There are thousands of studies accumulating in the scientific literature about the toll of lockdowns on the mental and physical health of our global community. While some have found a way to thrive in this environment, many are struggling. As I’ve been delving into the literature from around the world, I realize the effects of lockdown on mental and physical health know no borders. Whether in Kuwait, Brazil, Canada or the USA, we’ve all been behaving predictably human.
As a clinician I’m watching for how extended lockdown periods will affect cardiovascular disease risk. In 2020, COVID-19 was a primary health focus, and it was the 3rd leading cause of death in Canada and the United States. Heart disease and cancer were still 1 and 2, respectively. Americans were 2x more likely to die of heart disease in 2020 than COVID-19 and 1.7x more likely to die of cancer (ref). The Canadian stats are shaping up to look about the same (ref). Heart disease and cancer are yet formidable risks.
Of course, strategic prevention protocols and lockdowns have been an unavoidable and a variably effective way of controlling spread, however we have a triad of factors converging- increased rates of inactivity, obesity and prolonged stress – all risk factors for more heart disease.
In Canada:
-The number of people reporting “excellent” or “very good” mental health has decreased from 40% in the earlier months of the pandemic, to 29% in February (ref)
-For Canadians who were inactive before the pandemic, 40% have become more inactive. Of those who were active before lockdown, 22% have had a decline in activity (ref)
-Only 4.8% of Canadian children and 0.6% of youth are meeting recommended activity guidelines during COVID-19 restrictions (ref)
-Of those who had previously consumed cannabis, 34% said their consumption has increased during the pandemic and 12% have decreased consumption. Respondents indicated that stress, boredom and loneliness contributed to the increase (ref).
-Of those Canadians who had previously consumed alcohol, nearly one-quarter (24%) have increased alcohol consumption during the pandemic due to stress, boredom, insomnia and loneliness, while almost as many (22%) said their consumption had decreased, owing to social restrictions. The majority (54%) of Canadians who had consumed alcohol before have not changed their consumption habits during the pandemic (ref).
Around the world:
-In a global study of 7,753 participants in lockdown, weight gain was reported in 28% of the total sample compared with 33% in participants with obesity (ref)
-In Poland, 43% of adults surveyed reported eating more, and nearly 52% reported snacking more. Overweight, obese, and older adults (over age of 45) tended to gain weight, whereas those with underweight tended to lose it further. An increase in alcohol consumption was seen in 15% of survey participants. Over 45% of smokers experienced a rise in smoking frequency during the quarantine (ref)
-40% of American adults surveyed reported gaining weight during the peak-lockdown (March-May 2020), while 18.2% lost weight. Weight-gain was associated with higher intake of ultra-processed foods, and snacking, less activity, higher stress and less craving control. Of those gaining 5 lbs or more, 33% continued to gain weight after the lockdown eased, while 28% maintained their higher body weight (ref)
-In a survey of 4132 adults in Kuwait during the outbreak, 39% of the responders lost their jobs and only 13% were attending work regularly. Close to 60% of responders increased social media use compared to before the lockdown. When asked about their daily time spent following COVID19-related news, 38% spent more than 2 hours and 8% spent more than 4 hours. The overall prevalence of depressive symptoms was 30% and prevalence of anxiety symptoms was 25% (ref).
-A survey of adolescents in China found more than 20% of junior high and high school students were affected by anxiety, depression and stress (ref)
-In Brazil, those spending ≥10 h/day sedentary during the lockdown were more likely to have depressive symptoms (ref)
-In Italy, compliance with WHO recommendations for physical activity decreased from 35% to 25% (ref)
-In Lithuania, 49% of adults surveyed ate more than usual, 45% increased snacking, and 60% decreased physical activity. 30% of those already overweight, gained weight (ref)
Safeguarding our cardiovascular health through lockdown and beyond
A few evidence-based ideas to start:
Exercise
The WHO standard for physical activity for adults is 150-300 mins/week moderate intensity exercise (30+ mins 5x/week). For children, 60 minutes per day of active play and exercise.
Exercise is beneficial for heart health and has also proven to be beneficial for mental health through the pandemic.
Factors helping children and youth remain active through the pandemic include: parental encouragement and support, parents engaging in physical activity, and having a family dog (ref)
A survey conducted on older adults in North America in April 2020, revealed greater levels of physical activity were associated with lower levels of depression-like symptoms. Even light intensity exercise alleviated some of the negative mental health impacts (ref). Similar results in Spain (ref) and Brazil (ref)
Exercising indoors or outdoors has benefit. More women reported very good or excellent general and mental health if they were exercising outdoors (75%) compared with those who were not (49%). The same trend for those exercising indoors (69%) compared to those who were not (62%) (ref)
Decreasing screen time
-62-65% of adults rated their mental and general health as very good or excellent if they maintained or decreased TV and internet time compared with those who increased screen time during the lockdown (ref)
Diet
The Mediterranean diet is abundant in minimally processed plant-based foods, rich in monounsaturated fat from olive oil, and lower in saturated fat, meats, and dairy products, and is one of the most widely studied dietary patterns. A graphical representation of the Mediterranean diet can be found here. The Mediterranean style of eating is associated with better cardiovascular health outcomes, including clinically meaningful reductions in rates of coronary heart disease, ischemic stroke, and total cardiovascular disease (ref). Perhaps more importantly, it’s proven to be a very sustainable and satisfying style of eating.
Oatmeal
Oats contain a soluble fiber called beta-glucan. In over 49 clinical studies, beta glucans have been shown to reduce cholesterol. The range of beta glucans is 2.2-5grams/day and the rate of reduction for total cholesterol was 2.5-11.5% and LDL was 4-11% (ref). The Food and Drug Administration (FDA) in the United States was the first to approve, in 1997, a health claim between beta-glucan soluble fiber from oats and a reduced risk of heart disease. Similar claims have been approved in Canada, EU and 6 other countries. Beta-glucan is thought to lower serum cholesterol by binding bile acids rich in cholesterol and decreasing their reabsorption, as well as preventing the absorption of dietary cholesterol.
1 ½ cups of cooked oatmeal provide 3 grams beta glucan. Or, ¾ cup cooked oatmeal with ¼ cup oat bran. Oatmeal can be enjoyed as porridge, as overnight oats, baked oats and added to a smoothie.
Testing
There are a number of markers in the blood associated with cardiovascular risk, and many are modifiable by lifestyle and nutrition. Apart from cholesterol we consider glycemic control, levels of C-reactive protein (a non specific indicator of inflammation), homocysteine (a metabolite associated with blood vessel damage), lipoprotein B (thought to be a more specific indicator of heart disease risk than LDL cholesterol), and the omega 3 index (a measurement of the EPA and DHA omega 3 fats in red cell membranes). In a 2015 study, fewer than 3% of Canadian adults had Omega-3 Index levels associated with low risk for cardiovascular and heart disease (ref). When we’re looking for evidence-based ways to reduce heart disease risk, beyond diet, stress management and exercise, these markers in the blood help lead the way.
In the meantime, keep well and keep at it 🙂