COVID-19 lockdowns reduce exercise in CIED patients

Patients with cardiac implantable electronic devices (CIED) see lower levels of physical activity during the COVID-19 pandemic, especially during a period of lockdown, according to a recent Germany study. While younger patients resume exercise with the easing of restrictions, older patients tend to remain inactive.

“Our analysis covers the entire year 2020 including time-periods of eased restrictions and a second lockdown period and thus reflects how the pandemic evolved throughout the year,” the researchers said. “Importantly, in times of eased restrictions, activity levels remained depressed in the study population, implicating a persistent change of daily life attributed to the pandemic.”

A total of 147 CIED patients (median age 69 years, 76.2 percent men) participated in the present remote-monitoring study. Over a 338-day period during the COVID-19 pandemic, physical activity, heart rate, and implantable cardioverter defibrillator (ICD)-related therapies were assessed. Analysis was divided into six time intervals, each defined by the public health interventions in place to combat COVID-19.

Over a median monitoring period of 660 days, the researchers detected significant variations in physical activity patterns as compared with the year prior. In general, physical activity was lower in 2020, comprising an average of 11.49 percent of the day, than in 2019, when participants spent a mean of 12.43 percent of their day in exercise (p<0.0001). [PLoS One 2022;doi:10.1371/journal.pone.0269816]

Whereas under normal circumstances, exercise hours would start increasing by the start of spring, no such effect was reported in 2020. Instead, under COVID-19, device-derived physical activity remained low throughout the spring, when strict lockdowns were imposed, and started increasing only near the start of the summer, when public health restrictions were slowly eased.

During both years, patients performed less exercise during winter. However, the decline from previous seasons was more pronounced in 2020, likely driven by the co-occurrence of increased restrictions and eventual imposition of a second lockdown.

Individual comparisons between the two years showed that physical activity was significantly lower in all time intervals assessed, with such a discrepancy peaking in the two lockdown periods (p<0.0001 for both).

Stratifying the analysis by age group also showed notable differences in physical activity habits. Participants who were ≤70 years of age showed significantly greater physical activity for both years than their older counterparts (p<0.0001 for both).

Similarly, older participants were significantly more inactive across all time intervals in 2020 than in 2019. In contrast, between-year physical activity differences in younger CIED patients were only statistically significant during lockdown periods. This pattern suggests that in general, younger patients, but not older comparators, resumed exercise when restrictions were eased.

“Given the persistent and strongest reduction of physical activity levels among the elderly, motivation and guided activation of this vulnerable population are paramount to prevent further health impairments during the ongoing pandemic,” the researchers said, pointing out that physicians have an important role to play in promoting exercise to older patients and in helping them find ways to remain active despite public health restrictions.

“Future studies are necessary to investigate long-term effects of physical inactivity during the pandemic on cardiovascular health in general and arrhythmia risk in particular,” they added.