International Journal of

Environmental Research
and Public Health

Article
COVID-19 Pandemic Brings a Sedentary Lifestyle in
Young Adults: A Cross-Sectional and
Longitudinal Study
Chen Zheng 1 , Wendy Yajun Huang 2 , Sinead Sheridan 1 , Cindy Hui-Ping Sit 1 ,
Xiang-Ke Chen 3 and Stephen Heung-Sang Wong 1, *
1 Department of Sports Science and Physical Education, The Chinese University of Hong Kong,
Hong Kong 00852, China; zhengchen@link.cuhk.edu.hk (C.Z.); sineadsheridan@cuhk.edu.hk (S.S.);
sithp@cuhk.edu.hk (C.H.-P.S.)
2 Department of Sport and Physical Education, Hong Kong Baptist University, Hong Kong 00852, China;
wendyhuang@hkbu.edu.hk
3 School of Biomedical Sciences, The University of Hong Kong, Hong Kong 00852, China; xkchen@hku.hk
* Correspondence: hsswong@cuhk.edu.hk; Tel.: +852-3943-6095




Received: 16 July 2020; Accepted: 17 August 2020; Published: 19 August 2020


Abstract: The coronavirus disease 2019 (COVID-19) pandemic continues to pose profound
challenges to society. Its spread has been mitigated through strategies including social distancing;
however, this may result in the adoption of a sedentary lifestyle. This study aimed to investigate:
(1) physical activity (PA) levels, sedentary behavior (SB), and sleep in young adults during the
COVID-19 epidemic, and (2) the change in these behaviors before and during the pandemic. A total
of 631 young adults (38.8% males) aged between 18 and 35 participated in the cross-sectional study
and completed a one-off online survey relating to general information, PA, SB, and sleep. For the
longitudinal study, PA, SB, and sleep data, obtained from 70 participants before and during the
COVID-19 pandemic, were analyzed. Participants engaged in low PA, high SB, and long sleep
duration during the COVID-19 pandemic. Moreover, a significant decline in PA while an increase in
time spent in both SB and sleep was observed during the COVID-19 outbreak. The results of this study
demonstrated a sedentary lifestyle in young adults during the COVID-19 pandemic, which will assist
health policymakers and practitioners in the development of population specific health education
and behavior interventions during this pandemic and for other future events.

Keywords: COVID-19; physical activity; sedentary behavior; sleep; young adults

1. Introduction
Since the first outbreak of the coronavirus disease 2019 (COVID-19) in Wuhan, China, in early
December 2019 [1], the disease has rapidly spread across the world [2]. The first confirmed case in Hong
Kong was reported in late January 2020 [3], and an escalation in the number of cases was observed in
late March and early July 2020, respectively [4]. According to the World Health Organization (WHO),
recently, this pandemic has infected more than 20 million people from over 200 countries around the
world and has resulted in over 730,000 deaths [5]. Thus, unprecedented efforts have been made by
Governments across the globe to contain the epidemic—e.g., quarantine, social distancing, and the
isolation of infected individuals [6]. The efforts made by the Hong Kong Government, for instance,
included border entry restrictions, quarantine and the isolation of cases and contacts, and the closure
of schools, resulting in major disruptions to daily routines [7]. An escalation in the number of cases in
Hong Kong in late March 2020 further fueled the Government to enforce stricter measures, including

Int. J. Environ. Res. Public Health 2020, 17, 6035; doi:10.3390/ijerph17176035 www.mdpi.com/journal/ijerph
Int. J. Environ. Res. Public Health 2020, 17, 6035 2 of 11

