Who Were the Most Vulnerable to the COVID-19 Pandemic? A Nationwide Panel Survey on Infection, Exercise Habits, and Weight in Japan

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Introduction:Behaviors to avoid infection are key to minimizing casualties of the COVID-19 pandemic. Even so, infection-avoidance behavior may also cause distant health impacts like immobility and obesity. This research aims at identifying behavioral patterns associated with SARS-CoV-2 infection, exercise habits, and being overweight in the Japanese population.Method:Nationwide online questionnaires were conducted five times from October 2020 to October 2021. Individuals who answered with consistency to have been diagnosed with SARS-CoV-2 at a medical facility were categorized into a SARS-CoV-2 group. The difference in lifestyle is compared using multiple regression and inverse probability weighing. In addition, the change in exercise habits, body mass index (BMI), and status of overweight (BMI>25kg/m2) were compared between the first questionnaire and the later ones. Risk factors of losing exercise habits or developing overweight were analyzed using multiple regression.Results:Diagnosis of SARS-CoV-2 was negatively correlated with crowd avoidance, mask wearing, hand washing behavior. On the contrary, the diagnosis was positively correlated with some behaviors that appear as preventive actions against the infection, such as changing clothes frequently, sanitizing belongings, and remote working. Regarding exercise habit and overweight, people with high income and elderly females showed higher risk of decreased exercise days. The proportion of overweight was increased from 22.2% to 26.6% in males and from 9.3% to 10.8% in females. Middle-aged males, elderly females, males who experienced SARS-CoV-2 infection were at higher risks of developing overweight.Conclusion:It is important to conduct an evidence-based intervention on people’s behaviors and to avoid excessive intervention that is less effective so that people can minimize indirect harm such as exhaustion, economic loss, and other chronic health impacts. Our findings suggest that high-risk groups of COVID-19 infection and immobility and/or overweight are quite different. Further research may enable us to establish more effective interventions for each group.