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  1. Romdhani M, Washif JA, Taylor L, Chamari K, “Athletes’ Sleep During the Lockdown International Survey” Group Members
    PMID: 37030665 DOI: 10.1123/ijspp.2022-0187
    BACKGROUND: The effect of the 2020 COVID-19 lockdown on athlete sleep and training behavior is documented, albeit without a worldwide soccer-specific focus.

    METHOD: Soccer (football) players (N = 1639; 30 countries; age 22.5 [5.7] y; 81% ≤25 y; 56% male; 30% elite; 66% Muslim) answered a retrospective, cross-sectional questionnaire related to their behavioral habits before and during COVID-19 lockdown (survey period July to September 2020), including (1) Pittsburgh Sleep Quality Index PSQI, (2) Insomnia Severity Index (ISI), (3) bespoke questions about training behaviors, and (4) Muslim player focused sleep and training behavior questions.

    RESULTS: During lockdown (compared to prelockdown), PSQI (P < .001; moderate effect size [ES]) and ISI (P < .001; moderate ES) scores were higher in the overall sample and in elite versus nonelite (PSQI: P < .05; small ES and ISI: P < .001; small ES), >25 years versus ≤25 years (PSQI: P < .01; small ES and ISI: P < .001; moderate ES), females versus males (PSQI: P < .001; small ES), <1 month versus >1 month lockdown (PSQI: P < .05; small ES and ISI: P < .05; small ES), and players maintaining versus reducing training intensity (PSQI: P < .001; moderate ES and ISI: P < .001; small ES). Muslim players (41%) reported unfavorable sleep and/or training behaviors during Ramadan in lockdown compared to lockdown outside of Ramadan.

    CONCLUSIONS: Specific subgroups appear more vulnerable to lockdown effects, with training-intensity maintenance moderating negative effects relative to sleep. Policy and support (respectful of subgroup nuances) during lockdown-like challenges that facilitate training (including intensity) appear prudent, given their favorable relationship with sleep, mental health, and physical health, in the present data and elsewhere.

  2. Tabben M, Eirale C, Singh G, Al-Kuwari A, Ekstrand J, Chalabi H, et al.
    Br J Sports Med, 2021 Jan 05.
    PMID: 33402346 DOI: 10.1136/bjsports-2020-102945
    BACKGROUND: While football injury and illness epidemiology surveillance at professional club level in Europe is available, epidemiological data from other continents are lacking.

    PURPOSE: Investigating injury and illness epidemiology in professional Asian football.

    STUDY DESIGN: Descriptive prospective study.

    METHODS: Professional teams from the Asian Football Confederation (AFC) league were followed prospectively for three consecutive AFC seasons (2017 through 2019, 13 teams per season, 322 team months). Time-loss injuries and illnesses in addition to individual match and training exposure were recorded using standardised digital tools in accordance with international consensus procedures.

    RESULTS: In total, 232 665 hours of exposure (88.6% training and 11.4% matches) and 1159 injuries were recorded; 496 (42.8%) occurred during matches, 610 (52.6%) during training; 32 (2.8%) were reported as 'not applicable' and for 21 injuries (1.8%) information was missing. Injury incidence was significantly greater during match play (19.2±8.6 injuries per 1000 hours) than training (2.8±1.4, p<0.0001), resulting in a low overall incidence of 5.1±2.2.The injury burden for match injuries was greater than from training injuries (456±336 days per 1000 hours vs 54±34 days, p<0.0001). The two specific injuries causing the greatest burden were complete ACL ruptures (0.14 injuries (95% CI 0.9 to 0.19) and 29.8 days lost (29.1 to 30.5) per 1000 hours) and hamstring strains (0.86 injuries (0.74 to 0.99) and 17.5 days (17.0 to 18.1) lost per 1000 hours).Reinjuries constituted 9.9% of all injuries. Index injuries caused 22.6±40.8 days of absence compared with 25.1±39 for reinjuries (p=0.62). The 175 illnesses recorded resulted in 1.4±2.9 days of time loss per team per month.

    CONCLUSION: Professional Asian football is characterised by an overall injury incidence similar to that reported from Europe, but with a high rate of ACL ruptures and hamstring injury, warranting further investigations.