the closure of leisure facilities and cultural facilities [8], and the continued delivery of courses to
students via online platforms for the remainder of the academic term.
While these measures are highly commendable and critical to mitigate the spread of COVID-19,
they may result in inducing unhealthy behaviors, such as a sedentary lifestyle, with most individuals
adhering to social distancing by working or studying from home or, in other cases, self-isolating under
strict quarantine. Physical activity (PA), sedentary behaviors (SB), and sleep are three behaviors that
occupy a large proportion of an individual’s time over 24 h. Under normal circumstances, a sedentary
lifestyle, including physical inactivity and prolonged SB, has been previously identified as problematic
among adults globally, with one-third of adults physically inactive and 41.5% spending four or more
hours per day sitting [9]. An inactive and sedentary lifestyle are closely related to a higher risk for
cardiovascular diseases [10]. In addition, short sleep duration during the weekday, late sleep times,
and a variable sleep schedule are all associated with cardiometabolic health and weight gain [11,12].
In early March, researchers anticipated that social distancing, including the closure of schools
and home confinement, may result in less PA, prolonged SB and poor sleep quality [13]. To date,
several studies have reported relevant data for different populations in various countries. A longitudinal
study from Shanghai, China found that children and adolescents engaged in 435 min less PA and
spent 28 more hours in screen time per week since the COVID-19 outbreak [14]. A national survey in
Canada also found that children and youths had lower PA levels, higher SB (including leisure screen
time), and more sleep during the COVID-19 pandemic [15]. Similar results have been reported for
adults, such as a negative change in PA and sleep in Australia [16], and 40.5% of inactive Canadians
becoming less active [17]. Moreover, a national survey, including 35 research organizations, reported a
negative effect of COVID-19 home confinement on all PA intensity levels and an increase in daily
sitting time [18].
Accordingly, there is lack of evidence for the influence of the COVD-19 pandemic on lifestyle
behaviors in young adults, particularly from Asia. Thus, this study aimed to investigate: (1) PA levels,
time spent in SB, and sleep in Hong Kong young adults during the COVID-19 pandemic; (2) the
changes in these lifestyle behaviors after the COVID-19 outbreak.

2. Materials and Methods

2.1. Study Design and Participants

The study design included both a cross-sectional and longitudinal study. For recruitment for the
cross-sectional study, information was advertised online and through word of mouth. The inclusion
criteria for study participation included: (1) general healthy adults aged 18–35 years old and (2) living
in Hong Kong for the past two months. Participants completed an English online survey supported
by Google form (Google LLC, Mountain View, CA, USA), which included five components: general
information (e.g., age, sex, body weight, and height), COVID-19 related issues, PA, SB, and sleep.
Participant body mass index (BMI) was subsequently calculated as weight in kilograms divided by
height in meters squared. The online survey was conducted between 15 April 2020 and 26 April 2020,
with a total of 631 respondents. For the longitudinal study, 70 young adults’ baseline data—from a
previous cross-sectional study conducted in 2019 by our research group that investigated the relationship
between SB and risks of cardiovascular disease (unpublished data)—were obtained. The 70 adults were
invited to report their lifestyle behaviors during the pandemic. Of those participants, 60 completed all
three questionnaires to assess their PA, SB, and sleep, while only 10 participants completed the PA
questionnaire. The same questionnaires were used at baseline and for the follow-up measurement.
The cross-sectional study has similar characteristics to the longitudinal study. The protocol was
approved by the Survey and Behavioral Research Ethics, The Chinese University of Hong Kong
(SBRE-19-599).
Int. J. Environ. Res. Public Health 2020, 17, 6035 3 of 11

2.2. Physical Activity

The International Physical Activity Questionnaires (IPAQ) was used to assess the PA level in
participants. The short version of IPAQ’s validity and reliability have been tested in 12 countries [19],
which has been shown to be suitable for population surveillance and large-scale studies. Three items,
vigorous PA (VPA), moderate PA (MPA), and walking, were assessed by IPAQ. Moderate to vigorous
PA (MVPA) was calculated by adding MPA and VPA. The MET-minutes per week (MET.min/week)
were calculated using the following formula: intensity (MET) × duration × frequency. In addition,
to assess the impact of COVID-19 on PA, one more question was asked: “How has your physical activity
levels been since the onset of the COVID-19 pandemic? (e.g., increase, no change, and decrease)”.

2.3. Sedentary Behavior

SB was measured using the Sedentary Behavior Questionnaire (SBQ) in participants, which has
been previously validated in adults [20]. Intra-class correlation coefficients for all nine items and total
scale were acceptable (range = 0.51–0.93) [20]. A total of nine SBs (TV/DVD, computer/video games,
sitting listening to music, sitting talking on telephone, doing computer/paper work, reading books,
playing musical instrument, doing arts and crafts, and sitting for transport) were selected for this
questionnaire. All items were assessed for a usual weekday and weekend day for the past month
with nine options: none, ≤15 min, 30 min, 1 h, 2 h, 3 h, 4 h, 5 h, and ≥6 h. Based on the previous
methodology published, the time spent on each behavior was converted into hours (e.g., a response
of 15 min was recorded as 0.25 h) [20]. To obtain daily estimates, each item of weekday hours was
multiplied by 5 and weekend hours were multiplied by 2, and these were then divided by 7. The daily
SB was assessed by IPAQ with a separate question asking about sitting time [20].

