Exercise is Key in Rheumatic Disease During COVID-19 Isolation

Patients with rheumatic disease should be encouraged to undertake appropriate exercise programs to combat the physical inactivity imposed by self-isolation during the COVID-19 pandemic.

In commentary published in Nature Reviews Rheumatology, Bruno Gualan, Ph.D., of the Universidade de São Paulo in Brazil, and colleagues discuss the effects of both physical inactivity and activity on patients with rheumatic diseases, along with appropriate exercise regimes for these patients.

“Imposed physical inactivity and sedentary behavior can be disruptive to disease parameters, cardiovascular risk profile, physical capacity and function and mental health in patients with rheumatic diseases, resulting in poor quality of life, whereas maintaining more optimal physical activity levels can help to ameliorate these detrimental effects,” the authors wrote. “Patients should be provided with support to maintain physical activity and avoid prolonged periods of time spent sitting.”

The authors have provided a flexible clinical guide for physical activity promotion during the COVID-19 pandemic, which can shared with patients or used as a visual resource in telemedicine consultations.

Patients with rheumatic diseasea group that is at increased risk of infection and complications from COVID-19are more likely to be being inactive, which can be further aggravated by self-isolation. Sustained hypoactivity is associated with poor physical and mental health and increased mortality risk. Physical inactivity and sedentary behavior can exacerbate cardiovascular diseases, which are the leading cause of morbidity and mortality in patients with rheumatic disease. In patients with rheumatoid arthritis, hypoactivity is associated with poor disease-related outcomes, including high disease activity, fatigue and pain, along with cardiometabolic risk factors, such as such as obesity and insulin resistance. In children with rheumatic disease, prolonged inactivity may lead to muscle atrophy, fatigue, obesity, insulin resistance, dyslipidemia and poor quality of life.

In contrast, structured physical activity improves disease symptoms, cardiovascular risk factors, physical capacity and function, mental health and quality of life for patients with rheumatic diseases. Exercise is encouraged by the European League Against Rheumatism for patients with inflammatory arthritis and osteoarthritis, and has been shown not  to trigger inflammation in patients with systemic lupus erythematosus.

During the COVID-19 pandemic, home-based exercise programs designed for the general population should prescribed for patients with rheumatic diseases. Patients who are physically inactive and have no previous exercise experience should be advised to engage in less intensive exercise regimes and progress slowly. Meanwhile, physically active patients can either maintain their exercise routine, such as walking, or they can adapt their activities to be performed at home. Physical activity should be also recommended to pediatric patients with rheumatic disease.

However, unsupervised, home-based exercise programs designed for the general population might not be ideal for patients with rheumatic diseases and physical limitations, uncontrolled disease activity and/or at high injury risk. In such patients, strategies such as ‘move more and sit less’ should be advised, and simple plans including breaking up prolonged sedentary time with short bursts of walking may improve symptoms and cardiometabolic risk factors.

REFERENCE

Ana Jéssica Pinto, David W. Dunstan, Neville Owen, et al. “Combating physical inactivity during the COVID-19 pandemic.” Nature Reviews Rheumatology. April 30, 2020. https://doi.org/10.1038/s41584-020-0427-z