Longitudinal Analysis of Variations in Daily Step Counts and Long-Term Implications of COVID-19 Waves and Restriction...

Public health restrictive measures adopted during the COVID-19 pandemic led to significant changes in lifestyles. Global declines in physical activity (PA) and increases in sedentary behavior were noted. These trends were observed within different regions of the world, pointing toward potential long-term implications for PA behaviors.

This mixed methods study aims to assess variations in daily step counts in Qatar using device-driven data throughout all 3 COVID-19 waves (February 2020 to February 2023) compared with a full pre-COVID-19 year. In-depth interviews were further conducted with randomly selected participants to gain insights into determinants, perceptions, and barriers of PA during the pandemic.

A total of 362 participants (60/362, 16.6% female) from the Step Into Health community-based program reported daily step counts using pedometers (170/362, 47%) or a mobile phone app (192/362, 53%). Linear mixed models examined changes in daily step counts across 19 phases of implementation and lifting of restrictions. Overall, 9 participants also completed semistructured interviews that were analyzed thematically and phenomenologically. Triangulation of quantitative and qualitative data was applied to interpret convergences and divergences between device-measured activity patterns and lived experiences.

Significant declines in daily step counts (ie, from 689 to 1013 steps) were observed at the onset of each wave (P<.001), were especially marked at wave 2, and were followed by a recovery of step count following the lifting of restrictions at each wave (ie, increase of 609 to 1147 steps). Different patterns of change in step count emerged within sex (P=.03), age (P=.03), and BMI (P=.01) groups, where larger variations were seen among male individuals, pedometer users, and normal-weight participants. Qualitative themes (ie, disrupted routines, reliance on home-based exercise, and media influence) contextualized these patterns and explained subgroup differences.

The largest drops in daily step count coincided with increased case severity and Ramadan. Integration of quantitative and qualitative findings showed that declines in activity were shaped not only by restrictions but also by fear, motivation, and contextual factors. These results underscore the importance of designing interventions that encourage outdoor activity and provide reliable social media-based guidance during public health crises.