Reduced physical activity level was associated with poorer quality of life during the early phase of the COVID-19 pandemic: a sub-study of the last-long trial
DOI:
https://doi.org/10.2340/jrm.v55.12352Keywords:
stroke, covid 19 pandemic, physical activity level, quality of lifeAbstract
Objectives: To assess how physical activity levels changed in a stroke cohort during the COVID-19 (SARS-CoV-2) pandemic, and how these changes were associated with quality of life (QoL).
Methods: Between March and July 2021, 150 patients with stroke already included in the Life after Stroke (LAST-long) trial in Norway were invited to participate in this cross-sectional survey. Participants were asked to complete a questionnaire assessing changes in physical activity and self-reported health following the pandemic. Univariate and multivariate logistic regression analyses were used to explore the association between physical activity, loneliness, mental health, social activity and QoL.
Results: In all, 118 (79%) participants completed the questionnaire. A total of 80 (68%) reported less physical activity, 46 (39%) felt lonelier, and 43 (37%) reported worse mental health, while 50 (42%) reported reduced QoL compared with before the lockdown. In the univariate analyses less physical activity, feeling lonelier and changes in mental health were associated with reduced QoL. In the multivariate analysis only less physical activity odds ratio (OR) = 4.04 (95% confidence interval (95% CI) 1.44–11.34, p = 0.008) was significantly associated with reduced QoL.
Conclusion: More than two-thirds of patients with stroke reported reduced physical activity during the COVID-19 pandemic, and less physical activity was strongly associated with reduced QoL.
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References
Himmels JPW, Borge T, Brurberg KG, Gravningen KM, Feruglio SL, Berild JD. COVID-19 and risk factors for hospital admission, severe disease and death 3rd update. National Institute Oslo, Norway of Public Health 2020; report no.: 978-82-8406-141-2.
Romero Starke K, Petereit-Haack G, Schubert M, Kämpf D, Schliebner A, Hegewald J, et al. The age-related risk of severe outcomes due to covid-19 infection: a rapid review, meta-analysis, and meta-regression. Int J Environ Res Public Health 2020; 17: 5974.
https://doi.org/10.3390/ijerph17165974 DOI: https://doi.org/10.3390/ijerph17165974
Nygård AJ, Taraldsen K, Granbo R, Selbæk G, Helbostad JL. Impacts of COVID-19 restrictions on level of physical activity and health in home-dwelling older adults in Norway. Eur Rev Aging Phys Act 2022; 19: 30.
https://doi.org/10.1186/s11556-022-00309-w DOI: https://doi.org/10.1186/s11556-022-00309-w
Visser M, Schaap LA, Wijnhoven HAH. Self-reported impact of the COVID-19 pandemic on nutrition and physical activity behaviour in dutch older adults living independently. Nutrients 2020; 12: 3708.
https://doi.org/10.3390/nu12123708 DOI: https://doi.org/10.3390/nu12123708
van Bakel BMA, Bakker EA, de Vries F, Thijssen DHJ, Eijsvogels TMH. Impact of COVID-19 lockdown on physical activity and sedentary behaviour in Dutch cardiovascular disease patients. Neth Heart J 2021; 29: 273-279.
https://doi.org/10.1007/s12471-021-01550-1 DOI: https://doi.org/10.1007/s12471-021-01550-1
Tieges Z MG, Allerhand M, Duncan F, van Wijck F, Fitzsimons C, Greig C et al. Sedentary behavior in the first year after stroke: a longitudinal cohort study with objective measures. Arch Phys Med Rehabil 2015; 96: 15-23.
https://doi.org/10.1016/j.apmr.2014.08.015 DOI: https://doi.org/10.1016/j.apmr.2014.08.015
Reicherzer L, Wirz M, Wieber F, Graf ES. Facilitators and barriers to health enhancing physical activity in individuals with severe functional limitations after stroke: a qualitative study. Front Psychol 2022; 13: 982302.
https://doi.org/10.3389/fpsyg.2022.982302 DOI: https://doi.org/10.3389/fpsyg.2022.982302
Nicholson S, Sniehotta FF, van Wijck F, Greig CA, Johnston M, McMurdo al. A systematic review of perceived barriers and motivators to physical activity after stroke. Int J Stroke 2013; 8: 3573-3564.