  3. Washif JA, Kok LY, James C, Beaven CM, Farooq A, Pyne DB, et al.
    Front Physiol, 2022;13:1093965.
    PMID: 36714309 DOI: 10.3389/fphys.2022.1093965
    Purpose: We evaluated the extent of changes in training practices, recovery, mental health, and sleep patterns of athletes during the early COVID-19 lockdown in a single country-cohort. Methods: A total of 686 athletes (59% male, 41% female; 9% World Class, 28% International, 29% National, 26% State, 8% Recreational) from 50 sports (45% individual, 55% team) in Malaysia completed an online, survey-based questionnaire study. The questions were related to training practices (including recovery and injury), mental health, and sleep patterns. Results: Relative to pre-lockdown, training intensity (-34%), frequency (-20%, except World-Class), and duration (-24%-59%, especially International/World-Class) were compromised, by the mandated lockdown. During the lockdown, more space/access (69%) and equipment (69%) were available for cardiorespiratory training, than technical and strength; and these resources favoured World-Class athletes. Most athletes trained for general strength/health (88%) and muscular endurance (71%); and some used innovative/digital training tools (World-Class 48% vs. lower classification-levels ≤34%). More World-Class, International, and National athletes performed strength training, plyometrics, and sport-specific technical skills with proper equipment, than State/Recreational athletes. More females (42%) sourced training materials from social media than males (29%). Some athletes (38%) performed injury prevention exercises; 18% had mild injuries (knees 29%, ankles 26%), and 18% received a medical diagnosis (International 31%). Lower-level athletes (e.g., State 44%) disclosed that they were mentally more vulnerable; and felt more anxious (36% vs. higher-levels 14%-21%). Sleep quality and quantity were "normal" (49% for both), "improved" (35% and 27%), and only 16% and 14% (respectively) stated "worsened" sleep. Conclusion: Lockdown compromised training-related practices, especially in lower-level athletes. Athletes are in need of assistance with training, and tools to cope with anxiety that should be tailored to individual country requirements during lockdown situations. In particular, goal-driven (even if it is at home) fitness training, psychological, financial, and lifestyle support can be provided to reduce the difficulties associated with lockdowns. Policies and guidelines that facilitate athletes (of all levels) to train regularly during the lockdown should be developed.
  4. Fessi MS, Ben Saad H, Soares Oliveira RF, Washif JA, Chamari K, Moalla W
    Tunis Med, 2023 Nov 05;101(11):795-799.
    PMID: 38468578
    AIM: This research design protocol outlines the methodology for a thorough evaluation of workload monitoring and management strategies in football.

    METHODS: The study involves conducting a global survey to fitness coaches, sports scientists, analysts, and physicians with experience in load monitoring within football. The research adheres to the principles of the Helsinki Declaration and complies with General Data Protection Regulation standards, with ethical approvals obtained from multiple Ethics Committees across various countries, including Tunisia. A consortium of professionals collaboratively crafted the survey instrument, dividing it into seven sections, each addressing specific aspects of workload monitoring in football. Survey reliability will undergo evaluation in a pilot study utilizing Cronbach's alpha and intraclass correlation coefficient. To ensure inclusivity, the survey will be translated into multiple languages, facilitating participation from diverse regions. As such, survey distribution will consider online platforms (such as social media) and email invitations, with a specific focus on engaging football clubs, federations, and professional networks. The targeted sample size will remain at 385 participants. Statistical analysis planning encompasses descriptive examination, exploration of variable relationships, hypothesis testing, and qualitative analyses of participant feedback and recommendations regarding load monitoring practices.

    EXPECTED RESULTS: Expected outcomes include i) A comprehensive global overview of training and match load monitoring practices in football, ii) The identification of emerging trends, an improved understanding of training optimization processes, and iii) The development of practical recommendations to enhance player well-being and performance.

    CONCLUSION: This study will contribute to the ongoing development of knowledge in the field of football workload monitoring.

