**1. Introduction**

In the last decades, the literature has extensively described the numerous benefits of physical activity (PA) on health, including aspects directly associated with the amelioration of general health as well as the prevention of cardiovascular diseases, type II diabetes, colon cancer, immune function, and obesity [1–4]. The ability of different types of exercise to respond also to bone, muscle, and joint pathologies as well as degenerative diseases has been very well established [5–10].

Conversely, sedentary behaviour and a lack of daily PA might lead to health-related problems such as dyslipidaemia [11], microvascular dysfunction, and problems associated with peripheral insulin resistance [12], which are related to increased odds of weight

**Citation:** Gjaka, M.; Feka, K.; Bianco, A.; Tishukaj, F.; Giustino, V.; Parroco, A.M.; Palma, A.; Battaglia, G. The Effect of COVID-19 Lockdown Measures on Physical Activity Levels and Sedentary Behaviour in a Relatively Young Population Living in Kosovo. *J. Clin. Med.* **2021**, *10*, 763. https://doi.org/10.3390/ jcm10040763

Academic Editor: Michele Roccella

Received: 28 January 2021 Accepted: 11 February 2021 Published: 14 February 2021

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**Copyright:** © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

gain and an accompanying increased risk of indicators for cardiometabolic health-related risks [13]. Studies regarding health-related adverse effects of physical inactivity have defined it as the fourth leading risk factor, accounting for 6% of global deaths [14].

Since the beginning of 2020, humankind is globally fighting against a deadly virus (COVID-19) which is a very serious public health concern, initially detected in Wuhan (China) at the end of December 2019 [15,16]; it is now spread out worldwide, having infected over 48 million people and causing over 1.2 million deaths to date [17]. Due to its fast human-to-human transmission and the damage the virus causes to human beings—in serious cases, resulting in death—the World Health Organization (WHO) has declared the COVID-19 virus a pandemic (11 March 2020) [18]. In view of all the facts mentioned above, the WHO and other relevant national bodies, including also their respective governments, have implemented different kinds of lockdown strategies relative to the severity of the COVID-19 outbreak [19] including isolation, home confinement, and also social distancing [20]. In addition, due to the precaution measures imposed by the respective countries, restricted access to PA spaces (e.g., gyms) has limited PA possibilities, especially for activities usually performed outdoors and/or in groups [19].

After the first COVID-19 positive case was detected (March 13), the precaution measures were also taken in Kosovo by closing universities, schools, and borders, and also by suspending social gatherings and sports competitions at amateur and professional levels [21,22].

Yet, although social distancing and self-isolation are acknowledged as effective measures to flatten the spreading curve of COVID-19, these measures are also considered to increase the burden among humans [23,24]. In fact, home confinement and other imposed safety measures have negatively influenced PA levels, which has already been reported in other studies in countries such as Italy [25], Croatia [26], Spain [27], Canada [28], and also in large-scale surveys including countries from all over the world [20]. Furthermore, the negative impact of prolonged isolation on psychological well-being, causing post-traumatic stress symptoms, confusion, and anxiety, has been reported [29]. Moreover, studies have shown an increased time spent in sedentary behaviour (sitting time) during the COVID-19 pandemic compared to pre-pandemic time [20], which might be an increased concern for public health. Indeed, Hossain and his colleagues (2020) highlighted that there might be an association between regional anti-COVID-19 policies and socio-economic factors with differences in PA levels during COVID-19 lockdown [30]. Additionally, COVID-19 lockdown consequences on behavioural outcomes, including PA, affect all inhabitants regardless of age, sex, and ethnicity [10]. On the contrary, the living area was found to be an important factor related to the PA levels during COVID-19 lockdown [31].

In light of these facts, besides noticeable and severe changes, to the best of the authors' knowledge, no scientific data have been reported regarding the effect of COVID-19 lockdown measures on PA levels and sedentary behaviour in the Kosovo population.

Therefore, this exploratory study aimed 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, the potential link between factors such as age, gender, anthropometrics, and living area and the level and frequency of PA has been investigated.

We hypothesized that the COVID-19 lockdown would have a negative impact on the Kosovan population by decreasing the PA level and increasing the exposure time to sedentary behaviour. Additionally, it is hypothesized that the PA level and MET-minutes/week changes during COVID-19 lockdown depend on age, gender, anthropometrics, and living area.

#### **2. Materials and Methods**

*2.1. Study Design and Procedure*

The current study is a cross-sectional study design implemented using an online survey, including an adapted version of the International Physical Activity QuestionnaireShort Form (IPAQ-SF), created on the Google Forms platform (Google LLC, Mountain View, CA, USA) during the COVID-19 pandemic outbreak in Kosovo. During the period this study was conducted, Kosovo inhabitants were exposed to the government anti-COVID-19 restriction measures.

Approximately four weeks after the lockdown measures started (13 March 2020), the online survey was launched and randomly dispersed to as many people as possible. Initially, an official email including the link of the online survey was sent to all students and academic and non-academic staff of the University for Business and Technology. Afterwards, in order to increase the number of participants, the snowball sampling recruitment approach was used, spreading the online survey link via e-mailing channels and social media such as Instagram, Facebook, WhatsApp and Viber, encouraging participants to enroll in the study [20,25,27,28,32].

The study was conducted in accordance with the principles of the Declaration of Helsinki and received ethical clearance from the Ethics Committees of the University of Palermo (Protocol Number: 14/2020).
