Partial home confinement during the COVID-19 pandemic, physical function, and physical activity in patients with symptomatic lower extremity peripheral artery disease

The coronavirus disease 2019 (COVID-19) pandemic has forced people to stay at home and change their daily activity habits. This has severely increased physical inactivity, generating a rapid unfavorable neuromuscular and cardio-metabolic condition leading to decreased physical function.1 As exercise is first-line therapy in symptomatic patients with symptomatic lower extremity peripheral artery disease (PAD),2–5 these individuals could be particularly affected during the COVID-19 pandemic. In Switzerland, measures to counteract the spread of COVID-19 were ‘light’ (partial confinement with no prohibition on leaving home). However, the impact of partial confinement on physical function and physical activity in patients with symptomatic PAD remains to be determined. This study investigated the impact of partial confinement on physical function and physical activity in patients with PAD who previously completed a supervised exercise training (SET) program. We hypothesized that physical function and activity would be decreased post-partial compared to pre-partial confinement. Symptomatic patients with PAD having completed a 3-month SET program6 were included in the study. Following SET, patients have three follow-up (FU) visits: post-SET, 6 months (FU6), and 12 months (FU12). Patients were divided into two groups. (1) Study group (SG): patients who completed SET between November 2018 and February 2020, and underwent either the post-SET, FU6, or FU12 between November 2019 and February 2020 (prepartial confinement visit); these patients were all seen again at the end of the partial confinement period (May/June 2020). In the Vaud canton, between March 16 and May 11, the Swiss government decided to close restaurants, bars, non-essential shops, libraries, theatres, cinemas, and fitness centers. During this period, there was no strict prohibition to move from home, but people were strongly encouraged to stay at home as much as possible, to maintain social distancing, and avoid meeting with more than five people. (2) Comparator group (COMP): patients who completed SET between October 2016 and September 2018 and underwent the post-SET as well as FU6 and FU12 by September 2019. The study was approved by the local ethics committee and was conducted according to the Declaration of Helsinki. Informed consent was obtained for all participants. Physical function was assessed using a 6-minute walk test to determine the 6-minute walking distance (6MWD),7 the short physical performance battery (SPPB),8 and the stair climbing test (SCT). 9 During the consultation, patients in the SG were asked to recall their physical activity behavior 4 weeks before and during partial confinement. Three domains were investigated: (1) walking for exercise; (2) other exercise modalities (cycling, resistance training, swimming, gym); and (3) daily physical activities (household, childcare, gardening, or other activities reported by the patients). The mean number of minutes per week practiced in each of these domains was assessed. Owing to missing data, linear mixed models (group (SG vs COMP) × time (before SET vs pre-partial confinement/ FU6 vs post-partial confinement/FU12)) were performed (Table 1). When a significant interaction effect was revealed, significance was determined using multiple comparisons. Thirty-three symptomatic patients with PAD were included (SG (n = 16; 68.4 ± 2.3 y, 26.4 ± 1.4 kg·m–2, ankle–brachial index (ABI): 0.81 ± 0.05); COMP group (n = 17; 63.4 ± 2.5 y, 28.0 ± 1.3 kg·m–2, ABI: 0.82 ± 0.04)). None of the patients in the SG had symptoms of COVID-19 or had any new health-related diseases. Also, no patients had supervised exercise intervention during the Partial home confinement during the COVID-19 pandemic, physical function, and physical activity in patients with symptomatic lower extremity peripheral artery disease