Increased prolonged sitting in rheumatoid arthritis patients during the COVID-19 pandemic: a within-subjects, accelerometer-based study

Background: Social distancing measures designed to contain the COVID-19 pandemic can explicitly and implicitly restrict physical activity, a particular concern for high-risk patient groups. Using a within-subjects design with objective measurement (via validated accelerometers), we assessed rheumatoid arthritis patients9 physical activity and sedentary behavior levels prior to and during the social distancing measures implemented in Sao Paulo, Brazil. Methods: Post-menopausal women diagnosed with rheumatoid arthritis were assessed before (from March 2018 to March 2020) and during (from 24th May to 7th 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 postural-based accelerometry (ActivPAL micro). Findings: Mean age was 60.9 years (95%CI: 58.0, 63.7) and BMI was 29.5 Kg/m2 (95%CI: 27.2, 31.9). Disease activity ranged from remission to moderate activity. Most of the patients were using disease-modifying anti-rheumatic drugs and prednisone. Hypertension and dyslipidemia were the most frequent comorbidities During social distancing, there were reductions in total stepping time (15.7% [-0.3 h/day, 95%CI: -0.4, -0.1; p=0.004]), in light-intensity activity (13.0% [-0.2 h/day, 95%CI: -0.4, -0.04; p=0.016]) and in moderate-to-vigorous physical activity (38.8% [-4.5 min/day, 95%CI: -8.1, -0.9; p=0.015]), but no changes in total standing time or total sedentary time. However, time spent in prolonged bouts of sitting <30 min increased by 34% (1.0 h/day, 95%CI: 0.3, 1.7; p=0.006) and sitting bouts <60 min increased by 85% (1.0 h/day, 95%CI: 0.5, 1.6) Sit-stand transitions were reduced by 10% (-5.1/day, 95%CI: -10.3, 0.0; p=0.051). Conclusion: Imposed social distancing measures to contain the COVID-19 outbreak were associated with decreased physical activity and increased prolonged sitting among rheumatoid arthritis patients. Since this has the potential to increase the burden of cardiovascular disease in such high-risk patients, attention to maintaining physical activity is an urgent consideration during the pandemic.