practice physical activity during the pandemic.
However, strategies of physical activity for the
general healthy population are also urgently needed during
this difficult time. Further research is required to test
the effectiveness of the various recommended
strategies and their suitability for the general public.

Conclusions
This article explores the impact of the COVID-19 pandemic on physical activities and
the evidence that physical activities can maintain and/or improve mental health based
on a review of the literature on physical exercise and mental health published between
2019 and 2021. The empirical evidence reported in those studies shows that in the
context of COVID-19, maintaining regular exercise is effective, and engaging in
alternative modes of physical activity is a key strategy to maintain mental health and
well-being (Maugeri et al., 2020). Further research is called for to contribute to the
development and implementation of public health interventions to encourage various
physical activities across different social groups in different contexts.

Conflict of Interest
The authors declare that the research was conducted in the absence of any commercial
or financial relationships that could be construed as a potential conflict of interest.

Contextual Variables
The major contextual variables include exercise monitoring (or supervising and
mentoring), support from family and friends, and the place of residence.

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Monitoring
Ideally, a physical activity program should be evidence-based, self-sustaining, feasible,
acceptable, appropriate, and not dependent on remote or face-to-face supervision
(Rinsing et al., 2020). However, compared with self-directed exercise, supervised health
care is more likely to stimulate exercise, thereby reducing self-reported depressive
symptoms (Moreira-Neto et al., 2021). However, the pandemic restrictions make face-
to-face supervision infeasible, and remote supervision has become a viable alternative
(Moreira-Neto et al., 2021). Even home-based exercise requires mentoring programs
such as smartphone applications and wearable sensors for monitoring (Chtourou et
al., 2020) to help optimize activities, to achieve the desired benefits and minimize the
potential risks that occur when certain activities are excessive or incorrectly performed
(Puyat et al., 2020).

Importance of Sports to Health

Whether it’s a pickup

game of basketball or
an organized water
polo league, playing
sports can make you
healthier and happier
because of the
physical activity
involved. Playing
sports contributes to
muscle development,
coordination,
cardiovascular health
and numerous other benefits associated with disease prevention; physical activity can
help ward of chronic diseases including cardiovascular disease, diabetes, cancer,
hypertension, obesity, depression and osteoporosis, according to Sport and
[Link].

Sports and Special

Populations

Playing sports can help children

develop healthy bones, stronger
cardiovascular systems and

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powerful lungs, according to Sport and [Link]. Child athletes also develop
motor skills and cognitive skills. Being physically active as a child makes it more likely to
continue playing sports as an adult, promoting lifelong health, according to the United
Nations. Among women, sports can help prevent osteoporosis and hip fractures. Older
citizens who play sports have opportunities to keep their bodies moving, feel
independent and socialize with others in a healthy way.

Getting Physical

Playing sports can help people achieve

fitness goals related to weight loss,
muscle development and fat reduction
because of the physical activity
involved. Children who play sports are
less likely to experience childhood
obesity. Physical activity is associated
with hormone regulation and
strengthening the immune system,
according to True [Link].

In the Body, In the Mind

It’s not just your body that benefits from sports.

Playing sports contributes to mental health,
helping to prevent depression and increase self-
esteem and body image, according to Sport and
[Link]. Individuals who participate in
sports might also benefit from the social aspect,
developing friendships with teammates and
feeling part of a group. Children can learn
positive mental health skills including
accountability, leadership and dedication,
according to the University of Missouri Children’s
Hospital. Playing sports is a key strategy for reducing stress, because your body
releases feel-good endorphins while exercising.

Different Sports, Different Benefits

Some sports are associated with particular health

advantages. For example, bowling can help achieve greater
bone density because of the frequent heavy lifting,

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according to the Mother Nature Network. Fencing might help ward off cognitive decline,
given the complex thinking associated with this sport. People who play volleyball benefit
from increased hand-eye coordination and flexibility. Ping-pong also helps players
increase hand-eye coordination, while also promoting better brain health because of the
fast thinking involved.

It’s a Lifestyle Thing

Another reason that sports are important for health is that participating in sports can
encourage positive lifestyle decisions. For example, if you belong to a recreational
rugby league, you might spend your evenings and weekends practicing with your team
rather than stopping for a cocktail after work or ordering greasy happy hour food.

Sports Effect On Health

Sports and other physical
activities have innumerable
physical health benefits,
including improved
cardiorespiratory and
muscular fitness, bone
health, increased life
expectancy, and coronary
health. Sports can also help
prevent various types of
cancer and weight gain and
have positive effects on
mental health by reducing
depression and improving
cognitive function. pressure. Sports can help with all of these physical issues,
decreasing the risk of coronary disease by about 50 percent.

