Home-based exercise program for adolescents with juvenile dermatomyositis quarantined during COVID-19 pandemic: a mixed methods study

Abstract

Background Exercise has been suggested to prevent deterioration of health-related quality of life (HRQL) and overall health in pediatric rheumatologic diseases during the COVID-19 pandemic. Herein we describe the effects of a 12-week, home-based, exercise program on overall health and quality of life among quarantined patients with juvenile dermatomyositis (JDM). Method This prospective, quasi-experimental, mixed methods (qualitative and quantitative) study was conducted between July and December 2020, during the most restricted period of COVID-19 pandemic in Brazil. The home-based exercise program consisted of a 12-week, three-times-a-week, aerobic and strengthening (bodyweight) training program. Qualitative data were systematically evaluated. Strengths and Difficulties Questionnaire (SDQ), Pediatric Quality of Life Inventory (PedsQOL) and Pittsburgh Sleep Quality Index (PSQI) evaluate symptoms of mental health disorder, HRQL, and quality of sleep. Findings 11 patients (out of 27) met the inclusion criteria (91% female; mean ± SD age: 13.5 ± 3.2 years). Adherence to the intervention was 72.6%. Barriers to exercise involved poor internet connectivity, excessive weekly sessions, and other commitments. Even though not statistically significant, Self-report SDQ subscales Total Difficulties Score, Emotional Problems Score, and PedsQOL School Functioning Score improved after intervention (− 2.4; 95%confidence interval [CI] -5.1; 0.2, p = 0.06; − 1.0; 95%CI -2.2; 0.2, p = 0.09 and; 11.7; 95%CI -2.5; 25.8, p = 0.09, respectively). Remaining SDQ subscales were not altered. Six themes emerged from patients’ and parents’ comments (qualitative results). Patients engaged in exercise reported other health-related benefits including increased motivation, concentration and strength. Interpretation A home-based exercise program was associated with qualitative perceptions of improvements in overall health and HRQL by quarantined adolescents with JDM during COVID-19 pandemic. Lessons from this trial may help developing interventions focused on tackling physical inactivity in JDM.

The effectiveness of exercise programs accessible from home on children's and adolescents' emotional well‐being: Systematic review & meta‐analysis

“…Astley and colleagues' 20 study found no change in SDQ scores or Emotional Functioning scale in the PedsQL, whilst Wong and colleagues 23 reported significantly decreased SDQ scores in the intervention group. Furthermore, the remaining three studies that looked at anxiety‐related measures all reported results favoring the intervention.…”

“…Five of the nine identified articles involved live online exercise programs or pre‐recorded videos that were accessible online or through apps 15–17,20,23 . Four of these were conducted during home schooling or lockdowns due to the COVID‐19 pandemic, whilst the study by Wong et al 23 aimed to increase physical activity in children and adolescents using a mobile app, pre‐pandemic.…”

Use of Frame Running for Adolescent Athletes With Movement Challenges: Study of Feasibility to Support Health and Participation

“…It was feasible for one coach to lead several athletes. In addition, we were not limited by the physical distances of where athletes and coaches were located and athletes could participate from their own home, which lead to high convenience as has been shown in other studies (Rowland et al, 2016 ; Astley et al, 2021 ; Calcaterra et al, 2021 ; Weiss et al, 2021 ). However, it was difficult at times to fully engage remote athletes in a way that was both safe and challenging without anyone close by to supervise for their specific movement challenges.…”

Emotional, hyperactivity and inattention problems in adolescents with immunocompromising chronic diseases during the COVID-19 pandemic

“…Another advantage of this study was the prompt access to a pediatric multidisciplinary team, especially for adolescents with physical and mental impacts, such as pediatric psychiatrists or psychologists, nurses, nutritionists, social workers, and physical educators. 16 , 39 , 40 …”