The comparison of the lifestyle of vaccinated versus unvaccinated elite athletes during the Covid-19 pandemic: A multi-country comparison

Document Type : Research Paper


1 Graduated with a master's degree in sports nutrition from Imam Khomeini International University

2 Imam Khomeini International University

3 20 Noroozian

4 Faculty of Physical Education and Sport Science, Islamic Azad University, Tehran, Iran


Background: The COVID-19 pandemic has resulted in global home confinement and quarantine, leading to the vaccination of societies worldwide. However, some elite athletes have negative views toward vaccination.
Aim: This study aimed to compare the lifestyle of vaccinated versus unvaccinated international elite athletes during the COVID-19 pandemic.
Materials and Methods: From March to October 2021, an online survey was conducted, including socio-individual information of athletes, the International Physical Activity Questionnaire (IPAQ), the Rapid Eating Assessment for Participants (REAP-S), and the Petersburg Sleep Quality Questionnaire (PSQI). A total of 581 elite athletes from 4 continents (Europe, Asia, Africa, and America) and different countries, aged 18-35 years, were voluntarily recruited. Data analysis was performed using U-Mann-Whitney and Wilcoxon signed-rank tests, with the level of significance set at alpha P<0.05.
Results: The results indicated that there was a significant difference between the level of physical activity and eating behavior of vaccinated versus unvaccinated elite athletes (P<0.001). However, no significant difference was found between the quality of sleep among vaccinated and unvaccinated elite athletes (P=0.270).
Conclusion: It was shown that, despite the unvaccinated status of some elite athletes (49.9%), their physical activity levels were higher than those of vaccinated elite athletes during the COVID-19 pandemic. Additionally, the eating behavior of vaccinated elite athletes was better than that of unvaccinated elite athletes during the COVID-19 pandemic, but there was no significant difference in the quality of sleep between the groups.


[1] Wu J, Li J, Zhu G, Zhang Y, Bi Z, Yu Y, Huang B, Fu S, Tan Y, Sun J, Li X. “Clinical features of maintenance hemodialysis patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China”. Clin J Am Soc Nephrol. 2020; 15(8): 1139-1145. doi: 10.2215/CJN.04160320. Epub: 2020 May 22. PMID: 32444393; PMCID: PMC7409740.

[2] Kosendiak AA, Adamczak B, Kontek S, Kuźnik Z, Roman M, Gostkowski M, Niedziółka A. “Level of physical activity, sleep quality and use of personal protective equipment of students at Wroclaw Medical University during the COVID-19 pandemic”. Int J Environ Res Public Health. 2023; 20(3): 2406. doi: 10.3390/ijerph20032406. PMID: 36767774. PMCID: PMC9915195.

[3] Zangrillo A, Beretta L, Silvani P, Colombo S, Scandroglio AM, Dell’Acqua A, “Fast reshaping of intensive care unit facilities in a large metropolitan hospital in Milan, Italy: facing the COVID-19 pandemic emergency”. Crit Care Resusc. 2020; 22(2): 91-94. Epub ahead of print. PMID: 32227819.

[4] Remuzzi A, Remuzzi G. “COVID-19 and Italy: what next?”. Lancet. 2020; 395(10231): 1225-1228. doi: 10.1016/S0140-6736(20)30627-9. Epub 2020 Mar 13. PMID: 32178769; PMCID: PMC7102589.

[5] Hossain MM, Sultana A, Purohit N. “Mental health outcomes of quarantine and isolation for infection prevention: a systematic umbrella review of the global evidence”. Epidemiol Health. 2020; 42: e2020038. doi: 10.4178/epih.e2020038. Epub 2020 Jun 2. PMID: 32512661; PMCID: PMC7644933.

[6] Ammar A, Chtourou H, Boukhris O, Trabelsi K, Masmoudi L, Brach M, Bouaziz B, “COVID-19 home confinement negatively impacts social participation and life satisfaction: A worldwide multicenter study”. Int J Environ Res Public Health. 2020; 17(17): 6237. doi: 10.3390/ijerph17176237. PMID: 32867287. PMCID: PMC7503681.

[7] Hull JH, Wootten M, Moghal M, Heron N, Martin R, Walsted ES, Biswas A, Loosemore M, Elliott N, Ranson C. “Clinical patterns, recovery time and prolonged impact of COVID-19 illness in international athletes: The UK experience”. Br J Sports Med. 2022; 56(1): 4-11. doi: 10.1136/bjsports-2021-104392. Epub 2021 Aug 2. PMID: 34340972; PMCID: PMC8331321.

[8] Kim DS, Lee YH, Bae KS, Baek GH, Lee SY, Shim H, On MG, Rhie SJY. “PyeongChang 2018 Winter Olympic Games and athletes' usage of 'polyclinic' medical services”. BMJ Open Sport Exerc Med. 2019; 5(1): e000548. doi: 10.1136/bmjsem-2019-000548. PMID: 31548900. PMCID: PMC6733333.

