**4. Discussion**

The purpose of this study was to evaluate the effect of COVID-19 lockdown in PA levels expressed as energy expenditure (MET-minutes/week) and sedentary behaviour among the Kosovo population. Additionally, this study analysed the possible effect of covariates such as age, gender, anthropometrics, and living area on the PA levels of the Kosovan population.

This study has provided several important findings. The main finding of the present study showed a negative effect of COVID-19 home confinement on PA levels, leading to a significant decrease in days, minutes/day, and energy expenditure (MET-minutes/week) for three types of PA (vigorous intensity, moderate intensity, and walking activity) compared to the pre-home-confinement condition, as well as on overall PA level expressed as energy expenditure (MET-minutes/week).

Similarly, decreased PA levels during home confinement were reported also in other similar recent studies in people with and without disabilities [20,25–28,41–43]. Unsurprisingly, current results have demonstrated a significant negative effect of home confinement on PA intensity, causing an increased proportion of participants in the low and moderate activity category (16% and 17.6%, respectively), and a decrease in the high activity cohort of 32.4%. Further, this study strengthens the findings reported in comparable recent research, in which the authors reported the same pattern of PA reduction in active Sicilian adults due to home confinement restrictions [25].

As previously reported, sport clubs play a massive role in maintaining higher PA levels [44]. Particularly for Kosovo, the proportion of young individuals doing sports or other types of PA is relatively high as compared to older ones. Taking this into consideration, closing gyms, sports clubs and other public and private spaces has had the most detrimental impact on PA levels in the majority of the Kosovo population, taking into account the population demography. In addition, the lack of technical knowledge of the population on appropriate training routines has been reported as a factor leading to lower PA levels [45]. While other countries during COVID-19 lockdown were encouraging and stimulating their inhabitants to get enrolled in non-intensive indoor and outdoor PA to stimulate their mental and physical well-being [46], in Kosovo, no such governmental campaigns were organized.

Sitting behaviour (hours/day) was significantly higher during home confinement compared to pre-home-confinement. Results indicated a 34% increase in sitting behaviour (hours/day) during home confinement, most likely because participants were ordered to stay inside their homes to avoid infection. These results are in accordance with results reported in a recent large-scale research representing a multi-national and multi-continental sample, where a significant increase in sitting behaviour during home confinement was reported [20].

The amount of decrease in the PA level might be affected by different factors. In this regard, when our results were stratified by gender, significant differences were found between genders in PA levels pre-home-confinement, but such differences were not present during COVID-19 home confinement. A decrease in PA levels due to COVID-19 home confinement was noticed among both genders, with a higher drop among males. These findings are not in accordance with the results observed in a previous research, where gender differences in PA level during home confinement were reported [25]. This fact could be explained by the cultural context in which Kosovan people live in. In general, females living in Kosovo are more involved in household activities compared to males, which has helped the female participants to prevent as much of a decrease in PA levels as among males. This fact is supported by scientific evidence where household chores were reported to be the most prevalent PA type during home confinement [27].

For the age category variable, our results have revealed significant differences between pre- and during COVID-19 home confinement in PA levels. The highest PA level for both pre- and during home confinement conditions was reported from the young and young adult categories, while senior adults reported the lowest PA level. These findings are in complete agreement with the results published showing a similar trend of PA levels preand during home confinement [25,47]. Indeed, it has been previously reported that younger people are more physically active than the older ones [48] and the PA level progressively decreases with aging [43]. These results could have possibly been affected by such a high number of young and young adult participants. Nevertheless, this high number of young and young adult participants could be considered as representative for Kosovo, since the majority of the people belong to these two categories [49]. Considering the increased mortality rate of COVID-19 among older individuals, it might be speculated that this has prevented them from moving outside their living environments, resulting in higher levels of inactivity. Nevertheless, a recent study has shown that older adults who met the WHO physical activity guidelines during home confinement had better mental well-being [23]. Bearing this in mind, despite the restrictions, it is recommended that older adults engage in physical activity, even in their houses.

Furthermore, results of the current study have revealed significant differences in energy expenditure (MET-min/week) between BMI categories, with, as generally expected, the normal weight category expressing the highest values before and during COVID-19 home confinement. In fact, significant differences in energy expenditure between pre- and during home confinement existed for all three categories (underweight, normal weight, and overweight), with the normal weight category reporting the highest MET-min/week difference between pre- and during COVID-19 home confinement. This is not supported by the results of a similar study recently published, where no significant differences between BMI categories in energy expenditure were reported pre-confinement, but differences were reported to be present among the overweight category during COVID-19 home confinement [25]. Indeed, a higher decrease of PA during home confinement has been reported among participants with lower BMI compared to their counterparts with higher BMI [50].

Living area has been reported as an important factor influencing PA levels and fitness [51–53]. In this regard, our results demonstrated that the decrease in PA levels of Kosovan people during lockdown living in rural areas was smaller compared to the urban living ones, which showed a larger decrease in their PA levels. Such differences could be explained by the fact that people who live in rural areas of Kosovo usually have plenty of outdoor spaces and most of them are involved in farming and householding activities, which might have helped them to preserve their PA levels during the COVID-19 restrictions. These results are in line with the findings reported for Croatian adolescents, in which the authors found a larger decrease in PA levels during lockdown among urban living adolescents compared to their rural living counterparts [31].