  5. Galy O, Washif JA, Wattelez G, Farooq A, Hue O, Sandbakk Ø, et al.
    Sci Rep, 2024 Apr 17;14(1):8866.
    PMID: 38632327 DOI: 10.1038/s41598-024-59375-y
    The aim of this study was to investigate relationships between changes in training practices and human development index (HDI) levels, and identify strategies employed by athletes who consistently maintained their training quantity during the first 100 days of the COVID-19 pandemic. A total of 10,074 athletes (5290 amateur and 4787 professional athletes from 121 countries) completed an online survey between 17 May to 5 July 2020. We explored their training practices, including specific questions on training frequency, duration and quantity before and during lockdown (March-June 2020), stratified according to the human development index (HDI): low-medium, high, or very high HDI. During the COVID-19 lockdown, athletes in low-medium HDI countries focused on innovative training. Nevertheless, women and amateur athletes experienced a substantial reduction in training activity. Performance-driven athletes and athletes from higher HDI indexed countries, were likely to have more opportunities to diversify training activities during lockdowns, facilitated by the flexibility to perform training away from home. Factors such as lockdown rules, socioeconomic environment, and training education limited training diversification and approaches, particularly in low-medium and high HDI countries. Athletes (amateurs and professionals) who maintained the quantity of training during lockdown appeared to prioritize basic cardiovascular and strength training, irrespective of HDI level. Modifying training and fitness programs may help mitigate the decrease in training activities during lockdowns. Customized training prescriptions based on gender, performance, and HDI level will assist individuals to effectively perform and maintain training activities during lockdowns, or other challenging (lockdown-like) situations.
  6. Washif JA, Hettinga FJ, Ammar A, van Rensburg DCJ, Materne O, Trabelsi K, et al.
    BMC Sports Sci Med Rehabil, 2024 Apr 15;16(1):83.
    PMID: 38622683 DOI: 10.1186/s13102-024-00869-7
    BACKGROUND: For athletes, overcoming obstacles in challenging situations like pandemic home training is crucial. Strategies and approaches in this context are not well-documented. Our study aims to investigate such a scenario from a performance standpoint, based on a major global crisis: the COVID-19 pandemic and lockdown.

    METHODS: This cross-sectional study surveyed athletes without disabilities using online questionnaires (35 languages) from May to July 2020. Questions included aspects of alternative routines, training monitoring, recovery, sleep patterns, injury occurrence/prevention based on structured answers, and an open-ended question on lockdown training experiences.

    RESULTS: Of the 11,762 athletes from 142 countries, 63% were male, including at World-Class, International, National, State and Recreational levels. During lockdown, 25% athletes used innovative or modern ways to maintain or improve fitness e.g., virtual reality and tracking devices (favoring World-Class level, 30%). Many athletes, regardless of gender (43%) watched video competitions to improve/maintain their mental skills and performance [World-Class (47%) and International (51%)]. Contact frequency between athletes and their coaches was mainly at least once a week (36%), more among higher-level (World-Class/International) than lower-level athletes (27 vs. 16%). Higher-level athletes (≥ 54%) monitored training load and were assisted by their coaches (21%). During lockdown, stretching (67%) was considered one of the primary means of recovery, especially for higher-level athletes (> 70%). Compared to pre-lockdown, about two-thirds of athletes reported "normal" or "improved" sleep quality and quantity, suggesting a low sleep quality pre-lockdown. On average, 40% utilized injury prevention exercises (at least) once a week [World-Class (51%) and International (39%)]. Most injury occurrences during lockdown involved the knee (18%), ankle (16%), and back (9%). Four key themes emerged regarding lockdown experiences: remote training adaptation (e.g., shifting training focus), training creativity (e.g., using household items), performance enhancement opportunities (e.g., refocusing neglected aspects), and mental and motivation challenges.

    CONCLUSIONS: Both male and female athletes, particularly those of higher levels, displayed some adaptalibity during the COVID-19 lockdown, employing innovative approaches and technology for training. Many athletes implemented load monitoring, recovery, and attentive of injury prevention, while optimizing their sleep quality and quantity. Athletes demonstrated their abilities to navigate challenges, and utilized different coping strategies in response to the lockdown's constraints.