2.4. Sleep
The most commonly subjective sleep scale, the Pittsburgh Sleep Quality Index (PSQI), was used
to assess both sleep quality and sleep duration in participants. The PSQI is a validated 19-item,
self-reported questionnaire, which is categorized into seven sleep quality components (subjective sleep
quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping
medication, and daytime dysfunction) [21]. The final score of the seven sleep components ranged from
0 to 21 points. Final scores of 5 or <5 points are classified as having “good sleep quality”, and >5 points
are classified as “poor sleep quality” [21]. The sleep duration was calculated from participants’ reported
bed and wake-up times. Besides, to assess the impact of COVID-19 on sleep quality, one more question
was asked: “How was your sleep since the onset of the COVID-19 pandemic? (e.g., better than usual,
the same as usual, and worse than usual)”.

2.5. COVID-19 Related Issues

Participants were also asked the following five questions related to COVID-19: (1) “Please identify
your main source of information regarding the COVID-19 pandemic: Newspapers or Television,
Government websites, Work colleagues/friends, Facebook/Twitter/Instagram/YouTube”; (2) “Have you
ever been home quarantined or stayed in a quarantine center for compulsory quarantine? Yes, No or
Prefer not to say”; (3) “I am concerned about contracting COVID-19 myself”; (4) “I am concerned
about other family members or friends contracting COVID-19”—answers from participants for
questions (3) and (4) used one of the following five options: “not at all concerned, slightly concerned,
somewhat concerned, moderately concerned, extremely concerned”; (5) “How often do you practice
these prevention strategies against the spread of COVID-19?”—for this question, three of the most
common and effective prevention strategy methods were chosen, including “regular hand-washing
with soap, wearing a face mask, and avoiding restaurants/gyms/shops”. All three items were answered
using the following five options: “always, often, sometimes, rarely, and never”.
Int. J. Environ. Res. Public Health 2020, 17, 6035 4 of 11

2.6. Statistical Analysis

Three international guidelines for PA, SB and sleep for adults for health were applied for data
analysis: (1) achievement of at least 150 min of moderate-intensity aerobic PA or at least 75 min of
vigorous-intensity aerobic PA throughout the week [22]; (2) engagement in <9 h of SB per day for
adults [23]; (3) score of sleep quality <5 with sleep duration between 7 and 9 h [24]. Descriptive
information (all and stratified by sex), including participant characteristics, COVID-19 related issues,
and participants’ daily behaviors, were summarized and reported as means ± standard deviation
(SD) or median (interquartile range) for continuous variables and as proportions of participants for
categorical variables. The normality analysis was applied to all variables. Because VPA, MPA, MVPA,
walking, and MET min/week are not a normal distribution, the Wilcoxon Signed-Rank Test was used
to assess the differences between males and females for the above variables. For other variables,
independent samples t-tests and Chi-Square tests were used for continuous variables and categorical
variables, respectively. The change in participants’ daily behaviors (e.g., PA, SB, and sleep) was
determined using paired sample t-tests and shown as means ± SD. All statistical tests were performed
using SPSS for Windows, version 24 (IBM Corp., Armonk, NY, USA).

3. Results

3.1. Descriptive Statistics of Participant

A total of 631 participants (38.8% males) were included in data analysis. The characteristics of the
participants are shown in Table 1. The participants’ mean age was 21.1 years—specifically, 67.1% of
them younger than 22 years, 23.5% of them between 22 and 25 years, and 9.4% of them older than
25 years. Based on the WHO’s recommendations for Asian adults [25], 12.2% and 23.3% of the males
and females were overweight, respectively.

Table 1. Participant characteristics for cross-sectional study and stratified by sex.

