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Impact of the COVID-19 Pandemic on the Time of Utilitarian Walking
and Walking as Exercise Among Brazilian Community-Dwelling
Older Adults: The REMOBILIZE Study
Dayanne Ádyla Cândido Duarte,
1
Camila Astholphi Lima,
2
Maria do Carmo Correia de Lima,
3
Monica Rodrigues Perracini,
2,3
and Juleimar Soares Coelho de Amorim
1
1
Instituto Federal de Educação, Ciência e Tecnologia, Rio de Janeiro, Brazil;
2
Master’s and Doctoral Program in Physical Therapy,
Universidade Cidade de São Paulo, São Paulo, São Paulo, Brazil;
3
Master’s and Doctoral Programs in Gerontology,
Faculty of Medical Sciences, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil
This study aimed to investigate behavioral changes related to utilitarian walking and walking as exercise among Brazilian older
adults before and during the COVID-19 pandemic. Baseline data from the longitudinal REMOBILIZE study were used. The
survey was online and comprised 1,482 adults aged 60 years and older. The outcome was the hours per week of walking time (for
utilitarian purposes, as exercise, and total), estimated by the frequency and duration and analyzed by average and rate of decrease,
comparing pre- and during the pandemic. Total walking time was used to estimate transition patterns between levels of walking
intensity. A moderate reduction of 1.76 hr per week in the total walking time was observed, and 28.1% of the participants’
walking transition patterns were from more to less physically active. Our findings demonstrate the need for gender-specific
interventions and policies to increase the walking levels among older adults after the COVID-19 pandemic period.
Keywords:health of older adults, health disparities, epidemiology, disability
The SARS-Cov-2 (COVID-19) pandemic has presented a new
and unexpected challenge for health care systems worldwide.
Distancing and social isolation were some government measures
implemented to reduce the virus dissemination and flatten the
contamination curve (Pan American Health Organization, 2020;
Silva et al., 2020). Along with the positive effects of these
measures, the reduction of mobility in the living space and the
levels of physical activity are additional concerns for older adults,
who are generally more inactive than younger adults (Hallal et al.,
2012;Yamada et al., 2020). Even though some active older adults
can spend the same or almost the same time on physical activities as
young adults, older adults should engage in some impact activities,
such as walking (Chodzko-Zajko et al., 2009).
Evidence shows that walking provides the same health benefits
as other forms of moderate-intensity physical activity (Corseuil
Giehl et al., 2016); it can be a strategy to increase the level of
physical activity and decrease the sedentary behavior of older
adults (Sparling et al., 2015). One in three older adults reports
walking outdoors at least three times per week. Walking can be
realized for two main objectives: exercise and recreation or for the
utilitarian purposes of getting from one place to another (Procter-
Gray et al., 2015).
Walking for exercise is a safe form of physical activity; it is
accessible and can be practiced at any time and place (Simpson
et al., 2003). It is the most practiced exercise among older adults
(Carvalho et al., 2017;Cavalcante et al., 2011). Brazilian older
adults reported walking as exercise an average of 1 hr per week
(Lima et al., 2020). Only 9.3% of men and 1.4% of women reached
the levels of 30 min of moderate-intensity walking 5 days per week
(Lee, 2005). Different from walking as exercise, older adults
reported utilitarian walking an average of 2.2 hr per week
(Lima et al., 2020), moving to perform instrumental and advanced
activities of daily life (Kobe et al., 2008), and this volume con-
tributes to the total of physical efforts generated daily (Sparling
et al., 2015).
A growing body of literature has shown that as a consequence
of the COVID-19 pandemic, the total time spent on physical
activities decreased an average of 65 min/week in the first months
of 2020 (Yamada et al., 2020). In Brazil, only 6.2% of older adults
left their homes to exercise or walk during the pandemic (Lima-
Costa et al., 2020). However, to our knowledge, no study has
specifically investigated the impact of the pandemic on the perfor-
mance of utilitarian walking and walking as exercise. Studies
conducted in low- and middle-income populations examining
walking in the older adult population are scarce.
Concern about physical inactivity in older adults during the
pandemic was the target of several editorials and international
institutions’recommendations. Monitoring the impact of the pan-
demic on walking can help clinicians and health managers rein-
force actions to promote active aging, prevent noncommunicable
diseases, and design intervention programs, including prescription
of physical activity to optimize mobility (World Health
Organization, 2017,2020b). Health promoters, policymakers,
and urban planners can use information about utilitarian walking
and walking as exercise to contribute to effective policies, pro-
grams, and initiatives to promote walking after a pandemic period.