  7. Dergaa I, Ben Saad H, Zmijewski P, Farhat RA, Romdhani M, Souissi A, et al.
    Biol Sport, 2023 Oct;40(4):1249-1258.
    PMID: 37867752 DOI: 10.5114/biolsport.2023.131109
    The 2022 FIFA World Cup (FIFA-WC) held in Qatar presented unique challenges, given the potential for rapid transmission of coronavirus disease 2019 (COVID-19) among over 1.4 million international fans attending the event. This study aimed to investigate the impact of the FIFA-WC 2022 on COVID-19 cases, deaths, and reproduction rate (R0) in Qatar. Additionally, it sought to understand the implications of hosting large-scale events during a pandemic without COVID-19 restrictive measures, providing critical insights for future decision-making. Data from "Our World in Data" were analysed for three distinct periods: one week before the FIFA-WC (week-preWC), the four weeks of the event (week-1WC to week-4WC), and one week after (week-postWC). The results revealed a significant increase in COVID-19 cases during week-3WC and week-4WC (compared to week-preWC) in Qatar, followed by a subsequent decrease during the week-postWC. Notably, Qatar experienced a more pronounced surge in positive cases than the global trend. Regarding COVID-19-related deaths, Qatar's peak occurred during week-2WC, while globally deaths peaked from week-3WC to week-postWC. Nevertheless, Qatar's death toll remained relatively low compared to the global trend throughout the event. The findings highlight that the FIFA-WC 2022 in Qatar demonstrated the feasibility of organizing large-scale sporting events during a pandemic with appropriate measures in place. They emphasize the importance of high vaccination coverage, continuous monitoring, and effective collaboration between event organizers, healthcare authorities, and governments. As such, the event serves as a valuable model for future gatherings, underlining the significance of evidence-based decision-making and comprehensive public health preparedness.
  8. Trabelsi K, Ammar A, Boukhris O, Boujelbane MA, Clark C, Romdhani M, et al.
    Br J Sports Med, 2024 Feb 07;58(3):136-143.
    PMID: 37923379 DOI: 10.1136/bjsports-2023-106826
    OBJECTIVE: To systematically review, summarise and appraise findings of published systematic reviews, with/without meta-analyses, examining associations between Ramadan fasting observance (RO), health-related indices and exercise test performances in athletes and physically active individuals.

    DESIGN: Overview of systematic reviews with assessment of reviews' methodological quality.

    DATA SOURCES: PubMed, Web of Science, Scopus, Cochrane Database of Systematic Reviews, SPORTDiscus, ProQuest, PsycINFO and SciELO.

    ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Systematic reviews with/without meta-analyses examining associations of RO with health-related indices and exercise performances in athletes and physically active individuals.

    RESULTS: Fourteen systematic reviews (seven with meta-analyses) of observational studies, with low-to-critically-low methodological quality, were included. Two reviews found associations between RO and decreased sleep duration in athletes and physically active individuals. One review suggested athletes may experience more pronounced reductions in sleep duration than physically active individuals. One review found associations between RO and impaired sleep quality in athletes and physically active individuals. RO was associated with decreased energy, carbohydrate and water intake in adult-aged athletes, but not adolescents. One review suggests RO was associated with athletes' increased feelings of fatigue and decreased vigour. No association was found between RO and athletes' lean mass or haematological indices. RO was unfavourably associated with changes in athletes' performance during high-intensity exercise testing.

    CONCLUSION: Continuance of training during RO could be associated with athletes' mood state disturbances, decreased sleep duration and performance decline during high-intensity exercise testing, while preserving lean mass. However, careful interpretation is necessary due to the low-to-critically-low methodological quality of the included reviews.