Mean ± SD
Variables
All (n = 631) Males (n = 245) Females (n = 386) p Value
Age (years) 21.1 ± 2.9 21.5 ± 3.2 20.9 ± 2.5 0.01
Height (cm) 165.6 ± 8.3 173.2 ± 6.1 160.8 ± 5.5 <0.01
Weight (kg) 57.0 ± 10.1 64.3 ± 10.0 52.4 ± 7.0 <0.01
BMI (kg/m2 ) 20.7 ± 2.6 21.4 ± 2.9 20.3 ± 2.4 <0.01
BMI: body mass index; SD: standard deviation

3.2. Lifestyle Behavior during COVID-19 Pandemic

Lifestyle behaviors (e.g., PA, SB, and sleep) are presented in Table 2, where 30% of participants met
the PA guideline, and more than half of the participants (57.8%) did not engage in any VPA during the
COVID-19 pandemic. In total, 70% of participants reported that their PA level decreased since the onset
of the COVID-19 pandemic. Compared to males, engagement in computer/video games was lower
while engagement in computer/paper work and arts and crafts was higher in females. Despite the fact
that females had a significantly longer mean sleep duration than males (8.7 ± 1.2 vs. 8.5 ± 1.2, p < 0.05),
more male participants met the sleep guidelines than females (46.5 vs. 38.1, p < 0.05).
Int. J. Environ. Res. Public Health 2020, 17, 6035 5 of 11

Table 2. Participants’ lifestyle behaviors for cross-sectional study and stratified by sex.

Median (IQR) or Mean ± SD or %

Variables
All (n = 631) Males (n = 245) Females (n = 386) p Value
PA - - - -
Walking (min/day) 17.1 (28.6) 17.1 (27.1) 12.85 (28.6) 0.07
Moderate PA (min/day) 2.9 (11.4) 2.85 (12.9) 2.85 (10.4) 0.30
Vigorous PA (min/day) 0.0 (8.6) 0.0 (10.0) 0.0 (8.6) 0.16
Moderate to Vigorous PA(min/day) 8.6 (25.0) 8.6 (25.7) 5.7 (20.7) 0.18
Total Energy Expenditure (MET min/week) 792.0 (1398.0) 864.0 (1836.0) 792.0 (1230.0) 0.07
Change of PA Level - - - 0.05
Increase 16.5 12.2 19.2 -
No Change 11.3 10.6 11.7 -
Decrease 72.3 77.1 69.2 -
Meet PA Guideline a 29.6 30.2 29.3 0.80
SB - - - -
TV/DVD (h/day) 1.7 ±1.5 1.6 ± 1.5 1.8 ± 1.5 0.26
Computer/Video Games (h/day) 1.4 ±1.6 1.9 ± 1.8 1.1 ± 1.4 <0.01
Sitting Listening to Music (h/day) 1.1 ± 1.3 1.1 ± 1.4 1.1 ± 1.3 0.65
Sitting Talking on Telephone (h/day) 0.8 ± 1.2 0.9 ± 1.3 0.8 ± 1.2 0.90
Computer/Paper Work (h/day) 3.1 ± 1.8 2.9 ± 1.8 3.3 ± 1.8 <0.01
Reading Books (h/day) 0.5 ± 0.9 0.5 ± 0.9 0.6 ± 0.9 0.39
Play Musical Instrument (h/day) 0.2 ± 0.5 0.2 ± 0.4 0.2 ± 0.6 0.52
Doing Arts and Crafts (h/day) 0.2 ± 0.5 0.1 ± 0.4 0.2 ± 0.6 <0.01
Sitting for Transport (h/day) 0.4 ± 0.6 0.4 ± 0.7 0.4 ± 0.5 0.15
Daily SB (h/day) 9.4 ± 3.0 9.4 ± 3.2 9.5 ± 3.0 0.77
Meet SB Guideline b 42.5 44.1 41.5 0.97
Sleep - - - -
Sleep Duration (h/day) 8.6 ± 1.2 8.5 ±1.2 8.7 ± 1.2 0.02
Sleep Quality 5.2 ± 2.5 4.9 ± 2.3 5.3 ± 2.6 0.07
Meet Sleep Guideline c 41.4 46.5 38.1 0.04
Change in Sleep Quality - - - 0.07
Better than Usual 18.4 20.8 16.8 -
The Same as Usual 43.9 46.9 42.0 -
Worse than Usual 37.7 32.2 41.2 -
IQR: interquartile range; PA: physical activity; SB: sedentary behavior; SD: standard deviation. a At least 150 min of moderate-intensity aerobic PA or at least 75 min of vigorous-intensity
aerobic PA throughout the week. b Less than 9 h of SB per day. c The score of sleep quality <5 with the sleep duration in 7–9 h.
 Int. J. Environ. Res. Public Health 2020 6 of 11
Int. J. Environ. Res. Public Health 2020, 17, 6035 6 of 11