We hypothesized that there was a decrease in the weekly
walking time during the pandemic. We also assumed that patterns
of walking time decline would be similar for men and women and
Duarte https://orcid.org/0000-0002-0728-1314
Lima https://orcid.org/0000-0001-9882-6975
de Lima https://orcid.org/0000-0001-9018-5325
Perracini https://orcid.org/0000-0001-9331-3820
Amorim (juleimar@yahoo.com.br) is corresponding author, https://orcid.org/
0000-0003-3218-1769.
1
Journal of Aging and Physical Activity, (Ahead of Print)
https://doi.org/10.1123/japa.2021-0093
© 2021 Human Kinetics, Inc. ORIGINAL RESEARCH
First Published Online: Dec. 13, 2021
across age groups because the recommendation of social isolation
and mobility restriction measures were recommended for the entire
older adult population. Thus, this study aimed to identify the
impact of the pandemic on the time of walking (utilitarian and
as exercise) among Brazilian older adults, stratified by gender and
age group. We also aimed to identify, from the total walking time,
the change in the status of walking level between more walking
physically active ( 150 min/week), insufficiently walking physi-
cally active (1–150 min/week), and less walking physically active
(0 min/week), considering the recommendations of the World
Health Organization Guidelines on Physical Activity and Seden-
tary Behavior (World Health Organization, 2020c).
Methods
Study Design
This research was a cross-sectional study as part of the Network of
Studies on Mobility in Aging (REMOBILIZE), aiming to investi-
gate the impact of the COVID-19 pandemic on the mobility of
Brazilian older adults. Researchers from different Brazilian uni-
versities joined a research network called REMOBILIZE to con-
duct this study through online questionnaires and phone interviews.
The REMOBILIZE is a longitudinal study with a 12-month follow-
up since the initial pandemic declaration period in Brazil. For this
study, the baseline data (April to June 2020) were analyzed.
Participants reported their situation at the moment of the interview
(during the pandemic: May to July 2020) and in the period 3 months
prior to the pandemic (prepandemic: December 2019 to Febru-
ary 2020).
The Ethical Research Committee of Universidade Cidade de
São Paulo approved all research procedures (protocol number
4.032.523). All participants signed an informed consent form in
advance of their participation in the study.
Participants and Data Collection Procedures
Participants included were community-dwelling older adults, aged
60 years and over, living in urban areas of 22 states in Brazil, and of
both genders. Older adults living in long-term care facilities and/or
those who were bedridden were excluded. Participants were re-
cruited for convenience in the local community, according to the
snowball sampling methodology (Biernacki & Waldorf, 1981),
through phone, social media groups (Facebook, Instagram, and
WhatsApp), and referrals. We contacted community leaders and
allied health professionals working in vulnerable regions to include
participants with different educational and income levels, ethnici-
ties, and genders. Thus, 1,482 participants enrolled in the REMO-
BILIZE Study. More details can be found on the research
homepage (https://www.remobilize.com.br/us) and in another pub-
lication (Perracini et al., 2021).
Data collection was conducted online and self-administered. In
the case of older adults with dementia and cognitive decline, visual
or severe hearing problems, or digital illiteracy, the survey was
answered by a caregiver (proxy informant), or telephone interviews
were conducted by a trained researcher. The online form was
developed, accessed, and replied to on the SurveyMonkey platform.
Outcome
Walking was assessed using the Incidental and Planned Exercise
Questionnaire (IPEQ), a tool consisting of 10 questions on physical
activity pertaining to an average week (Delbaere et al., 2010), used
to monitor physical activity in older adults and populational
studies. This version of the IPEQ was chosen because of its higher
test–retest repeatability (0.84; Delbaere et al., 2010). In this study,
we used only the questions related to walking to estimate the time
spent on total walking, walking as exercise, and utilitarian walking.
To calculate the utilitarian and exercise walking time before and
during the pandemic period, the questionnaire was organized in
two sections; participants answered the questions twice according
to a specific moment. Walking as exercise included walking in the
park, walking on the street, ecological walks, walking on trails, and
walking with the dog. A utilitarian walk was considered to be
related to walking to the doctor, pharmacy, bakery, and/or super-
market. Total walking time referred to the sum of all types of
walking (utilitarian and exercise walking).