  9. Washif JA, Ammar A, Trabelsi K, Chamari K, Chong CSM, Mohd Kassim SFA, et al.
    PMID: 35010662 DOI: 10.3390/ijerph19010402
    The COVID-19 pandemic has affected the lifestyles and training of elite athletes around the world. The detrimental effects of lockdown periods may vary among individuals, as well as among sports and sexes. This study investigated the changes in dietary habits, and the predictors of perceived stress during lockdown and a "bubble" training camp. This cross-sectional, online survey involved 76 elite and world-class athletes from six able-bodied sports and nine parasports, all of whom were involved in a 30-day "bubble" training camp. Questions were asked on socio-demographics, training routines and wellbeing, perceived stress, and dietary habits, pertaining to "normal" training (prelockdown), lockdown training, and "bubble" camp training periods. Changes in perceived stress were trivial to small during lockdown compared to "normal" training, and trivial to moderate during a "bubble" camp, compared to lockdown. Para-athletes, males, older athletes, less experienced athletes, married individuals, and specific ethnicities appeared to be more detrimentally affected (increased perceived stress) by lockdown. These negative experiences, however, were largely reversed during "bubble" camps. During lockdown, more athletes reported increased evening snack consumption (+8%), later meal-times (+6%), decreased fluid intake (-6%), and no breakfast (+7%). These changes were reversed during "bubble" camps (12-18% improvements). Sport classification accounted for 16% of the increased perceived stress (p = 0.001) during lockdown. Overall, socio-demographic factors, improvements in training routines, well-being, and dietary habits explained 28% of the decreased perceived stress during a "bubble" camp. In conclusion, better dietary habits, training routines and well-being have implications for reduced perceived stress. During lockdown, "bubble" camps may be beneficial, but this observation may be a case-by-case consideration, and short split "bubble" periods are recommended.
  10. Washif JA, Mujika I, DeLang MD, Brito J, Dellal A, Haugen T, et al.
    Int J Sports Physiol Perform, 2023 Jan 01;18(1):37-46.
    PMID: 36470251 DOI: 10.1123/ijspp.2022-0186
    The COVID-19 lockdown challenged the training options of athletes worldwide, including players from the most popular sport globally, football/soccer.

    PURPOSE: The authors explored the training practices of football players worldwide during the COVID-19 lockdown.

    METHODS: Football players (N = 2482, 30% professional, 22% semipro, and 48% amateur) completed an online survey (May-July 2020) on their training practices before versus during lockdown (March-June 2020). Questions were related to training frequency and session duration, as well as training knowledge and attitudes.

    RESULTS: Before lockdown, more professional (87%) than semipro (67%) and amateur (65%) players trained ≥5 sessions/wk, but this proportion decreased during the lockdown to 55%, 35%, and 42%, respectively. Players (80%-87%) trained ≥60 minutes before lockdown, but this proportion decreased to 45% in professionals, 43% in amateurs, and 36% in semipros during lockdown. At home, more than two-thirds of players had training space (73%) and equipment (66%) for cardiorespiratory training, while availability of equipment for technical and strength training was <50% during lockdown. Interactions between coach/trainer and player were more frequent (ie, daily) among professional (27%) than amateur (11%) and semipro (17%) players. Training load monitoring, albeit limited, was mostly performed by fitness coaches, more so with professionals (35%) than amateurs (13%) and semipros (17%). The players' training knowledge and attitudes/beliefs toward training were relatively modest (50%-59%).

    CONCLUSION: COVID-19 lockdown negatively affected training practices of football players worldwide, especially amateurs and semipros, for example, in training frequency, duration, intensity, technical, recovery, and other fitness training and coaching-related aspects. During lockdown-like situations, players should be monitored closely and provided appropriate support to facilitate their training.

  11. Romdhani M, Rae DE, Nédélec M, Ammar A, Chtourou H, Al Horani R, et al.
    Sports Med, 2021 Dec 08.
    PMID: 34878639 DOI: 10.1007/s40279-021-01601-y
    OBJECTIVE: In a convenience sample of athletes, we conducted a survey of COVID-19-mediated lockdown (termed 'lockdown' from this point forward) effects on: (i) circadian rhythms; (ii) sleep; (iii) eating; and (iv) training behaviors.

    METHODS: In total, 3911 athletes [mean age: 25.1 (range 18-61) years, 1764 female (45%), 2427 team-sport (63%) and 1442 elite (37%) athletes] from 49 countries completed a multilingual cross-sectional survey including the Pittsburgh Sleep Quality Index and Insomnia Severity Index questionnaires, alongside bespoke questions about napping, training, and nutrition behaviors.