Weight Maintenance

Sports can help promote long-term

weight loss and help avoid weight gain.
Sports increase metabolic rates and can
help increase lean body mass while

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burning calories and getting rid of excess fat. Although the amount of physical activity
needed varies by body type and caloric intake, sports can help a person maintain a
healthy weight. According to the U.S. Department of Health and Human Services,
between two and half to five hours of moderately-intensive physical activity can help
achieve weight stability. High-intensity sports can help people who want to lose weight
or maintain a significant amount of weight loss.

Cardiorespiratory Health

Sports can help people of

all ages maintain and
improve the health of their
heart, lungs and blood
vessels. Physical activity
can significantly reduce the
risk of coronary disease
and stroke. According to
the British Parliamentary
Office of Science and
Technology, approximately
40 percent of deaths
related to coronary heart disease are related to inadequate physical activity, obesity,
stress and raised blood pressure. Sports can help with all of these physical issues,
decreasing the risk of coronary disease by about 50 percent.

Muscle and Bone Health

As you grow older, physical activity becomes increasingly important for the health of
bones, muscles and joints. Building bone, muscle and joint strength is important for
children.

Cancer

Sports can decrease the risk of colon cancer by as much as 300 percent, according to
the British Parliamentary Office of Science and Technology. It can also significantly
decrease the risk of breast cancer, and might decrease the risk of endometrial and lung
cancer.

Psychological Health

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Sports can be a form of mental therapy for people with psychological disorders and
depression. Sports may promote self-esteem in the form of positive perception of body
image and self-worth. By participating in sports with others, people can also enter in
positive social environments to promote psychological health. Physical activity can also
decrease the risk of cognitive decline that comes with aging and can reduce anxiety in
adolescents.

Tips and Warnings

Some risk is involved
with participating in
sports. While little risk
is involved in
participating in
moderate-intensity
sports such as
swimming or cycling at
a moderate pace, the
risk of musculoskeletal
injury increases with
the amount of intense
physical activity.
People who are
normally inactive
should start slow and
gradually increase the
intensity and duration
of their participation in
sports.

Sports in
Socialization

Socialization is “the process by which a human being beginning at infancy acquires

the habits, beliefs, and accumulated knowledge of society through education and

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 training for adult status,” according to Merriam-Webster. Research suggests sports
play both a positive and negative role in socialization, not only between young
athletes and their peer group, but also between children and adults. Research also
indicates that sports play differing roles in socialization for boys and girls.

Part of a Team

Sports foster identity and friendship. “Sports participation helps create a social identity,”
Ann Rosewater wrote in a 2009 study published by Team-Up for Youth. She cited
previous research where “high school youth participating in organized sports activities
viewed sports as providing a place to meet other young people ‘who had at least one
shared interest.’”
Indeed, a
Wheelock/Boston
Youth Sports Initiative
2010 study said “that
quality sport programs
can help to develop
and maintain healthy
relationships amongst
youth.”

Boys and Girls

Sports may help boys

and girls socialize in
different ways, and this
may be either a
positive or a negative.
Rosewater writes,
“Sports participation
socializes boys into
traditional gender
roles, while similar
participation socializes
girls into nontraditional
gender roles.” She
says sports have an additional social benefit for female high school student-athletes,
who “find participation in sports to be a way to break gender stereotypes, enhancing
their sense of possibility.”

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Kids and Adults

Youth sports can also help children learn to interact with adults such as parents and
their teachers. The Wheelock/BYSI study reports that the same “quality sport programs”
that can benefit interactions between children may also benefit exchanges between
“youth and adults.” Rosewater’s research suggests a ripple effect. “Parents promote
children’s social development and social skills by enrolling them in programs,” she
wrote. “(These) skills can improve children’s relationships with their teachers.”

Warning Signs

Athletes might
participate in
unhealthy social
activities: “skipping
school, cutting
classes, having
someone from
home called to the
school for
disciplinary
purposes, and
being sent to the
principal’s office,”
Rosewater
reported. She also
noted, “Abuse of
alcohol by adolescents who participate in competitive sports is a social phenomenon —
that is, a function of the peer group with which the students are associated.” But she
said, “Some studies also show that teens participating in sports report lower use of
alcohol than those who are not involved in sports activities.”

Pros and Cons of Middle School Sports

Middle school sports can provide numerous benefits to participants. They promote
fitness to those who might not otherwise consider participation in a sport, and help
teach new skills that translate into the classroom as well. But if school sports programs

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aren’t run with the needs of the middle school age group in mind, negatives may be
associated with them as well.