According to guidelines in the validation study (Merom et al.,
2014), we calculated the hours of walking for utilitarian purposes,
for exercise, and total per week during the prepandemic period
based on frequency and duration. Next, the participants were
classified according to their walking level as being more physically
active if they reported walking 150 min per week, as insufficiently
physically active if they reported walking between 1 and 150 min
per week, and less physically active if they did not report walking
(0 min/week), according to the recommendations of the World
Health Organization Guidelines on Physical Activity and Seden-
tary Behavior (World Health Organization, 2020c) and previous
study (Corseuil Giehl et al., 2016;Nelson et al., 2007;Romo-Perez
et al., 2016). Finally, we estimated the walking time to define
transition patterns between the levels of walking intensity before
and during the pandemic. The difference in total hours per week for
all walking was presented as a delta ( walking equal hours per
week before and during the pandemic).
Covariates
To characterize the sample, we developed a questionnaire com-
posed of questions related to sociodemographic characteristics: age
groups (60–69, 70–79, and 80 years and over), race (White, Black,
and “Pardo”and “Amarelo”/Indigenous), marital status (single,
married, separated, and widowed), years of schooling (illiterate, 1–
4, 5–8, and 9 years or more), income minimum wage ( 1, 2–3, 4–7,
8–10, and 10 or more [Brazilian minimum wage salary 1,045.00
BRL—corresponding to 189.3 USD; May 1, 2020]) and occupa-
tion (working, retired and not working, or unemployed), health
conditions, functional limitation, and adoption of social isolation
measures during the pandemic. Adherence to social restriction
measures was captured using a 5-point Likert scale question, “Do
you think you are following the recommendations for social
restriction measures?”categorized as agree (strongly agree and
partially agree) and disagree (indifferent, partially disagree, and
totally disagree).
Health conditions were assessed using the comorbidity func-
tional index. The comorbidity functional index is an easy and
intuitive tool that can be self-administered. It includes a list of 18
comorbidities related to physical function. Each comorbidity pres-
ent is counted as one point, resulting in a cumulative score (Groll
et al., 2005). Participants who reported two or more comorbidities
were classified with multimorbidity.
Functional limitation was assessed using the Brazilian Multi-
dimensional Functional Assessment Questionnaire. The Brazilian
Multidimensional Functional Assessment Questionnaire is an
instrument that evaluates the level of difficulty in performing
2DUARTE ET AL.
(Ahead of Print)
the 15 basic activities of daily living and instrumental activities of
daily living. For this study, activities performed without difficulty
were categorized as zero, and activities performed with difficulty
were categorized as one. A total score was created varying from 0
to 15 (Fillenbaum & Smyer, 1981).
Data Analysis
Analyses were performed for the total sample and stratified by
gender. Descriptive analysis presented sociodemographic charac-
teristics, and the chi-square test was used to verify differences in
characteristics according to gender. The normality of the distribu-
tion of the walking variables was verified using the Shapiro–Wilk
test. The walking time (in hours per week) was presented as
mean ± SD, and student’sttest was used for paired samples to
verify the differences in the mean walking time before and during
the pandemic. The difference in mean walking time between the
periods (delta) was calculated as well as the rate of change. The
effect size (Cohen’sdtest) was calculated to determine the
magnitude of the change and was interpreted using the following
criteria: 0.2 (small), 0.5 (moderate), and 0.8 (large) (Cohen, 1988).
Total walking time before and during the pandemic was estimated
to verify the transition patterns between intensity levels. All
statistical analyses were performed using the Stata software (ver-
sion 14.0; StataCorp LLC, College Station, TX), considering
statistical significance p.05.
Results
Characteristics of the Participants
We included 1,482 participants in the study; 73.9% were women,
and 56.1% were aged between 60 and 69 years old. Among men,
77.2% were married, 36.9% received 1 minimum wage, and
60.8% were retired and not working. Regarding women, the
majority were married (45.4%), received between 2 and 3 mini-
mum wages (29.5%), and were working (49.7%). More than half of
participants (56.8%) reported having two or more comorbidities,
these being more prevalent among women (51.3%). It is essential to
highlight that 22.5% of women and 17.6% of men presented some
functional limitation, according to the Brazilian Multidimensional
Functional Assessment Questionnaire assessment. The general
characteristics of the population and the statistically different
variables according to gender (marital status, income, occupation,
multimorbidity, and functional impairment) are present in Table 1.
