The impact of covid-19 shielding on levels of Physical activity and health-related quality of Life in COPD patients following pulmonary Rehabilitation

ABSTRACT

Introduction To prevent infection during the peak of the COVID-19 pandemic, COPD patients were instructed to 'shield', resulting in restrictions to usual daily activities, potentially negating health benefits attained during pulmonary rehabilitation (PR). The aim of this study was to determine the impact of a shielding period on physical activity levels and health-related quality of life (HRQoL) in COPD patients who completed a course of supervised PR before shielding in March 2020 Methods COPD patients who completed an 8-week PR course between January and March 2020 were enrolled into this single centre, observational cohort study. Physical activity was measured using accelerometry (Actigraph wGT3X) and the Clinical Visit of Proactive Physical Activity in COPD (CPPAC) instrument (that captures the domains of amount and difficulty of physical activity;Gimeno-Santos et al. ERJ 2015) in the week preceding PR, the week following completion of PR and for a week 3 months following completion of PR during the shielding period (April to July 2020). Additionally, assessment of HRQoL (COPD Assessment Test [CAT] and Clinical COPD Questionnaire [CCQ]) and psychological wellbeing (Hospital Anxiety and Depression Scale [HADS]) was undertaken. Results In ten COPD patients (FEV1 55±23% predicted), a significant and clinically meaningful decrease in daily steps was shown from post-PR to shielding (4129±2245 versus 2508±1186 steps/day;p=0.030), as well as pre-PR to shielding (3681±2025 versus 2508±1186 steps/day;p=0.015). Likewise, there was a significant and clinically meaningful worsening in the C-PPAC score from post-PR to shielding (68 ±13 versus 59±13 points;p=0.060), but not pre-PR to shielding (61±11 versus 59±13 points;p=1.000). There were no statistically or clinically meaningful changes in HADS and CAT scores. However, the worsening in CCQ scores from post-PR to shielding did exceed clinically meaningful margins (±0.4 points) for both functional (+0.5 points) and mental domains (+0.7 points). Conclusions In COPD, the shielding period had a negative impact on physical activity levels, evidenced by reduced daily steps compared to not only post-PR, but also pre-PR. This decline below baseline values could have led to further physical deconditioning, potentially reversing some of the benefits gained during PR and worsening long term disease-related outcomes.