Healthier Students

A prime benefit of middle school sports is that they promote exercise and physical
activity. The Center for Disease Control and Prevention reports that the percentage of
children aged 12 to 19 considered obese increased from 5 percent in 1980 to 21
percent in 2012. With the main focus of the school day centered around academics and
limited physical education course time in most schools, middle school sports provide an
outlet that encourages students to make fitness a priority.

Increased Opportunity
Middle school sports provide opportunities for those who can’t participate in outside
activities because of logistical or financial reasons. If the teams are inclusive -- meaning
anyone who tries out and is willing to come to practices is on the team -- middle school
sports may be the only
practical chance a
student has to learn how
to play a new sport.
Middle school sports
such as track and field
or cross-country, which
can have large squads,
provide an excellent
opportunity for students
to get in shape.

New Skills
Sports allow participants
to develop skills that go
beyond the physical
activity that the
individual sport requires.
An emphasis on
teamwork and working
in groups can
complement similar

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activities that occur in the classroom. Students may form connections through sports
teams that wouldn't otherwise occur. Sportsmanship lessons likewise can translate into
the classroom experience by emphasizing the importance of appropriate behavior.

Too Restrictive
When middle school sports serve only as pre-teams for making high school and college
squads, it can introduce high-pressure competition to students who may not be ready
for it. Too much of an emphasis on winning, as opposed to building skills, may defeat
the positives that middle school sports can bring. In addition, this emphasis may lead to
the introduction of developmental activities not appropriate for children in this age
group.

Cost and Focus

Middle school sports often become a casualty of budget cuts as schools choose to
focus on academic resources rather than extracurricular activities. Should that happen
and the parents elect to make up shortfalls via alternative means, such as requiring
families to contribute more money in order to buy equipment, that can lead to a situation
where low-income students are shut out from participation because of the costs.
Alternatively, sports can take on enough importance for some students that they neglect
their schoolwork, which can have negative consequences for their academic future.

Advantages and Disadvantages of Sports at Schools

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Participation in sports offers students a number of benefits. Sports helps students stay
in shape, learn to work as a team, and enhance their attractiveness as college
applicants. But when athletes take them so seriously that they neglect their academics,
or focus solely on
winning, school sports
can have negatives as
well.

College Prep
Higher-education
institutions want more
from prospective
students than
academics -- they look
for well-rounded
students to fill up their
classes. Having sports
in schools gives
students an opportunity
to enhance their
college applications.
They also can serve as
a motivation for
talented athletes to
work hard in the
classroom. Because
players need to meet
established standards to be admitted to college, and to be eligible to participate in
sports when there, getting acceptable grades takes on more importance than it might
otherwise.

Health and Opportunity

As the issue of childhood obesity takes on more prominence, sports provide a way for
kids to get the exercise needed to stay in shape. It offers students the opportunity to
build confidence and leadership skills, and can encourage students to spend time with
other students they don't otherwise associate with. School sports can also be more
affordable than those run by outside organizations, giving more students an opportunity
to participate.

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Inappropriate Focus
School sports can become a negative when they detract from the academic experience
that schools are charged with providing. Extracurricular, including sports, take time that
otherwise might be devoted to
studies. Schools need to be
careful to monitor the amount of
practice time, both official and
“voluntary,” that participants are
expected to devote to their sport.
They also need to be sure that
athletic success isn't emphasized
more than academic achievement.

Competition and Risk

Along with the benefits of
participating on a sports team can
come pressure to win. Because
word of a poor performance for a
school team can spread around
the classrooms quickly, the stakes
may seem higher for athletes, and
the possibility of failure more
troubling. This pressure can have
negative impacts both on and off
the field. In addition, youth sports
carry an injury risk, so schools can
find themselves contributing to the
ill health of their students. Schools with coaches that aren't trained in the proper
techniques or who espouse unsafe practices can increase that risk -- for example, a
soccer coach who urges his players to head the ball without properly showing his team
how to do so increases the risk of concussions for his players.

Techniques Used by Coaches to Improve the

Performance of Athletes
Sports coaches play an integral role in maintaining the performance of a team and
its athletes. According to the National Association for Sport and Physical Education,

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 coaches take on a variety of responsibilities including team fitness rate,
communication, motivation, strength and overall integration and performance. By
adhering to a set of proven techniques, coaches of any sport can create and
maintain a high standard of athletic ability and communication in their team.