Total Walking Time, Walking as Exercise, and
Utilitarian Walking
There was a decrease (p.001) in the average walking of the
participants during the pandemic compared with the period pre-
pandemic, with an average reduction of 1.05 hr per week of
walking as exercise, 0.84 hr per week of utilitarian walking, and
1.76 hr per week of total walking. The highest average rate of
decrease was observed in walking as exercise ( 37.4%).
In the period prepandemic, women reported an average of
3.69 hr per week, and men reported and average of 3.28 hr per week
of total walking. During the pandemic, there was a decrease in the
average hours per week in all types of walking. Total walking was
1.96 hr per week for women and 1.16 hr per week for men during
the pandemic. Table 2shows the average time in hours per week for
walking as exercise, utilitarian walking, and total walking.
Figure 1shows the mean in an hour per week of utilitarian
walking, walking as exercise, and total walking for both genders
and stratified by age groups. Among women, compared with the
prepandemic period, a significant decrease was observed in the 60–
69 years (1.3 ± 2.1; 0.5 ± 1.6; p.001) and 70–79 years groups for
utilitarian walking (1.5 ± 1.7; 0.5 ± 3.2; p.001), in the 60–
69 years (1.7 ± 3.1; 0.7 ± 1.8; p.001) and 70–79 years groups
(2.2 ± 3.8; 0.8 ± 2.3; p.001) for walking as exercise, and in the
60–69 years (3.3 ± 4.6; 1.4 ± 3.1; p.001) and 70–79 years groups
(3.7 ± 6.0; 1.6 ± 3.8; p.001) for total walking. Among male older
adults, a significant decrease was observed in the 70–79 years
group for utilitarian walking (2.0 ± 5.5; 0.3 ± 0.7; p= .043), in the
60–69 years (2.0 ± 2.8; 1.2 ± 2.7; p= .002) and 70–79 years groups
(1.9 ± 2.6; 0.8 ± 1.7; p= .002) for walking as exercise, and in the
70–79 years group (4.2 ± 7.7; 1.2 ± 2.2; p= .015) for total walking.
No significant reduction was observed for the age group 80 years
and over.
Transition Patterns Between Levels of Total
Walking Before and During the Pandemic
Transition patterns between walking levels are shown in Figure 2.
It was observed that 28.1% of the total older adults moved from a
more physically active walking pattern to a less physically active
walking pattern, corresponding to 29.4% for women and 24.9% for
men. For both genders, 13.2% who had an insufficiently physically
active walking pattern prepandemic became less physically active
in terms of walking during the pandemic. This transition pattern
was also similar for men and women. Only 1.6% of women who
had an insufficient physically active walking pattern prepandemic
moved to a more physically active walking pattern during the
pandemic, and this transition was seen in 3.8% of men.
Discussion
The results from this study suggest that during the pandemic,
(a) there was a reduction of time in all types of walking and among
both genders, as expected; (b) there was a significant decrease in
total walking hours per week among all age groups in both genders
with the exception of those aged 80 years and older; and (c) women
transitioned to a walking pattern less physically active during the
pandemic compared with their prepandemic levels.
Our results point to a decrease in time of all types of walking
(total walking) of 1.76 hr per week. The greatest decrease was in
walking as exercise, with an average of 1.05 hr per week (37.4%).
