Physical activity (PA) is defined as any bodily movement produced by the skeletal muscles that requires energy expenditure above resting levels, in addition to heart rate and breathing frequency [6]. The risk of death from chronic disease such as CVDs is generally the highest among the least fit and physically inactive and the lowest among the most fit and physically active [7]. Physical inactivity as a result of personal restrictions in the COVID-19 lockdown era may hamper physical activity prophylaxis effects on CVDs [8]. It was already established that there exists an inverse relationship between leisure time physical activity and the risk of cardiovascular mortality regardless of age, sex, and the presence or lack of pre-existing cardiovascular disease [9].
COVID-19 lockdown may increase the risk of CVDs by promoting an increase in unhealthy eating behavior and decrease in physical activity [10]. Improper eating habit due to the lack of healthy food availability may result in weight gain which in turn can cause obesity and lipid accumulation in the blood vessels [11]. Increased social isolation, loneliness, boredom, anxiety, and depression generated by the pandemic might have played major roles in the lifestyle changes, emotional changes, and mood disorders which may influence food choices, with the search for comfort foods, such as processed snacks and sweets [12, 13]. Increased consumption of sweetened beverages, including soft drinks, cordial (a sweet, flavored, concentrated syrup that is mixed with water to taste), and fruit juices, may contribute to the development of obesity [14].
Lockdown is a complex social phenomenon which may provoke many behavioral responses, and alcohol use has been shown to be associated with stress [15]. Thus, the period of isolation may trigger an increase in alcohol misusage, relapsing, and emergence of new alcohol misusers [15]. An interplay among lockdown-related consequences such as the increase in financial problems, loneliness, and uncertainty about the future may increase the rate of alcohol consumption during lockdown period of COVID-19. Twenty-four percent (24%) of participants in a particular study on the effects of alcohol consumption among patients with pre-existing alcohol use disorder increase their alcohol consumption rate while 19% decrease their rate of consumption [16]. It was also reported that 38% of the respondent abstained from alcohol consumption before lockdown, but 17% of the respondents that abstained from drinking before lockdown had relapsed to alcohol consumption [16]. Only 12% of the participants drinking alcohol abstain from the act during lockdown [16]. A study by Chodkiewicz et al. [17] found a 30% change in the pattern of their alcohol consumption among the participants in the study, with 16% increasing their rate of alcohol consumption and 14% reducing their consumption habit. Furthermore, a 240% rise in alcohol online sales was reported [18]. It was also stated that 1 in every four (25%) of alcohol consumers drink alcohol more frequently since the beginning of COVID-19 lockdown [19]. The increase in drinking rate may be due to boredom and having more free time [19] due to the stay-at-home nature of the lockdown.
Tobacco usage and increased risk of CVDs have since been established [4]. Tobacco usage is the second substance being abused during COVID-19 lockdown [17]. An increase in tobacco usage was also noted in Italy, India, South Africa, the UK, and the USA during the COVID-19 lockdown [20]. The effect of tobacco smoking does not only affect the smoker but a family member exposed to the second-hand smoke [21]. Second-hand smoking also increase one to a CVD risk factor by 30% [22].