[9] Kozloff N, Mulsant BH, Stergiopoulos V, Voineskos AN. “The COVID-19 global pandemic: Implications for people with schizophrenia and related disorders”. Schizophr Bull. 2020; 46(4): 752-757. doi: 10.1093/schbul/sbaa051. PMID: 32343342. PMCID: PMC7197583.

[10] Trabelsi K, Ammar A, Masmoudi L, Boukhris O, Chtourou H, Bouaziz B, “Globally altered sleep patterns and physical activity levels by confinement in 5056 individuals: ECLB COVID-19 international online survey”. Biol Sport. 2021; 38(4): 495-506. doi: 10.5114/biolsport.2021.101605. Epub 2020 Dec 23. PMID: 34937958. PMCID: PMC8670812.

[11] Ammar A, Mueller P, Trabelsi K, Chtourou H, Boukhris O, Masmoudi L, “ECLB-COVID19 consortium. Psychological consequences of COVID-19 home confinement: The ECLB-COVID19 multicenter study”. PLoS One. 2020; 15(11): e0240204. doi: 10.1371/journal.pone.0240204. PMID: 33152030. PMCID: PMC7643949.

[12] Preedy VR, Watson RR. Handbook of Disease Burdens and Quality of Life Measures. Springer. 2010.

[13] Cena H, Calder PC. “Defining a healthy diet: Evidence for the role of contemporary dietary patterns in health and disease”. Nutrients. 2020; 12(2): 334. doi: 10.3390/nu12020334. PMID: 32012681. PMCID: PMC7071223.

[14] Belenky G, Wesensten NJ, Thorne DR, Thomas ML, Sing HC, Redmond DP, et al. “Patterns of performance degradation and restoration during sleep restriction and subsequent recovery: A sleep dose‐response study”. Journal of Sleep Research. 2003; 12(1): 1-12.

[15] Walker MP, Stickgold R. “It's practice, with sleep, that makes perfect: implications of sleep-dependent learning and plasticity for skill performance”. Clinics in Sports Medicine. 2005; 24(2): 301-17.

[16] Haack M, Mullington JM. “Sustained sleep restriction reduces emotional and physical well-being”. Pain. 2005; 119(1-3): 56-64. doi: 10.1016/j.pain.2005.09.011. Epub 2005 Nov 16. PMID: 16297554.

[17] Czeisler CA, Klerman EB. “Circadian and sleep-dependent regulation of hormone release in humans”. Recent Prog Horm Res. 1999; 54: 97-130. discussion 130-2. PMID: 10548874.

[18] Spiegel K, Leproult R, Van Cauter E. “Impact of sleep debt on metabolic and endocrine function”. Lancet. 1999; 354(9188): 1435-9. doi: 10.1016/S0140-6736(99)01376-8. PMID: 10543671.

[19] Spiegel K, Tasali E, Penev P, Van Cauter E. “Brief communication: Sleep curtailment in healthy young men is associated with decreased leptin levels, elevated ghrelin levels, and increased hunger and appetite”. Ann Intern Med. 2004; 141(11): 846-50. doi: 10.7326/0003-4819-141-11-200412070-00008. PMID: 15583226.

[20] Cohen S, Doyle WJ, Alper CM, Janicki-Deverts D, Turner RB. “Sleep habits and susceptibility to the common cold”. Arch Intern Med. 2009; 169(1): 62-7. doi: 10.1001/archinternmed.2008.505. PMID: 19139325. PMCID: PMC2629403.

[21] Fullagar HH, Skorski S, Duffield R, Hammes D, Coutts AJ, Meyer T. “Sleep and athletic performance: the effects of sleep loss on exercise performance, and physiological and cognitive responses to exercise”. Sports Med. 2015; 45(2): 161-86. doi: 10.1007/s40279-014-0260-0. PMID: 25315456.

[22] Facer-Childs ER, Hoffman D, Tran JN, Drummond SPA, Rajaratnam SMW. “Sleep and mental health in athletes during COVID-19 lockdown”. Sleep. 2021; 44(5): zsaa261. doi: 10.1093/sleep/zsaa261. PMID: 33535229. PMCID: PMC7928674.

[23] Irandoust K, Taheri M, Chtourou H, Nikolaidis PT, Rosemann T, Knechtle B. “Effect of time-of-day-exercise in group settings on level of mood and depression of former elite male athletes”. Int J Environ Res Public Health. 2019; 16(19): 3541. doi: 10.3390/ijerph16193541. PMID: 31546685. PMCID: PMC6801561.

[24] Woods JA, Hutchinson NT, Powers SK, Roberts WO, Gomez-Cabrera MC, Radak Z, Berkes I, Boros A, Boldogh I, Leeuwenburgh C, Coelho-Júnior HJ, Marzetti E, Cheng Y, Liu J, Durstine JL, Sun J, Ji LL. “The COVID-19 pandemic and physical activity”. Sports Med Health Sci. 2020; 2(2): 55-64. doi: 10.1016/j.smhs.2020.05.006. Epub 2020 May 30. PMID: 34189484. PMCID: PMC7261095.