3.3. Changes in Lifestyle Behaviors after COVID-19 Outbreak

3.3. Changes in Lifestyle Behaviors after COVID-19 Outbreak
The changes in lifestyle behaviors in participants from the longitudinal study are presented in
The1.changes
Figure After the inCOVID-19
lifestyle behaviors
outbreak,inall participants
PA levels, from the longitudinal
including VPA (beforestudy are presented
vs. during COVID-19, in
Figure 1. After
9.5 ± 12.5 vs. 6.0the COVID-19
± 11.6, outbreak,
p < 0.05), MPA (11.2all PA levels,
± 16.0 vs. including
5.5 ± 8.7, pVPA (before
< 0.01), vs. during
and walking COVID-19,
(39.7 ± 30.7 vs.
9.5
19.8± ±12.5
24.5,vs.p 6.0 ± 11.6,
< 0.01), p < significantly
were 0.05), MPA (11.2 ± 16.0while
declined, ± 8.7,
vs. 5.5both p <spent
time 0.01),inand
SBwalking
(7.8 ± 3.2(39.7 ± 30.7
vs. 10.0 vs.
± 3.2,
19.8 ± 24.5,
p < 0.01) and p< 0.01),
sleep were significantly
duration (7.7 ± 1.0 vs.declined,
8.4 ± 1.2, while both
p < 0.01) in SB (7.8 ±
time spentincreased.
significantly A 3.2 10.0 ± 3.2,
vs. percentage
lower
pof< participants
0.01) and sleep metduration (7.7 ± 1.0
the guidelines forvs.
PA8.4(50.0% p <20.0%),
± 1.2,vs. 0.01) significantly
SB (54.3% vs. increased.
40.0%), andA lower
sleeppercentage
(67.1% vs.
of participants
57.1%) after the met the guidelines
COVID-19 for PA
outbreak. When(50.0% vs. 20.0%),
considering SBSB
the (54.3% vs. 40.0%),
by types and sleep
of activities, (67.1% vs.
engagement in
57.1%)
TV/DVD after the
(0.9 COVID-19
± 0.8 vs. 1.7 ± outbreak. When
1.4, p < 0.01) and considering
computer/paper the SB by types
work (2.2 ± of
1.7activities, engagement
vs. 3.1 ± 2.0, in
p < 0.01) was
TV/DVD (0.9 ±higher
significantly 1.7 ±
0.8 vs.and sitting < 0.01)
1.4, p time and computer/paper
during transportation (0.7work ± (2.2 ± 1.7
0.7 vs. 0.6,±p2.0,
0.4vs.± 3.1 p < 0.01)
< 0.01) was
was significantly
significantly lowerhigher
duringand sitting time
COVID-19 thanduring the epidemic.(0.7 ± 0.7 vs. 0.4 ± 0.6, p < 0.01) was
beforetransportation
significantly lower during COVID-19 than before the epidemic.

Figure 1. The changes in participants’ lifestyle behaviors. (A) Physical activity, (B) sedentary behavior
Figure 1. The changes in participants’ lifestyle behaviors. (A) Physical activity, (B) sedentary behavior
and sleep duration, (C) sedentary behavior by types by activities. MPA: moderate physical activity;
and sleep duration, (C) sedentary behavior by types by activities. MPA: moderate physical activity;
VPA: vigorous physical activity. * p < 0.05, ** p < 0.01, compared with before.
VPA: vigorous physical activity. * p < 0.05, ** p < 0·01, compared with before.
3.4. COVID-19 Related Issues
3.4. COVID-19 Related Issues
COVID-19 related issues are presented in Table 3, including the main sources of information,
concernCOVID-19 relatedCOVID-19,
of contracting issues are and
presented in Table
prevention 3, including
strategies. the main
Generally, sources
females of information,
had greater concern
concern of contracting COVID-19, and prevention strategies. Generally, females had greater
for contracting COVID-19 themselves and for their family members contracting COVID-19. Therefore, concern
for contracting
females COVID-19
engaged more themselves
in COVID-19 and strategies,
prevention for their such
family membersa face
as wearing contracting
mask andCOVID-19.
avoiding
restaurants, gyms, and shops, compared to males.
Int. J. Environ. Res. Public Health 2020, 17, 6035 7 of 11

Table 3. COVID-19 related issues for cross-sectional study and stratified by sex.