    RESULTS: Pittsburgh Sleep Quality Index (4.3 ± 2.4 to 5.8 ± 3.1) and Insomnia Severity Index (4.8 ± 4.7 to 7.2 ± 6.4) scores increased from pre- to during lockdown (p 

  12. Washif JA, Pyne DB, Sandbakk Ø, Trabelsi K, Aziz AR, Beaven CM, et al.
    Biol Sport, 2022 Oct;39(4):1103-1115.
    PMID: 36247962 DOI: 10.5114/biolsport.2022.117576
    Ramadan intermittent fasting during the COVID-19 lockdown (RIFL) may present unique demands. We investigated training practices (i.e., training load and training times) of athletes, using pre-defined survey criteria/questions, during the 'first' COVID-19 lockdown, comparing RIFL to lockdown-alone (LD) in Muslim athletes. Specifically, a within-subject, survey-based study saw athletes (n = 5,529; from 110 countries/territories) training practices (comparing RIFL to LD) explored by comparative variables of: sex; age; continent; athlete classification (e.g., world-class); sport classification (e.g., endurance); athlete status (e.g., professional); and level of training knowledge and beliefs/attitudes (ranked as: good/moderate/poor). During RIFL (compared to LD), athlete perceptions (ranges presented given variety of comparative variables) of their training load decreased (46-62%), were maintained (31-48%) or increased (2-13%). Decreases (≥ 5%, p < 0.05) affected more athletes aged 30-39 years than those 18-29 years (60 vs 55%); more national than international athletes (59 vs 51%); more team sports than precision sports (59 vs 46%); more North American than European athletes (62 vs 53%); more semi-professional than professional athletes (60 vs 54%); more athletes who rated their beliefs/attitudes 'good' compared to 'poor' and 'moderate' (61 vs 54 and 53%, respectively); and more athletes with 'moderate' than 'poor' knowledge (58 vs 53%). During RIFL, athletes had different strategies for training times, with 13-29% training twice a day (i.e., afternoon and night), 12-26% at night only, and 18-36% in the afternoon only, with ranges depending on the comparative variables. Training loads and activities were altered negatively during RIFL compared to LD. It would be prudent for decision-makers responsible for RIFL athletes to develop programs to support athletes during such challenges.
  13. Dergaa I, Saad HB, El Omri A, Glenn JM, Clark CCT, Washif JA, et al.
    Biol Sport, 2024 Mar;41(2):221-241.
    PMID: 38524814 DOI: 10.5114/biolsport.2024.133661
    The rise of artificial intelligence (AI) applications in healthcare provides new possibilities for personalized health management. AI-based fitness applications are becoming more common, facilitating the opportunity for individualised exercise prescription. However, the use of AI carries the risk of inadequate expert supervision, and the efficacy and validity of such applications have not been thoroughly investigated, particularly in the context of diverse health conditions. The aim of the study was to critically assess the efficacy of exercise prescriptions generated by OpenAI's Generative Pre-Trained Transformer 4 (GPT-4) model for five example patient profiles with diverse health conditions and fitness goals. Our focus was to assess the model's ability to generate exercise prescriptions based on a singular, initial interaction, akin to a typical user experience. The evaluation was conducted by leading experts in the field of exercise prescription. Five distinct scenarios were formulated, each representing a hypothetical individual with a specific health condition and fitness objective. Upon receiving details of each individual, the GPT-4 model was tasked with generating a 30-day exercise program. These AI-derived exercise programs were subsequently subjected to a thorough evaluation by experts in exercise prescription. The evaluation encompassed adherence to established principles of frequency, intensity, time, and exercise type; integration of perceived exertion levels; consideration for medication intake and the respective medical condition; and the extent of program individualization tailored to each hypothetical profile. The AI model could create general safety-conscious exercise programs for various scenarios. However, the AI-generated exercise prescriptions lacked precision in addressing individual health conditions and goals, often prioritizing excessive safety over the effectiveness of training. The AI-based approach aimed to ensure patient improvement through gradual increases in training load and intensity, but the model's potential to fine-tune its recommendations through ongoing interaction was not fully satisfying. AI technologies, in their current state, can serve as supplemental tools in exercise prescription, particularly in enhancing accessibility for individuals unable to access, often costly, professional advice. However, AI technologies are not yet recommended as a substitute for personalized, progressive, and health condition-specific prescriptions provided by healthcare and fitness professionals. Further research is needed to explore more interactive use of AI models and integration of real-time physiological feedback.
  14. Trabelsi K, Ammar A, Masmoudi L, Boukhris O, Chtourou H, Bouaziz B, et al.
    Biol Sport, 2021 Oct;38(4):495-506.
    PMID: 34937958 DOI: 10.5114/biolsport.2021.101605
    Symptoms of psychological distress and disorder have been widely reported in people under quarantine during the COVID-19 pandemic; in addition to severe disruption of peoples' daily activity and sleep patterns. This study investigates the association between physical-activity levels and sleep patterns in quarantined individuals. An international Google online survey was launched in April 6th, 2020 for 12-weeks. Forty-one research organizations from Europe, North-Africa, Western-Asia, and the Americas promoted the survey through their networks to the general society, which was made available in 14 languages. The survey was presented in a differential format with questions related to responses "before" and "during" the confinement period. Participants responded to the Pittsburgh Sleep Quality Index (PSQI) questionnaire and the short form of the International Physical Activity Questionnaire. 5056 replies (59.4% female), from Europe (46.4%), Western-Asia (25.4%), America (14.8%) and North-Africa (13.3%) were analysed. The COVID-19 home confinement led to impaired sleep quality, as evidenced by the increase in the global PSQI score (4.37 ± 2.71 before home confinement vs. 5.32 ± 3.23 during home confinement) (p < 0.001). The frequency of individuals experiencing a good sleep decreased from 61% (n = 3063) before home confinement to 48% (n = 2405) during home confinement with highly active individuals experienced better sleep quality (p < 0.001) in both conditions. Time spent engaged in all physical-activity and the metabolic equivalent of task in each physical-activity category (i.e., vigorous, moderate, walking) decreased significantly during COVID-19 home confinement (p < 0.001). The number of hours of daily-sitting increased by ~2 hours/days during home confinement (p < 0.001). COVID-19 home confinement resulted in significantly negative alterations in sleep patterns and physical-activity levels. To maintain health during home confinement, physical-activity promotion and sleep hygiene education and support are strongly warranted.
  15. Trabelsi K, Ammar A, Masmoudi L, Boukhris O, Chtourou H, Bouaziz B, et al.
    PMID: 33921852 DOI: 10.3390/ijerph18084329
    BACKGROUND: The COVID-19 lockdown could engender disruption to lifestyle behaviors, thus impairing mental wellbeing in the general population. This study investigated whether sociodemographic variables, changes in physical activity, and sleep quality from pre- to during lockdown were predictors of change in mental wellbeing in quarantined older adults.

