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

Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Universidade de São Paulo, São Paulo, Brazil. Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, HC-FMUSP, Av. Dr. Arnaldo, 455, 3° andar, São Paulo, SP, 01246-903, Brazil. Instituto da Criança e do Adolescente (ICr), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, HC-FMUSP, São Paulo, Brazil. Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil. Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Universidade de São Paulo, São Paulo, Brazil. gualano@usp.br. Rheumatology Division, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, HC-FMUSP, Av. Dr. Arnaldo, 455, 3° andar, São Paulo, SP, 01246-903, Brazil. gualano@usp.br. Food Research Center, Universidade de São Paulo, São Paulo, Brazil. gualano@usp.br.

Pediatric rheumatology online journal. 2021;(1):159
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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.