%
Variables
All (n = 631) Males (n = 245) Females (n = 386) p Value
Main Sources of Information - - - 0.12
Newspapers or TV 37.4 33.5 39.9 -
Government Websites 2.4 1.2 3.1 -
Work Colleagues/Friends 1.0 0.8 1.0 -
Facebook/Twitter/Instagram/YouTube 59.3 64.5 56.0 -
Home Quarantine/Compulsory
- - - 0.35
Quarantine
Yes 7.1 5.7 8.0 -
No 92.1 93.1 91.5 -
Prefer not to Say 0.8 1.2 0.5 -
Contracting COVID-19 Myself - - - <0.01
Not at All Concerned 3.2 5.7 1.6 -
Slightly Concerned 13.6 15.5 12.4 -
Somewhat Concerned 22.5 25.3 20.7 -
Moderately Concerned 43.1 37.6 46.6 -
Extremely Concerned 17.6 15.9 18.7 -
Family Members Contracting
- - - 0.02
COVID-19
Not at all Concerned 1.4 2.4 0.8 -
Slightly Concerned 9.0 12.2 7.0 -
Somewhat Concerned 20.6 23.3 18.9 -
Moderately Concerned 43.4 38.4 46.6 -
Extremely Concerned 25.5 23.7 26.7 -
Prevention Strategies - - - -
Hand-Washing with Soap - - - 0.07
Always 55.6 49.8 59.3 -
Often 32.5 35.5 30.6 -
Sometimes 9.4 11.0 8.3 -
Rarely 2.2 2.9 1.8 -
Never 0.3 0.8 0.0 -
Wearing a face mask - - - 0.02
Always 88.9 84.9 91.5 -
Often 8.1 9.4 7.3 -
Sometimes 2.1 3.7 1.0 -
Rarely 0.5 0.8 0.3 -
Never 0.5 1.2 0.0 -
Avoiding Restaurants/Gyms/Shops - - - 0.02
Always 35.0 28.6 39.1 -
Often 34.2 34.7 33.9 -
Sometimes 24.4 27.3 22.5 -
Rarely 5.5 8.2 3.9 -
Never 0.8 1.2 0.5 -

4. Discussion
This is the first study, to the best of our knowledge, to investigate PA levels, time spent in SB,
and sleep in young adults during the COVID-19 pandemic and the changes in these lifestyle behaviors
after the COVID-19 outbreak in Hong Kong. The major findings of our study were that engagement in
all PA behaviors significantly declined while time spent in SB and sleep duration significantly increased
following the COVID-19 outbreak.
Our finding of a decrease in all types of PA (i.e., MPA, VPA and walking) after the COVID-19
outbreak are consistent with a recent national survey in Canada, which reported a significant decline
in all physical activities in children and adolescents [15]. The cross-sectional analysis also revealed the
low volume of PA that participants engaged in during the COVID-19 pandemic, with an average of
Int. J. Environ. Res. Public Health 2020, 17, 6035 8 of 11