A study carried out in Japan assessed the level of physical activity
using the International Physical Activity Questionnaire short ver-
sion, which includes the assessment of walking; the results indi-
cated that the total time of physical activity per week for older
adults decreased by 65 min ( 26.5%) from January to April 2020
(Yamada et al., 2020). This was already expected worldwide due to
protective measures against COVID-19, especially among older
adults as they are considered a risk group. In addition, a Brazilian
survey that investigated the effects of the COVID-19 pandemic on
health, income, and work conditions showed that among the older
adults in the study, only 8.3% (95% CI [6.4, 10.7]) continued to
work, and 21.9% (95% CI [18.7, 25.4]) had worsening health status
during the pandemic (Romero et al., 2021). These two factors can
also be considered important reasons for the decrease in average
walking time. This finding reinforces the importance of developing
political, environmental, and health strategies to restore walking to
minimum recommended levels. However, this will be an additional
COVID-19 IMPACT ON WALKING 3
(Ahead of Print)
Table 1 Sample Characteristics Concerning Sociodemographics, Occupation, and Disease of Older Adults
Participants (REMOBILIZE Study, 2020)
Characteristics
Overall Women Men
N = 1,482 (%) n = 1,096; 73.9% n = 384; 26.1%
Age group (years)
60–69 831 (56.1) 621 (56.7) 212 (54.7)
70–79 420 (28.4) 318 (29.0) 102 (26.7)
80 and over 229 (15.5) 157 (14.3) 72 (18.8)
Race
White 915 (61.7) 671 (61.4) 241 (62.8)
Black 100 (6.8) 69 (6.3) 31 (8.1)
“Pardo”and “Amarelo”/Indigenous 467 (31.5) 354 (32.3) 112 (29.2)
Marital status**
Single 152 (10.3) 141 (12.9) 11 (2.9)
Married 796 (53.7) 498 (45.4) 298 (77.2)
Separated 184 (12.4) 153 (14.0) 31 (8.0)
Widowed 350 (23.6) 304 (27.7) 46 (11.9)
Complete years of schooling (years)
Illiterate 117 (7.9) 86 (7.9) 31 (8.0)
1–4 282 (19.0) 199 (18.2) 83 (21.5)
5–8 181 (12.2) 134 (12.2) 47 (12.2)
9 or more 902 (60.9) 677 (61.8) 225 (58.3)
Income (minimum wage
a
)**
1 512 (34.5) 404 (36.9) 108 (28.0)
2–3 413 (27.9) 299 (21.3) 114 (29.5)
4–7 267 (18.1) 207 (18.8) 61 (15.8)
8–10 114 (7.7) 79 (7.3) 34 (8.8)
10 or more 176 (11.9) 107 (9.8) 69 (17.9)
Occupation**
Working 545 (36.8) 353 (32.2) 192 (49.7)
Retired and not working 836 (56.4) 666 (60.8) 170 (44.0)
Unemployed 101 (6.8) 77 (7.0) 24 (6.2)
Multimorbidity (2 or more
b
)** 841 (56.9) 654 (59.8) 187 (48.7)
Social isolation (totally and partially disagree) 47 (3.2) 33 (3.0) 14 (3.6)
Functional limitation
c,
* 325 (21.9) 251 (22.9) 74 (19.2)
a
Brazilian minimum wage salary 1,045.00 BRL (corresponding to 189.3 USD; May 1, 2020).
b
Multimorbidity included stroke, Parkinson’s disease, arthritis, osteoporosis,
urinary and fecal incontinence, acute myocardial infarction, intestinal and depressive disease, anxiety, visual and hearing impairment, spine, overweight, hypertension, and
dizziness.
c
Functional limitation was assessed by disability in lying down and getting out of bed, eating, combing your hair, walking on the plane, shower, get dressed, go to
the bathroom on time, climb a flight of stairs, among others.
*p.05. **p.001.
Table 2 Analysis of Mean Hours Per Week of Exercise and Utilitarian Walking Among Older Adults, According to
Gender (REMOBILIZE Study, 2020)
Mean hours per week Prepandemic During pandemic ( %) Cohen s dpvalue
Overall
Exercise walking 1.94 ± 3.5 0.78 ± 2.4 1.05 ( 37.4) 0.40 .001
Utilitarian walking 1.66 ± 3.4 0.51 ± 2.2 0.84 ( 34.3) 0.41 .001
Total walking 3.59 ± 5.8 1.51 ± 4.5 1.76 ( 19.6) 0.40 .001
Women
Exercise walking 1.94 ± 3.7 0.73 ± 2.4 1.15 ( 52.2) 0.40 .001
Utilitarian walking 1.77 ± 3.5 0.55 ± 2.4 0.94 ( 38.6) 0.41 .001
Total walking 3.69 ± 6.1 1.49 ± 4.9 1.96 ( 39.9) 0.40 .001
Men
Exercise walking 1.95 ± 2.9 0.11 ± 2.3 0.75 (2.1) 0.48 .001
Utilitarian walking 1.33 ± 2.9 0.40 ± 1.3 0.55 ( 21.8) 0.42 .018
Total walking 3.28 ± 4.7 1.58 ± 3.4 1.16 (38.0) 0.42 .002
Note. The pvalue refers to paired student’sttest.
4
