COVID-19 Negatively Impacts Physical Activity in Patients with Rheumatic Disease

The COVID-19 pandemic has intensified barriers to physical activity (PA) in patients with rheumatic and musculoskeletal diseases (RMDs). Results of a survey emphasize a critical need to provide support, resources, and multifaceted programs to encourage PA in this patient population, according to a cross-sectional study published in ACR Open Rheumatology.¹

“Despite known benefits of PA in RMD management, patients with RMDs often do not engage in adequate PA, reporting barriers such as limited time, motivation, and support for and access to PA opportunities as well as disease-specific barriers (eg, fatigue, pain, fear of exacerbating disease),” investigators stated. “Patients with RMDs also experienced unique additional stressors due to the COVID-19 pandemic, including barriers to medication access and concern for increased risk of infection.”

Adult patients with RMDs (n = 8361), identified through the UNC Health Care System electronic medical records (EMRs) and the Carolina Data Warehouse for Health (CDW-H), were eligible to participate in an online survey sent between July and September 2020. Investigators aimed to assess self-reported changes in PA during the COVID-19 pandemic. Statistics, age-adjusted prevalence odds ratios (PORs), and 95% confidence intervals (CIs) were used to evaluate patient characteristics linked to decreased PA. Demographics, including age, sex, ethnicity, income, and education, contact information, and diagnoses were collected.

Patients were asked about activity levels since the beginning of the pandemic, with the “before” period defined as 6 months prior to the pandemic. Health-related quality of life (HRQoL) was determined via self-rated general health and patients were asked if they were meeting exercise goals and interested in learning about interventions to support PA.

Ultimately, 893 patients completed the survey, with a mean age of 57.8 years and 75.8% were female. The most common primary diagnoses were rheumatoid arthritis (RA) (27.3%), osteoarthritis (16.0%), and systemic lupus erythematosus (SLE) (13.0%).

Most (67.4%) patients did not meet their exercise goals and over half of participants (56.8%) stated that they engaged in less PA since the pandemic began, while 27.4% self-reported unchanged PA, and 15.3% had an increase in PA. Factors for a decrease in PA included lower self-reported general health (POR, 2.21; CI, 1.64-2.97) and being diagnosed with SLE (POR, 1.57; CI, 1.03-2.38). Other reasons for decreased PA included depression (POR, 1.48; CI, 1.09-2.01), chronic pain (POR, 1.38; CI, 1.04-1.82), and hypertension (POR, 1.44; CI, 1.10-1.90). The most commonly reported barriers included fear and anxiety (33.5%), a lack of motivation (32.4%), and the risk of contracting COVID-19 (32.1%). Ways to promote exercise included self-directed home-based programs for individuals (26.9%), with a partner or guide (21.6%), online opportunities (23.9%), and in-person programs (22.8%).

The large sample size strengthened the study; however, the small response rate (17%) may have led to selection bias. Further, potential bias from self-reported data, using newly developed measures for the perception of changes in PA during the COVID-19 pandemic, and being unable to assess temporal or causal relationships due to the cross-sectional design limited the study. Distributing the survey online may have limited participation for those with limited digital literacy or internet access. Lastly, generalizability may be hindered by the single health care system and lack of geographic variability.

“Enhanced monitoring and evaluation of PA in RMD care is critical to improve PA and health and QoL outcomes, particularly among patients with relevant comorbidities (eg, depression) who may be more likely to benefit from increasing PA,” investigators concluded. “These findings underscore the need to provide diverse resources, support, and multifaceted programs to encourage PA in patients with RMDs during the COVID-19 pandemic and beyond.”

Reference:

Saxena-Beem S, Dickson TA, Englund TR, et al. Perceived Impact of the COVID-19 Pandemic on Physical Activity Among Adult Patients With Rheumatologic Disease [published online ahead of print, 2022 Oct 31]. ACR Open Rheumatol. 2022;10.1002/acr2.11507. doi:10.1002/acr2.11507