3 min/day spent in MPA and 17 min/day walking. Similarly, Xiang et al. reported that children and
adolescents engaged in 105 min per week during the COVID-19 pandemic in Shanghai [14]. The low
volume of PA undertaken by participants may be due to social distancing (e.g., cancellation of all
team sports training and competitions and the closure of public leisure facilities and gymnasiums),
working from home and concern of the threat posed by COVID-19 in Hong Kong. Furthermore,
the limited living space in Hong Kong, which is smaller than in other Asian cities, including Tokyo
and Singapore, may further restrict the opportunities for young adults to exercise at home [26].
The total time spent in SB during the waking day was significantly higher during COVID-19
than prior to the outbreak. This is consistent with a national survey, which reported that daily sitting
time increased from 5 to 8 h (28.6%) per day during home confinement [18]. Similarly, children and
adolescents in both Shanghai and Canada engaged in more than 5 h of screen time per day [14,15].
This may be partially explained by young adults engaging in social distancing by staying home,
and online teaching, which subsequently resulted in prolonged screen time, such as elevated time
spent watching TV, playing computer games, and online teaching [13]. Specifically, students spent less
time on transportation, less time in P.E. class, and the majority of the academic term in screen time
during the online teaching period. Consequently, we also found that time spent in both TV/DVD and
computer/paper work significantly increased while sitting time for transport decreased following the
COVID-19 outbreak.
Increased screen time, which was reported in this study, has been previously shown to be
accompanied by prolonged sedentary bouts without interruption, which have a more negative impact
on health outcomes [27]. Interventions that increase PA while decrease SB in young adults during
the COVID-19 pandemic are warranted, especially for inactive individuals as they are more likely to
become less active during the COVID-19 pandemic [17]. For instance, simple home-based exercises,
such as body resistance training or high-intensity interval training (HIIT), can be applied to this
population. Appropriate health education and behavior interventions via online platforms can also be
developed during this pandemic, as more than 70% of participants reported that their engagement in
PA had significantly decreased during the COVID-19 pandemic. Interestingly, one study reported that
women who spent more time exercising outdoors had better mental and general health than those who
were not [28]. Moreover, maintaining regular PA during the COVID-19 pandemic is important for
preventing future chronic health conditions due to a sedentary lifestyle [29].
The COVID-19 pandemic brings significant disruptions to daily routines. With a more flexible
schedule due to the closure of schools, colleges, universities and businesses, participants had
significantly longer sleep duration during the pandemic. Of particular interest is that 37% of
participants reported having poorer sleep quality during the COVID-19 pandemic. Since poor sleep is
highly correlated with stress [30], poor sleep quality reported by participants may be due to the stress
induced by the threat of COVID-19. Notably, 40.7% of Australian adults reported a negative change
in sleep since the onset of COVID-19 because of change in exercise behaviors, and employment and
relationship concerns [16]. Thus, maintaining a regular sleep routine during the COVID-19 pandemic
is essential. Furthermore, the effect of COVID-19 on sleep and mental health among young adults
warrants further investigation.
Individual behaviors of young adults have been changed in response to the threat posed by
COVID-19. Based on our results, 90% of participants reported that they always wear a face mask when
leaving home, and only 0.3% of participants reported never wearing a face mask. Previous research
has shown that wearing face-masks during exercise causes a significant increase in physiological
demand [31]. This may influence PA or exercise behaviors of individuals. Similarly, a recent study
found that 99% of participants reported wearing face masks when leaving home [7]. In addition, 85% of
participants reported that they always or often wash their hands with soap. When the severe acute
respiratory syndrome (SARS) occurred in Hong Kong in 2003, the proportion of face mask use and
washing hands among adults was 79% and 82%, respectively [32]. Interestingly, females showed more
concerns about contracting COVID-19 themselves or their family members contracting it, and therefore
Int. J. Environ. Res. Public Health 2020, 17, 6035 9 of 11

engaged in more prevention strategies that included always wearing a face mask and avoiding
restaurants/gyms/shops than males, which may lead to gender-difference in reduced outdoor activities
during the pandemic.
One major strength of this study is that both cross-sectional and longitudinal analyses were
applied. Secondly, there was a relatively large sample size in the cross-sectional analysis. Thirdly,
three behaviors (PA, SB, and sleep), which occupy a large proportion of time in individuals over 24 h
were assessed in the current study.
The limitations of this study include the use of subjective measurements to assess PA, SB and
sleep, which are associated with increased risk of bias. Though all the questionnaires used in this study
have been previously validated, objective measurement, such as the use of an accelerometer, would be
more accurate in assessing PA and SB in participants. Moreover, the longitudinal study has a limited
sample size. Finally, the current study may have selection bias, as participation was voluntary.

5. Conclusions
Low PA levels, high amount of time spent on SBs, and long sleep duration were identified in
young adults during the COVID-19 pandemic, with less than half of the participants meeting any of the
recommended guidelines for PA, SB or sleep. There was also a significant reduction in PA behaviors
and a significant increase in SB and the sleep duration of young adults following the outbreak of
COVID-19. These findings may have important public health implications and provide evidence for
future intervention studies.

Author Contributions: Conceptualization, C.Z. and X.-K.C.; methodology, W.Y.H.; validation, C.Z. and S.H.-S.W.;
formal analysis, W.Y.H.; investigation, X.-K.C.; resources, C.H.-P.S.; data curation, C.Z.; writing—original draft
preparation, C.Z.; writing—review and editing, S.S.; supervision, S.H.-S.W.; project administration, S.H.-S.W.
All authors have read and agreed to the published version of the manuscript.
Funding: This research received no external funding.
Acknowledgments: We would like to thank all participants for their efforts and participation in this study.
We thank Zhang Xiaoyuan and Waris Wongpipit from the Department of Sports Science and Physical Education,
Faculty of Education, The Chinese University of Hong Kong for their support during the data collection.
Conflicts of Interest: The authors declare no conflict of interest.

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