Physical Activity Decreased in Patients With RA During COVID-19 Pandemic


For patients with rheumatoid arthritis, reduced levels of PA may impact disease activity, increase the likelihood of obesity, and may even lead to more frequent hospitalizations.

Participation in physical activity (PA) during the first COVID-19 lockdown period was significantly lower among patients with rheumatoid arthritis (RA), according to a study published in Springer.1

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“This sustained period of reduced PA may have adverse health implications. Indeed, among people with RA, PA is a major determinant of obesity and even associates with disease activity and frequency of hospitalization,” investigators explained. “Therefore, it is important to understand how the pandemic may have impacted PA and associated health aspects of people with RA.”

Data from 128 UK participants, comprised of 27 patients with RA and 101 non-RA controls, was collected via an online questionnaire between April and June 2020. Questions included RA diagnosis, demographics, COVID-19-related information, body weight, dietary questions, mental wellbeing, PA before and after lockdown, any barriers participants may have faced, and the International Physical Activity Questionnaire—short form (IPAQ). Respondents with RA were asked about disease activity and were evaluated based on the visual analogue scale (VAS) for pain and fatigue, Health Assessment Questionnaire (HAQ), and the RA quality of life questionnaire (RAQoL). Non-RA participants received World Health Organization Quality of Life Questionnaire Short Form (WHOQoL-BREF), VAS fatigue, and the Short Warwick Edinburgh Mental Wellbeing Scale (SWEMWBS).

Patients with RA had significantly lower levels of PA when compared with non-RA respondents. Pre-lockdown, 48% of patients with RA and 64% of non-RA participants reported that they were physically active. During the lockdown, PA levels were reduced by 38% across both groups, with a more significant decrease in the RA population (59% vs 33%, respectively). Body weight increased by 40% across all participants, with the RA cohort experiencing weight gain significantly more than the non-RA group (59% vs 35%, respectively). Despite this, those without RA reported eating more during this time than patients with RA (25% vs 15%, respectively).

The biggest barrier participants faced regarding PA was access to equipment and facilities (RA: 37%; non-RA: 33%), although home-based exercises increased 53% during this time.

Mental wellbeing was low in both groups (RA: 20.8 ± 4.2; non-RA: 22.2 ± 3.4, p = 0.080). Nearly half of patients with RA (44%) and 28% of non-RA respondents fell into the low mental wellbeing category.

A group of 27 non-RA participants were matched for age, sex, height, weight, and BMI with the 27 patients with RA. In this evaluation, patients with RA were less likely to be physically active when compared with the matched controls (67% vs 48%, respectively) and were more likely to further reduce PA during the lockdown (59% vs 41%, respectively). Mental wellbeing scores were lower for RA respondents when compared with non-RA participants (44% vs 33%, respectively).

Results may have been affected by the convenience sampling approach, which hindered an accurate response rate. Further, assessment of causality was unavailable due to the study’s cross-sectional design. The small sample size and demographic differences limited the study and potentially underpowered the analysis. Investigators found, however, that after matching groups, results were similar throughout the sample. Lastly, there is always a risk of bias for all self-reported data.

“The key reason for reduced PA participation appears to be limited access to equipment and facilities, which has then impacted on types of exercise performed. Therefore, our findings show the lockdown has perhaps unintentionally created restrictions on incidental and volitional PA,” investigators concluded. “The combination of low PA levels and obesity could negatively impact on disease activity and overall health for people with RA. Following the COVID-19 pandemic, PA promotion specifically for people with RA will be needed to prevent a pandemic of inactivity.”


Balchin C, Tan AL, Wilson OJ, McKenna J, Stavropoulos-Kalinoglou A. Participation in physical activity decreased more in people with rheumatoid arthritis than the general population during the COVID-19 lockdown: a cross-sectional study [published online ahead of print, 2021 Nov 30]. Rheumatol Int. 2021;1-10. doi:10.1007/s00296-021-05054-4

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