Changes in Quality of Life, Sleep, and Physical Activity During COVID-19: A Longitudinal Study of Adolescent Athletes

<bold>Context: </bold>The abrupt cessation of school and sport participation during the COVID-19 pandemic may have negative implications for adolescent mental health.<bold>Objectives: </bold>To (1) compare mental, physical, and social health and behaviors during pandemic-related stay-at-home mandates with the same measures collected 1 to 2 years earlier and (2) evaluate the relationships between physical activity and sleep during the pandemic and changes in anxiety, fatigue, and peer relationships between assessment times.<bold>Design: </bold>Cohort study.<bold>Setting: </bold>Pediatric sports medicine center.<bold>Patients or other participants: </bold>A total of 39 high school athletes (25 adolescent girls, 14 adolescent boys; age = 16.2 +/- 0.9 years).<bold>Main outcome measure(s): </bold>Patient-Reported Outcome Measurement System anxiety, fatigue, and peer relationships short forms and the Pittsburgh Sleep Quality Index were completed twice (initial assessment in May 2018 or 2019, follow-up assessment in May or June 2020). Frequency and duration of physical activity and frequency of interaction with other individuals (family, peers, sport coaches, etc) were self-reported at follow-up assessment for the 2 weeks before school or sport closure and the 2 weeks before questionnaire completion.<bold>Results: </bold>Higher levels of anxiety (5.5 +/- 4.0 versus 3.6 +/- 3.4 points; P = .003) and fatigue (5.4 +/- 3.7 versus 2.3 +/- 2.5 points; P < .001) and worse sleep quality (6.6 +/- 2.9 versus 4.3 +/- 2.3 points; P < .001) were observed during the pandemic compared with previous assessments. Reductions in physical activity were noted between assessments (exercise duration: 86.4 +/- 41.0 versus 53.8 +/- 30.0 minutes; P < .001). Sleep quality but not physical activity during the pandemic predicted changes in fatigue (P = .03, beta = 0.44 [95% CI = 0.06, 0.83]) and peer relationships (P = .01, beta = -0.65 [95% CI = -1.16, -0.15]) from initial to follow-up assessment.<bold>Conclusions: </bold>Mental and physical health declined during stay-at-home mandates compared with assessments 1 to 2 years earlier. Physical activity behaviors and sources of social interaction underwent changes after school and sport cessation. Sleep quality may have provided some protection against declining adolescent mental health during the pandemic, although this relationship requires further investigation.