[25] Inciardi RM, Lupi L, Zaccone G, Italia L, Raffo M, Tomasoni D, Cani DS, Cerini M, Farina D, Gavazzi E, Maroldi R, Adamo M, Ammirati E, Sinagra G, Lombardi CM, Metra M. “Cardiac involvement in a patient with coronavirus disease 2019 (COVID-19)”. JAMA Cardiol. 2020; 5(7): 819-824. doi: 10.1001/jamacardio.2020.1096. PMID: 32219357. PMCID: PMC7364333.

[26] Filgueira TO, Castoldi A, Santos LER, de Amorim GJ, de Sousa Fernandes MS, Anastácio WLDN, Campos EZ, Santos TM, Souto FO. “The relevance of a physical active lifestyle and physical fitness on immune defense: Mitigating disease burden, with focus on COVID-19 consequences”. Front Immunol. 2021; 12: 587146. doi: 10.3389/fimmu.2021.587146. PMID: 33613573. PMCID: PMC7892446.

[27] Irandoust K, Taheri M. “The effect of aquatic exercises on inflammatory markers of cardiovascular disease in obese women”. International Archives of Health Sciences. 2018; 5(4): 145.

[28] Rodrigues CMC, Plotkin SA. “Impact of vaccines; Health, economic and social perspectives”. Front Microbiol. 2020; 11: 1526. doi: 10.3389/fmicb.2020.01526. PMID: 32760367. PMCID: PMC7371956.

[29] Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. “The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research”. Psychiatry Res. 1989; 28(2): 193-213. doi: 10.1016/0165-1781(89)90047-4. PMID: 2748771.

[30] Kakoui H, Zare M, Akhlaghi M, Panahi R. “Investigation of sleep quality among professional drivers in the intercity terminals: a case study in Tehran”. Traffic Management Studies. 2010; 16(5): 1-10.

[31] Kim Y, Park I, Kang M. “Convergent validity of the international physical activity questionnaire (IPAQ): meta-analysis”. Public Health Nutr. 2013; 16(3): 440-52. doi: 10.1017/S1368980012002996. Epub 2012 Jul 2. PMID: 22874087. PMCID: PMC10271683.

[32] Segal-Isaacson CJ, Wylie-Rosett J, Gans KM. “Validation of a short dietary assessment questionnaire: the Rapid Eating and Activity Assessment for Participants short version (REAP-S)”. Diabetes Educ. 2004; 30(5): 774, 776, 778 passim. doi: 10.1177/014572170403000512. PMID: 15510530.

[33] Li Z, Ma Y, Huo S, Ke Y, Zhao A. “Impact of COVID-19 vaccination status and confidence on dietary practices among Chinese residents”. Foods. 2022; 11(9): 1365. doi: 10.3390/foods11091365. PMID: 35564088. PMCID: PMC9104347.

[34] Schmitz NC, van der Werf YD, Lammers-van der Holst HM. “The importance of sleep and circadian rhythms for vaccination success and susceptibility to viral infections”. Clocks & Sleep. 2022; 4(1): 66-79.

[35] Frank A, Fatke B, Frank W, Förstl H, Hölzle P. “Depression, dependence and prices of the COVID-19-crisis”. Brain Behav Immun. 2020; 87:99. doi: 10.1016/j.bbi.2020.04.068. Epub 2020 Apr 29. PMID: 32360604. PMCID: PMC7189841.

[36] Newbury JW, Foo WL, Cole M, Kelly AL, Chessor RJ, Sparks SA, Faghy MA, Gough HC, Gough LA. “Nutritional intakes of highly trained adolescent swimmers before, during, and after a national lockdown in the COVID-19 pandemic”. PLoS One. 2022; 17(4): e0266238. doi: 10.1371/journal.pone.0266238. PMID: 35381043. PMCID: PMC8982883.

[37] Woodford L, Bussey L. “Exploring the perceived impact of the COVID-19 pandemic social distancing measures on athlete wellbeing: A qualitative study utilising photo-elicitation”. Front Psychol. 2021; 12: 624023. doi: 10.3389/fpsyg.2021.624023. PMID: 34322049. PMCID: PMC8311490.

[38] da Silva Santos AM, Rossi FE, Dos Santos Nunes de Moura HP, de Sousa Junior AVM, Machado DCD, Neves LM, Brito AS, Moura P, Monteiro PA, Freitas Junior IF, Dos Santos MAP, Ribeiro SLG. “COVID-19 pandemic impacts physical activity levels and sedentary time but not sleep quality in young badminton athletes”. Sport Sci Health. 2021; 17(4): 969-977. doi: 10.1007/s11332-021-00763-6. Epub 2021 Apr 21. PMID: 33903803; PMCID: PMC8059427.

[39] Lopes Soares L, Bernardes Leite L, Quintão Guilherme L, Teixeira Rezende LM, Noce F, DE Azambuja Pussieldi G. “Anxiety, sleep quality and mood in elite athletes during the COVID-19 pandemic: a preliminary study”. J Sports Med Phys Fitness. 2022; 62(6): 867-872. doi: 10.23736/S0022-4707.21.12276-5. Epub 2021 Apr 19. PMID: 33871245.