https://doi.org/10.1111/j.1747-4949.2012.00880.x DOI: https://doi.org/10.1111/j.1747-4949.2012.00880.x
Kang SM, Kim SH, Han KD, Paik NJ, Kim WS. Physical activity after ischemic stroke and its association with adverse outcomes: a nationwide population-based cohort study. Top Stroke Rehabil 2021; 28: 170-180.
https://doi.org/10.1080/10749357.2020.1799292 DOI: https://doi.org/10.1080/10749357.2020.1799292
Hooker SP, Diaz KM, Blair SN, Colabianchi N, Hutto B, McDonnell MN, et al. Association of accelerometer-measured sedentary time and physical activity with risk of stroke among US adults. JAMA Netw Open 2022; 5: e2215385.
https://doi.org/10.1001/jamanetworkopen.2022.15385 DOI: https://doi.org/10.1001/jamanetworkopen.2022.15385
van de Port IG, Kwakkel G, van Wijk I, Lindeman E. Susceptibility to deterioration of mobility long-term after stroke: a prospective cohort study. Stroke 2006; 37: 167-171.
https://doi.org/10.1161/01.STR.0000195180.69904.f2 DOI: https://doi.org/10.1161/01.STR.0000195180.69904.f2
Choi-Kwon S, Choi JM, Kwon SU, Kang DW, Kim JS. Factors that affect the quality of life at 3 years post-stroke. J Clin Neurol 2006; 2: 34-41.
https://doi.org/10.3988/jcn.2006.2.1.34 DOI: https://doi.org/10.3988/jcn.2006.2.1.34
van Mierlo ML, van Heugten CM, Post MW, Hajós TR, Kappelle LJ, Visser-Meily JM. Quality of life during the first two years post stroke: the Restore4Stroke Cohort Study. Cerebrovasc Dis 2016; 41: 19-26.
https://doi.org/10.1159/000441197 DOI: https://doi.org/10.1159/000441197
Callow DD, Arnold-Nedimala NA, Jordan LS, Pena GS, Won J, Woodard JL, et al. The mental health benefits of physical activity in older adults survive the COVID-19 pandemic. Am J Geriatr Psychiatry 2020; 28: 1046-1057.
https://doi.org/10.1016/j.jagp.2020.06.024 DOI: https://doi.org/10.1016/j.jagp.2020.06.024
Carriedo A, Cecchini JA, Fernandez-Rio J, Méndez-Giménez A. COVID-19, psychological well-being and physical activity levels in older adults during the nationwide lockdown in Spain. Am J Geriatr Psychiatry 2020; 28: 1146-1155.
https://doi.org/10.1016/j.jagp.2020.08.007 DOI: https://doi.org/10.1016/j.jagp.2020.08.007
Askim T, Hokstad A, Bergh E, Døhl Ø, Ellekjær H, Ihle-Hansen H, et al. A multimodal individualized intervention to prevent functional decline after stroke. Protocol of a randomised controlled trial on long-term follow-up after stroke (LAST-long). BMJ Open 2023; 13: e069656.
https://doi.org/10.1136/bmjopen-2022-069656 DOI: https://doi.org/10.1136/bmjopen-2022-069656
Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994; 49: M85-M94.
https://doi.org/10.1093/geronj/49.2.M85 DOI: https://doi.org/10.1093/geronj/49.2.M85
Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005; 53: 695-699.
https://doi.org/10.1111/j.1532-5415.2005.53221.x DOI: https://doi.org/10.1111/j.1532-5415.2005.53221.x
Carr JH, Shepherd RB, Nordholm L, Lynne D. Investigation of a new motor assessment scale for stroke patients. Phys Ther 1985; 65: 175-180.
https://doi.org/10.1093/ptj/65.2.175 DOI: https://doi.org/10.1093/ptj/65.2.175
Lerdal A, Kottorp A. Psychometric properties of the Fatigue Severity Scale-Rasch analyses of individual responses in a Norwegian stroke cohort. Int J Nurs Stud 2011; 48: 1258-1265.
https://doi.org/10.1016/j.ijnurstu.2011.02.019 DOI: https://doi.org/10.1016/j.ijnurstu.2011.02.019
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67: 361-370.
https://doi.org/10.1111/j.1600-0447.1983.tb09716.x DOI: https://doi.org/10.1111/j.1600-0447.1983.tb09716.x
Kurtze N, Rangul V, Hustvedt BE, Flanders WD. Reliability and validity of self-reported physical activity in the Nord-Trøndelag Health Study: HUNT 1. Scand J Public Health 2008; 36: 52-61.
