Increased Prolonged Sitting in Patients with Rheumatoid Arthritis during the COVID-19 Pandemic: A Within-Subjects, Accelerometer-Based Study

  1. Ana Jessica Pinto
  2. Diego Rezende
  3. Sofia Mendes Sieczkowska
  4. Kamila Meireles
  5. Karina Bonfiglioli
  6. Ana Cristina de Medeiros Ribeiro
  7. Eloisa Bonfá
  8. Neville Owen
  9. David W. Dunstan
  10. Hamilton Roschel
  11. Bruno Gualano

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Abstract

Background: Social distancing measures designed to contain the COVID-19 pandemic can restrict physical activity, a particular concern for high-risk patient groups. We assessed rheumatoid arthritis patients’ physical activity and sedentary behavior level, pain, fatigue, and health-related quality of life prior to and during the social distancing measures implemented in Sao Paulo, Brazil. Methods: Post-menopausal females diagnosed with rheumatoid arthritis were assessed before (from March 2018 to March 2020) and during (from 24 May to 7 July 2020) social distancing measures to contain COVID-19 pandemic, using a within-subjects, repeated-measure design. Physical activity and sedentary behavior were assessed using accelerometry (ActivPAL micro). Pain, fatigue, and health-related quality of life were assessed by questionnaires. Results: Mean age was 60.9 years and BMI was 29.5 Kg/m2. Disease activity ranged from remission to moderate activity. During social distancing, there were reductions in light-intensity activity (13.0% [−0.2 h/day, 95% CI: −0.4 to −0.04; p = 0.016]) and moderate-to-vigorous physical activity (38.8% [−4.5 min/day, 95% CI: −8.1 to −0.9; p = 0.015]), but not in standing time and sedentary time. However, time spent in prolonged bouts of sitting ≥30 min increased by 34% (1.0 h/day, 95% CI: 0.3 to 1.7; p = 0.006) and ≥60 min increased by 85% (1.0 h/day, 95% CI: 0.5 to 1.6). There were no changes in pain, fatigue, and health-related quality of life (all p > 0.050). Conclusions: Imposed social distancing measures to contain the COVID-19 outbreak were associated with decreased physical activity and increased prolonged sedentary behavior, but did not change clinical symptoms sitting among patients with rheumatoid arthritis.

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  1. Version published to 10.3390/ijerph20053944
  2. ScreenIT

    SciScore for 10.1101/2020.09.09.20191395: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIACUC: This trial was approved by the local ethical committee (Commission for Analysis of Research Projects).
    Consent: Patients signed an informed consent form before participation.
    IRB: We then obtained a new approval from the ethics committee for collecting data during the social distancing.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableSample and experimental design: Sixty-four post-menopausal women diagnosed with RA (11) were recruited from the Outpatient Rheumatoid Arthritis Clinic of the Clinical Hospital (School of Medicine, University of Sao Paulo) between March 2018 and March 2020 to participate in a trial (clinicaltrials.gov: NCT03186924).

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistics: Dependent variables were tested using repeated measures mixed models, with time as fixed factor and participants as random factor, using SAS 9.3 (SAS Institute Inc., Cary, USA).
    SAS Institute
    suggested: (Statistical Analysis System, RRID:SCR_008567)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    The limitations include the relatively low sample size and the inability to stablish a cause-andeffect relationship between changes in behavior with social distancing measures, although elements of temporality and plausibility do support our assumptions. In conclusion, imposed social distancing measures to contain the COVID-19 outbreak were associated with decreased physical activity and increased prolonged sitting time among RA patients. Since this has the potential to increase the burden of cardiovascular diseases in such high-risk patients, attention to maintaining their activity levels is an urgent consideration during the pandemic.

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    NCT03186924RecruitingReducing Sedentary Time in Rheumatoid Arthritis: The Take a …

    Results from Barzooka: We found bar graphs of continuous data. We recommend replacing bar graphs with more informative graphics, as many different datasets can lead to the same bar graph. The actual data may suggest different conclusions from the summary statistics. For more information, please see Weissgerber et al (2015).

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.09.09.20191395v1 on medRxiv