It has been well established that physical activity (PA) has a positive impact on patients affected by rheumatoid arthritis (RA) [1]. However, the prolonged lockdown triggered by COVID-19 from March to May 2020 has dramatically decreased opportunities for PA in France. This study aimed to describe and measure the impact of this lockdown on PA practice, quality of life, and relationships with rheumatologists of patients affected by RA.
The study was conducted on http://www.carenity.com, a global online patient community where chronic illness patients can share their experience and get health information. Volunteer patients can also contribute to medical research by participating in online studies. RA patients were invited to answer an online questionnaire from May, 25th to June, 15th 2020. Patients gave consent online at the beginning of the study to confirm their participation. Statistical analyses were performed using chi-squared tests to analyze differences between categorical variables. In the overall study, RA activity level was defined by the number of symptoms and the discomfort caused.
Carenity.com has 698 patients actively involved in its RA community, of whom 204 (29%) participated (86% women, mean age 54 years, 84% diagnosed more than 3 years ago).
The proportion of patients engaged in PA plummeted during lockdown: from 74% to 42% for active mobility, from 22% to 11% for moderate-intensity sports and from 16% to 6% for high-intensity sports (Table 1 ). During the lockdown, 50% of patients significantly decreased the amount of PA they did, 57% reduced the frequency, and 48% reduced the intensity (p < 0.05, significant decrease compared to patients who increased/remained stable PA during lockdown). To maintain PA, most patients reported using a specific method, which was mainly digital (online exercise videos, computer applications, etc.).
Table 1.
Impact of the lockdown on the types of physical activity in which patients were engaged.
| Before lockdown | During lockdown | Neither | |
|---|---|---|---|
| Active mobility (e.g. walking, biking, etc.) | 74% | 42%* | 23% |
| Domestic activities (e.g. housework, gardening, etc.) | 82% | 77% | 8% |
| Physical activities in a professional or academic setting | 24% | 6%* | 75% |
| Moderate-intensity sports (e.g. yoga, tai chi, Pilates, dance, etc.) | 22% | 11%* | 72% |
| High-intensity sports (e.g. tennis, fast running, aerobics, etc.) | 16% | 6%* | 81% |
Percentage of patients engaged in each type of PA before and during lockdown.
Significantly lower than before lockdown (chi-squared test, p-value < 0.05).
Twenty-one percent reported a negative impact of the lockdown on treatment intake. In addition, 30% of patients reported disease flares during lockdown vs. 20% of patients who experienced flares before lockdown (p < 0.05).
The more active their RA was during lockdown, the greater the impact was on quality-of-life indicators (Table 2 ). Regarding medical appointments, 64% of patients felt the need to consult their rheumatologist during the lockdown, but 9% failed to do so, and 14% preferred to delay consultation. Of the 40% of patients who did consult, 60% did so remotely. During the consultation, the rheumatologist discussed PA in only 30% of cases, mostly by asking questions (72%) or giving advice (44%). Only 4% were referred to remote PA sessions.
Table 2.
Patient-reported impact level on several quality of life indicators reported by level of “disease activity”.
| N | Sleep quality | Joint mobility | Fatigue | Pain | Morale | Stress | |
|---|---|---|---|---|---|---|---|
| In remission** | 15 | 0.0 | 0.0 | 0.0 | 0.0 | −1.0 | −1.0 |
| Low activity** | 51 | −1.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 |
| Moderate activity** | 76 | −2.0* | −1.0 | −2.0* | −3.0* | −1.0 | −1.0 |
| Flare-up** | 62 | −3.0* | −4.0* | −3.0* | −4.0* | −2.0 | −2.5* |
Answers of RA to the question: “How did you feel each of the following indicators were impacted during lockdown?”. Evaluated on a scale from −5 (maximal deterioration) to 5 (maximal improvement). The median score is captured for each level of RA activity for each quality-of-life indicator.
Significantly worse than patients in remission (t-test, p-value < 0.05).
In remission = No activity, no symptoms. Low activity = Presence of some symptoms but little discomfort experienced. Moderate activity = Presence of symptoms causing moderate discomfort. Flare-up = Many symptoms leading to severe discomfort.
Though RA patients did not directly suffer from higher Covid incidence [2], a pandemic-linked lack of PA could put them at risk. The extensive use of teleconsultation and digital means for PA practice may have helped patients implement doctors’ recommendations to better manage their illness, at a time when they needed specific help globally [3] [4].
We report that during lockdown, PA decreased, RA disease activity increased, and patients’ quality of life deteriorated. The rheumatologist plays a critical role in supporting RA patients in the management of their disease, including medication compliance, PA practice, and maintaining preventive measures during COVID-19.
Role of the funding source
The study, led by Carenity, was funded by Sanofi Genzyme France.
Disclosure of interests
Valentin Morisseau and Alexis Bombezin--Domino are employees of Carenity.
Sandrine Jousse-Joulin, Vincent Tiffreau and Raymond Perez are members of Sanofi's scientific committee.
René-Marc Flipo is a member of Sanofi's national advisory board.
Florence E. Lévy-Weil is an employee of Sanofi Genzyme France.
References
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