https://doi.org/10.1177/1403494807085373 DOI: https://doi.org/10.1177/1403494807085373
Jebb AN, Vincent; Tay,L A . Review of key Likert scale development advances: 1995-2019. Front Psychol 2021; 12: 637547
https://doi.org/10.3389/fpsyg.2021.637547 DOI: https://doi.org/10.3389/fpsyg.2021.637547
van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988; 19: 604-607.
https://doi.org/10.1161/01.STR.19.5.604 DOI: https://doi.org/10.1161/01.STR.19.5.604
Hackett RA, Steptoe A, Lang RP, Jackson SE. Disability discrimination and well-being in the United Kingdom: a prospective cohort study. BMJ Open 2020; 10: e035714.
https://doi.org/10.1136/bmjopen-2019-035714 DOI: https://doi.org/10.1136/bmjopen-2019-035714
Bentzen M, Brurok B, Roeleveld K, Hoff M, Jahnsen R, Wouda MF, et al. Changes in physical activity and basic psychological needs related to mental health among people with physical disability during the COVID-19 pandemic in Norway. Disabil Health J 2021; 14: 101126.
https://doi.org/10.1016/j.dhjo.2021.101126 DOI: https://doi.org/10.1016/j.dhjo.2021.101126
Di Stefano V, Battaglia G, Giustino V, Gagliardo A, D'Aleo M, Giannini O, et al. Significant reduction of physical activity in patients with neuromuscular disease during COVID-19 pandemic: the long-term consequences of quarantine. J Neurol 2021; 268: 20-26.
https://doi.org/10.1007/s00415-020-10064-6 DOI: https://doi.org/10.1007/s00415-020-10064-6
Motton S, Vergriete K, VanPhi LN, Lambaudie E, Berthoumieu A, Pous J, et al. Evaluation of the impact of the COVID-19 lockdown on the quality of life of patients monitored for cancer who practice an adapted physical activity: rugby for health. J Cancer Res Clin Oncol 2022; 148: 425-439.
https://doi.org/10.1007/s00432-021-03621-7 DOI: https://doi.org/10.1007/s00432-021-03621-7
Nightingale TE, Heneghan NR, Fenton SAM, Veldhuijzen van Zanten J, Jutzeler CR. Physical activity and health-related quality of life in adults with a neurologically-related mobility disability during the COVID-19 pandemic: an exploratory analysis. Front Neurol 2021; 12: 699884.
https://doi.org/10.3389/fneur.2021.699884 DOI: https://doi.org/10.3389/fneur.2021.699884
Goverover Y, Kim G, Chen MH, Volebel GT, Rosenfeld M, Botticello A, et al. The impact of the COVID-19 pandemic on engagement in activities of daily living in persons with acquired brain injury. Brain Inj 2022; 36: 183-190.
https://doi.org/10.1080/02699052.2022.2043441 DOI: https://doi.org/10.1080/02699052.2022.2043441
The National Public Health Survey 2020. Norwegian Institute of Public Health. Available from: https://www.fhi.no/nyheter/2021/pandemien-har-hatt-storst-utslag-pa-fysisk-aktivitet-og-kosthold-hos-yngre-/
Park AH, Zhong S, Yang H, Jeong J, Lee C. Impact of COVID-19 on physical activity: a rapid review. J Glob Health 2022; 12: 05003.
https://doi.org/10.7189/jogh.12.05003 DOI: https://doi.org/10.7189/jogh.12.05003
Hansen T, Sevenius Nilsen T, Knapstad M, Skirbekk V, Skogen J, Vedaa Ø, et al. Covid-fatigued? A longitudinal study of Norwegian older adults' psychosocial well-being before and during early and later stages of the COVID-19 pandemic. Eur J Ageing 2022; 19: 463-473.
https://doi.org/10.1007/s10433-021-00648-0 DOI: https://doi.org/10.1007/s10433-021-00648-0
Ribeiro de Souza F, Sales M, Rabelo Laporte L, Melo A, Manoel da Silva Ribeiro N. Body structure/function impairments and activity limitations of post-stroke that predict social participation: a systematic review. Top Stroke Rehabil 2023; 30: 589-602.