Team-Building Techniques

Bad communication and poor strategy can cause your team to suffer on the field despite
the outstanding
performance of
your individual
athletes. Divide
your team in half
and simulate
competitions that
pit one half of the
team against the
other. Create your
practice sessions
around drills and
exercises that
emphasize team-
building activities.
To gain the most
benefit out of this
technique, break
your team into
specific groups --
such as offensive
and defense -- and
create drills and
exercises that keep these individuals in a close proximity. Working together and
learning when and how to depend on each other’s strengths is crucial for improving
team performance.

Aerobic Routines

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Aerobic exercises are the quickest methods for improving the athletic performance of
individual athletes. Regular aerobic exercises such as athletic drills and sports practice
can greatly improve your stamina while improving the amount of activity you can
maintain on the field.
Maximize the aerobic
activity level in your
sports practice by
having your team run
five or more laps at the
beginning and end of
each practice session
as you deliver
instructions through a
megaphone.

Plyometric

Jump training or
plyometric is a
technique used by
coaches to encourage
explosiveness. Olympic
athletes from eastern
Europe started using
plyometric in the 1970s.
By stretching and
contracting muscles
through depth and drop
jumping, athletes can
increase their hamstring
strength by 44 percent
according to the
American Council on
Exercise. Every coach
will run their player through drills specific to their sport and their position within that
sport. The drills are aimed at improving skill as well as overall speed, agility and
quickness. These techniques should only be taught by a qualified coach and to those in
excellent physical condition.

The Motivational Speech

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Every team encounters its rough moments and performance dips. As coach, it is your
duty to provide the necessary lift in morale that can spur your athletes to victory and
greater field performance. Boost morale by delivering a speech before a game or during
half-time that speaks to
what your athletes are
feeling. As coach you have
the particular benefit of
being the one that your
athletes seek approval
from; take this opportunity
to show the genuine
approval and praise that
you may have been
withholding during
practice. Refrain from
negative reinforcement
and overcome past issues
and failures by bringing the
attention of your athletes
back to the game at hand.

Diet Education

The National Association

for Sport and Physical
Education lists diet
education as Standard 13
of the coaching guidelines.
Instead of giving a lecture
on diet and nutrition, give
“homework assignments”
that involve bringing a
receipt from a grocery
store or meal purchase that proves that they ate a healthy meal during the day. Give
your athletes a list of healthy foods that they can take home and keep in their kitchen,
and be a good example by eating healthy snacks during your sports practice.

Summary
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Sport is one of the top activities
which bring great results for people
of any age. First, it helps to improve
health significantly, including blood
circulation and overall physical
stamina. Second, it helps to make
your body more flexible and
responsive. Moreover, sports help
to improve brain activity as well,
making it the best way to avoid
numerous possible aging illnesses.

Since sport is a competition, it also

brings numerous possibilities and
allows improving ability to build proper tactics and strategies. Thus, you can develop
your organizational and decision-making skills by going in for sports. Sports and games
teach you how to think and respond quickly in order to succeed in your competition.

Sport develops physical, social, and organizational skills improving people’s abilities to
become a part of a team and always heading to the main goal. All these skills are
beneficial in personal and professional life and must always be obtained.

In all the times and societies, it was very beneficial for playing sports. Sports and games
give needed competitive nature and a strong desire to win. Moreover, when competing
with opponents, it is easier to gain proper organizational, decision-making and strategy
building skills. Thus, participation in sports was always aimed at bringing numerous
benefits for participants.

It is great when people know about all the benefits of sports. In the same time,
authorities should promote sports and games among young people to keep them
healthy and fit. In fact, sports allow improving people’s lives significantly, including the
mentioned physical shape, blood pressure, brain activity, etc. Every nation and society
must reveal the importance of sports for people to let them improve their health and life
in general. With a strong love for sports, people can easily physically fit any community
or society. Healthy and happy people always make proper life decisions and advise very
wise solutions. Besides, sports are always developing a sense of natural
competitiveness and goal-oriented personal approach.

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Once dealing with
sports activity, every
person can improve the
physiological functions
of the body organs and
improve the functionality
of the entire organism.
Sports allow keeping
the body healthy and
mind peaceful. It is the
best therapy for
numerous diseases.
Sport prolongs people’s lives and makes them more active and satisfied with life in
general. If you want to reach the biggest goals in sports, it is easy to build a great
professional sports career if to pay enough time and efforts. When you can control your
body and make it stronger every day, you can be fully satisfied with your body and mind
functioning. Sports also teach you to work in a team and obtain team goals easily taking
care of every team member’s thoughts and desires. Therefore, sport should be
promoted in schools and colleges for sure.

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