    METHODS: A 12-week international online survey was launched in 14 languages on 6 April 2020. Forty-one research institutions from Europe, Western-Asia, North-Africa, and the Americas, promoted the survey. The survey was presented in a differential format with questions related to responses "pre" and "during" the lockdown period. Participants responded to the Short Warwick-Edinburgh Mental Wellbeing Scale, the Pittsburgh Sleep Quality Index (PSQI) questionnaire, and the short form of the International Physical Activity Questionnaire.

    RESULTS: Replies from older adults (aged >55 years, n = 517), mainly from Europe (50.1%), Western-Asia (6.8%), America (30%), and North-Africa (9.3%) were analyzed. The COVID-19 lockdown led to significantly decreased mental wellbeing, sleep quality, and total physical activity energy expenditure levels (all p < 0.001). Regression analysis showed that the change in total PSQI score and total physical activity energy expenditure (F(2, 514) = 66.41 p < 0.001) were significant predictors of the decrease in mental wellbeing from pre- to during lockdown (p < 0.001, R2: 0.20).

    CONCLUSION: COVID-19 lockdown deleteriously affected physical activity and sleep patterns. Furthermore, change in the total PSQI score and total physical activity energy expenditure were significant predictors for the decrease in mental wellbeing.

  16. Ammar A, Chtourou H, Boukhris O, Trabelsi K, Masmoudi L, Brach M, et al.
    Int J Environ Res Public Health, 2020 Aug 27;17(17).
    PMID: 32867287 DOI: 10.3390/ijerph17176237
    Public health recommendations and governmental measures during the new coronavirus disease (COVID-19) pandemic have enforced numerous restrictions on daily living including social distancing, isolation, and home confinement. While these measures are imperative to mitigate spreading of COVID-19, the impact of these restrictions on psychosocial health is undefined. Therefore, an international online survey was launched in April 2020 to elucidate the behavioral and lifestyle consequences of COVID-19 restrictions. This report presents the preliminary results from more than one thousand responders on social participation and life satisfaction.