https://doi.org/10.1080/10749357.2022.2095086 DOI: https://doi.org/10.1080/10749357.2022.2095086
Oliveira MR, Sudati IP, Konzen VM, de Campos AC, Wibelinger LM, Correa C, et al. Covid-19 and the impact on the physical activity level of elderly people: a systematic review. Exp Gerontol 2022; 159: 111675.
https://doi.org/10.1016/j.exger.2021.111675 DOI: https://doi.org/10.1016/j.exger.2021.111675
Sepúlveda-Loyola W, Rodríguez-Sánchez I, Pérez-Rodríguez P, Ganz F, Torralba R, Oliveira DV, et al. Impact of social isolation due to COVID-19 on health in older people: mental and physical effects and recommendations. J Nutr Health Aging 2020; 24: 938-947.
https://doi.org/10.1007/s12603-020-1500-7 DOI: https://doi.org/10.1007/s12603-020-1500-7
Tomioka K, Kurumatani N, Hosoi H. Association between social participation and 3-year change in instrumental activities of daily living in community-dwelling elderly adults. J Am Geriatr Soc 2017; 65: 107-113.
https://doi.org/10.1111/jgs.14447 DOI: https://doi.org/10.1111/jgs.14447
Singam AY, C; Tham, K; von Koch, L. Participation in complex and social everyday activities six years after stroke: predictors for return to pre-stroke Level. PLoS One 2015; 10: e0144344.
https://doi.org/10.1371/journal.pone.0144344 DOI: https://doi.org/10.1371/journal.pone.0144344
Kuvås KR, Saltvedt I, Aam S, Thingstad P, Ellekjær H, Askim T. The risk of selection bias in a clinical multi-center cohort study. results from the Norwegian Cognitive Impairment After Stroke (Nor-COAST) Study. Clin Epidemiol 2020; 12: 1327-1336.
https://doi.org/10.2147/CLEP.S276631 DOI: https://doi.org/10.2147/CLEP.S276631
Krzych Ł J, Lach M, Joniec M, Cisowski M, Bochenek A. The Likert scale is a powerful tool for quality of life assessment among patients after minimally invasive coronary surgery. Kardiochir Torakochirurgia Pol 2018; 15: 130-134.
https://doi.org/10.5114/kitp.2018.76480 DOI: https://doi.org/10.5114/kitp.2018.76480
Dyrstad SM, Hansen BH, Holme IM, Anderssen SA. Comparison of self-reported versus accelerometer-measured physical activity. Med Sci Sports Exerc 2014; 46: 99-106.
https://doi.org/10.1249/MSS.0b013e3182a0595f DOI: https://doi.org/10.1249/MSS.0b013e3182a0595f
Ferrari GLM, Kovalskys I, Fisberg M, Gómez G, Rigotti A, Sanabria LYC, et al. Comparison of self-report versus accelerometer - measured physical activity and sedentary behaviors and their association with body composition in Latin American countries. PLoS One 2020;15: e0232420.
https://doi.org/10.1371/journal.pone.0232420 DOI: https://doi.org/10.1371/journal.pone.0232420
Bovim MR, Indredavik B, Hokstad A, Cumming T, Bernhardt J, Askim T. Relationship between pre-stroke physical activity and symptoms of post-stroke anxiety and depression: An observational study. J Rehabil Med 2019; 51: 755-760.
https://doi.org/10.2340/16501977-2610 DOI: https://doi.org/10.2340/16501977-2610
Olsson OA, Persson HC, Alt Murphy M, Sunnerhagen KS. Early prediction of physical activity level 1 year after stroke: a longitudinal cohort study. BMJ Open 2017; 7: e016369.
https://doi.org/10.1136/bmjopen-2017-016369 DOI: https://doi.org/10.1136/bmjopen-2017-016369
Viktorisson A, Andersson EM, Lundström E, Sunnerhagen KS. Levels of physical activity before and after stroke in relation to early cognitive function. Sci Rep 2021; 11: 9078.
https://doi.org/10.1038/s41598-021-88606-9 DOI: https://doi.org/10.1038/s41598-021-88606-9
Jiménez-Pavón D, Carbonell-Baeza A, Lavie CJ. Physical exercise as therapy to fight against the mental and physical consequences of COVID-19 quarantine: special focus in older people. Prog Cardiovasc Dis 2020; 63: 386-388.
https://doi.org/10.1016/j.pcad.2020.03.009 DOI: https://doi.org/10.1016/j.pcad.2020.03.009
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