Post-Acute Sequelae of COVID-19 in Adolescents: A Cross-Sectional Study on Perceived Physical Activity Decline and Mental Health

Abstract

Purpose: The COVID-19 pandemic has severely impacted the mental and physical well-being of adolescents. In particular,
the literature has shown that the pandemic has had a significant impact on anxiety, depression and physical activity. The
present study aims to investigate whether adolescents have changed their frequency of physical activity after the pandemic.
It also examines whether these changes were in any way related to their mental health status in the post-acute phase of
the COVID-19 pandemic, when the immediate emergency measures had subsided, but residual psychological consequences
were still observable.

Methods: A sample of 218 high school students (Female=130; Male= 88) from two Italian public schools completed the
Depression Anxiety Stress Scale (DASS-21) and the International Physical Activity Questionnaire (IPAQ), along with ad hoc
questions to assess their self-perceived impact of COVID-19 on their physical activity. Multinomial logistic regression analysis
was used to examine the relationships between mental health variables and physical activity behavior.

Results: Stress, anxiety and depression were significant predictors of a perceived reduction in physical activity, with
depression showing the strongest influence (χ²(6) = 31.489, P< .001; χ²(6) = 32.223, P< .001; χ²(6) = 40.083, P< .001). In
addition, gender differences were notable: women reported higher levels of psychological distress and a greater decrease
in physical activity. The IPAQ data confirmed that most respondents experienced a decrease in physical activity after the
pandemic and linked this to the psychological experiences of the pandemic.

Conclusions: To our knowledge, this is the first study to show how COVID-19 affects the frequency of physical activity in
adolescents and how this change is related to the psychological distress they reported as a result of the pandemic. These
findings highlight the need for school and community-based interventions that combine physical activity promotion with
mental health support, particularly for vulnerable subgroups such as female adolescents.