Physical activity before, during and after COVID-19: socioeconomic and diabetes-related inequalities

Background

The COVID-19 pandemic raised concerns that physical activity inequalities might widen, particularly among socially disadvantaged populations and those with chronic diseases. This study examined changes in adherence to the Dutch physical activity guideline before, during, and after the pandemic by educational level, standardized household income, migration background, and diabetes status.

Methods

Repeated cross-sectional Rotterdam-Rijnmond Health Monitor data (2016, 2020, 2022, and 2024; N = 105,891) were analysed using Complex Samples logistic regression to examine trends and subgroup differences, adjusting for age, sex, and household composition.

Results

Adherence to the Dutch physical activity guideline was significantly lower in 2020 than in 2016 (44.0% vs. 49.2%) and remained below pre-pandemic levels thereafter. Educational level accounted for most socioeconomic variation in adherence. Educational inequalities narrowed during COVID-19, with the difference between the low and high educational groups decreasing from 24.3 to 15.3 percentage points, before increasing to 17.1 percentage points in 2024. This reflected a larger decline in the high educational group. Household income differences remained stable, while adherence among second-generation migrants declined from 54.6% in 2016 to 39.8% in 2024. After adjustment for educational level, standardized household income, and migration background, individuals with diabetes consistently showed about 20 percentage points lower adherence than those without diabetes, with similar trends in both groups.

Conclusions

The COVID-19 pandemic was not associated with a consistent widening of inequalities in adherence to the Dutch physical activity guideline. Educational inequalities temporarily narrowed, income- and diabetes-related differences remained stable, and the initially favourable pattern among second-generation migrants reversed over time. Overall adherence remained below pre-pandemic levels through 2024.

Key messages

• Socioeconomic inequalities changed differently over time: educational inequalities narrowed temporarily, income inequalities remained stable, and adherence declined among second-generation migrants.

• People with type 2 diabetes consistently had lower physical activity guideline adherence, with stable differences from 2016 to 2024.