    METHODS: Thirty-five research organizations from Europe, North-Africa, Western Asia, and the Americas promoted the survey through their networks to the general society, in 7 languages (English, German, French, Arabic, Spanish, Portuguese, and Slovenian). Questions were presented in a differential format with questions related to responses "before" and "during" confinement conditions.

    RESULTS: 1047 participations (54% women) from Asia (36%), Africa (40%), Europe (21%), and others (3%) were included in the analysis. Findings revealed psychosocial strain during the enforced COVID-19 home confinement. Large decreases (p < 0.001) in the amount of social activity through family (-58%), friends/neighbors (-44.9%), or entertainment (-46.7%) were triggered by the enforced confinement. These negative effects on social participation were also associated with lower life satisfaction (-30.5%) during the confinement period. Conversely, the social contact score through digital technologies significantly increased (p < 0.001) during the confinement period with more individuals (+24.8%) being socially connected through digital technology.

    CONCLUSION: These preliminary findings elucidate the risk of psychosocial strain during the early COVID-19 home confinement period in 2020. Therefore, in order to mitigate the negative psychosocial effects of home confinement, implementation of national strategies focused on promoting social inclusion through a technology-based solution is strongly suggested.

  17. Ammar A, Mueller P, Trabelsi K, Chtourou H, Boukhris O, Masmoudi L, et al.
    PLoS One, 2020;15(11):e0240204.
    PMID: 33152030 DOI: 10.1371/journal.pone.0240204
    BACKGROUND: Public health recommendations and government measures during the COVID-19 pandemic have enforced restrictions on daily-living. While these measures are imperative to abate the spreading of COVID-19, the impact of these restrictions on mental health and emotional wellbeing is undefined. Therefore, an international online survey (ECLB-COVID19) was launched on April 6, 2020 in seven languages to elucidate the impact of COVID-19 restrictions on mental health and emotional wellbeing.

    METHODS: The ECLB-COVID19 electronic survey was designed by a steering group of multidisciplinary scientists, following a structured review of the literature. The survey was uploaded and shared on the Google online-survey-platform and was promoted by thirty-five research organizations from Europe, North-Africa, Western-Asia and the Americas. All participants were asked for their mental wellbeing (SWEMWS) and depressive symptoms (SMFQ) with regard to "during" and "before" home confinement.

    RESULTS: Analysis was conducted on the first 1047 replies (54% women) from Asia (36%), Africa (40%), Europe (21%) and other (3%). The COVID-19 home confinement had a negative effect on both mental-wellbeing and on mood and feelings. Specifically, a significant decrease (p < .001 and Δ% = 9.4%) in total score of the SWEMWS questionnaire was noted. More individuals (+12.89%) reported a low mental wellbeing "during" compared to "before" home confinement. Furthermore, results from the mood and feelings questionnaire showed a significant increase by 44.9% (p < .001) in SMFQ total score with more people (+10%) showing depressive symptoms "during" compared to "before" home confinement.

    CONCLUSION: The ECLB-COVID19 survey revealed an increased psychosocial strain triggered by the home confinement. To mitigate this high risk of mental disorders and to foster an Active and Healthy Confinement Lifestyle (AHCL), a crisis-oriented interdisciplinary intervention is urgently needed.

  18. Washif JA, Farooq A, Krug I, Pyne DB, Verhagen E, Taylor L, et al.
    Sports Med, 2022 04;52(4):933-948.
    PMID: 34687439 DOI: 10.1007/s40279-021-01573-z
    OBJECTIVE: Our objective was to explore the training-related knowledge, beliefs, and practices of athletes and the influence of lockdowns in response to the coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

    METHODS: Athletes (n = 12,526, comprising 13% world class, 21% international, 36% national, 24% state, and 6% recreational) completed an online survey that was available from 17 May to 5 July 2020 and explored their training behaviors (training knowledge, beliefs/attitudes, and practices), including specific questions on their training intensity, frequency, and session duration before and during lockdown (March-June 2020).

    RESULTS: Overall, 85% of athletes wanted to "maintain training," and 79% disagreed with the statement that it is "okay to not train during lockdown," with a greater prevalence for both in higher-level athletes. In total, 60% of athletes considered "coaching by correspondence (remote coaching)" to be sufficient (highest amongst world-class athletes). During lockdown, 

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