Entry Type: Initiative & Success Story	Status: Online
State:	Submitted: 2020
Domain Addressed: Environmental Approaches

More than 23 percent of adults in the U.S. have arthritis.¹ This disease has high comorbidity, commonly occurring with other diseases such as diabetes, heart disease, and obesity, which can complicate the management of arthritis and co-occurring conditions.²

Research has shown physical activity, specifically walking, can reduce harmful arthritis symptoms.³ According to the Centers for Disease Control and Prevention (CDC), low-impact and “joint-friendly” activities, such as brisk walking and flexibility exercises, do not put stress on the joints. Repeated exercise over time can decrease arthritis pain while increasing muscle function and overall quality of life. Other benefits of participating in regular physical activity include reduced anxiety and depression. Research suggests such improvements in mood are caused by increased blood flow to the brain and circulation around the body.⁴

Physical and mental wellness are particularly important for warding off depression and anxiety, such as that which can arise during a global pandemic. Just a few months into the pandemic, data indicated a high prevalence of mental distress in countries around the world.⁵ In May 2020, the Director-General of the World Health Organization remarked about the impact of the pandemic on people’s mental health, calling it “extremely concerning.”⁶
A recently-published study confirms this, showing a significant increase in stress-induced cardiomyopathy, or “broken heart syndrome,” during the early months of the coronavirus (SARS-CoV-2 or COVID-19) pandemic.5 The syndrome is triggered by stressful events and occurs when muscles in the heart weaken, leading to symptoms that mimic a heart attack, such as shortness of breath and chest pain.⁵

Even those not infected with COVID-19 are experiencing the stressors of the pandemic. The study’s lead cardiologist, Dr. Ankur Kalra, states, “emotional distancing is not healthy.”⁵ Top stressors concluded from the study include strict social distancing rules, imposed quarantine, and lack of social interaction.⁵

Lack of social interaction is regarded as a public health risk affecting a majority of older adults. In the U.S. of the 25 percent of community-dwelling older adults that are considered to be socially isolated, 43 percent report feeling lonely.⁷ The COVID-19 pandemic is only increasing feelings of loneliness within this age group, with “safer at home” orders further limiting social interaction.7 Restrictions were established to minimize the spread of the virus, particularly for most at-risk groups including older adults and those with preexisting health conditions.⁸

Though the effects of the novel coronavirus on those with preexisting conditions are still being assessed, some research suggests that those who suffer from rheumatoid arthritis (RA) may be more at risk for contracting COVID-19 due to their weakened immune system from immunosuppressive therapy treatments and presence of comorbidities.⁹ Their health status also puts those who have RA at risk for developing more severe symptoms.⁹ In addition to these physical health effects, people living with arthritis “are experiencing a substantially higher increase in anxiety and depression compared to before the coronavirus pandemic,” according to the Arthritis Foundation Live Yes! INSIGHTS Program.¹⁰ 

Participating in a physical activity program, whether it’s self-directed or in a group setting with appropriate safety protocols, is one example of a healthy behavior that can be done safely during these unprecedented times. According to the CDC, community-based, structured physical activity programs are proven to not only reduce arthritis symptoms, but also to teach participants how to effectively manage their disease through moderate exercise.¹¹ The CDC recognizes several national activity-based programs for treatment of arthritis through physical activity including Walk With Ease (WWE), which provides participants the opportunity to engage in individualized or group-based walking.¹¹

Sources:
1. https://www.cdc.gov/chronicdisease/resources/publications/factsheets/arthritis.htm#:~:text=Fast%20Facts,arthritis%20report%20severe%20joint%20pain.
2. https://www.cdc.gov/arthritis/data_statistics/comorbidities.htm
3. https://www.cdc.gov/arthritis/basics/physical-activity-overview.html#:~:text=Low%2Dimpact%20aerobic%20activities%20do,group%20exercise%20classes%2C%20and%20dancing.
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470658/
5. https://www.cnn.com/2020/05/14/health/un-coronavirus-mental-health/index.html
6. https://www.cnn.com/2020/07/09/health/broken-heart-syndrome-coronavirus-wellness/index.html
7. https://ghrp.biomedcentral.com/articles/10.1186/s41256-020-00154-3
8. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/older-adults.html
9. https://www.medicalnewstoday.com/articles/rheumatoid-arthritis-and-covid-19
10. https://www.arthritis.org/care-connect/coronavirus-survey
11. https://www.cdc.gov/arthritis/interventions/physical-activity.html

By September 29, 2020, NACDD will increase the availability of and participation in arthritis appropriate evidence-based interventions (AAEBIs) through the implementation of an effective intervention, dissemination, and delivery model.  The anticipated outcomes of these efforts include sustained delivery of AAEBIs and increased reach of individuals with AAEBIs.

Prior to the coronavirus pandemic, the NACDD Arthritis Team worked with a group of organizations across the country funded to implement and spread the reach of WWE in their respective communities (hub grantees). Each grantee created a workplan that included engaging local partners in an effort to reach a goal or specific number of individuals with the program.  

As a result of the COVID-19 pandemic and related “safer at home” orders, nearly every grantee was forced to re-evaluate their WWE workplan. Many grantees experienced a shift in their day-to-day work to support state or local COVID-19 response efforts. Unfortunately, nearly every grantee’s plans related to WWE were put on pause or canceled altogether.

NACDD collected information about the impact of COVID-19 on hub grantees and their respective workplans through routine conference calls, two Community of Practice calls, and the submission of monthly or quarterly progress reports. Additionally, grantees report the number of program participants and program completers in a spreadsheet tracking tool designed specifically for this project. 

Despite COVID-19-related challenges, the WWE hub grantees were resilient. They shifted direction, revised plans, and by summer’s end, were back to planning or already implementing WWE in a new way. During the reporting period from March 1, 2020 through mid-September, the hub grantees, inclusive of those named in this success story, as well as the grantees from the Greater Flint Health Coalition (GFHC) in Flint, Michigan and Baylor Scott & White Health (BSW) in Dallas, Texas, collectively engaged more than 500 participants.

COVID-19 required the South Dakota State University Extension (South Dakota) in Brookings, South Dakota to transition its in-person group classes to a remote self-directed format. Despite this change in venue and the staff’s shift to working remotely, the team maintained twice a week email communication with participants enrolled in its group WWE courses. South Dakota also added an optional online session using Zoom. The online session involved a 20-minute discussion of that week’s lesson led by the same group leader participants were used to seeing. Attendance in the optional online session was good and retention remained so high that South Dakota began another cohort of participants following the same format.

Bernalillo County Community Health Council (Bernalillo) in Albuquerque, New Mexico attempted to offer virtual WWE sessions using an acquired Meetup subscription. The tool was successful in getting the word out, engaging more than 30 people; however, none converted to participating in the WWE program. Even with COVID-19 limitations, Bernalillo continued an ongoing collaboration with the University of New Mexico’s Pathways Program, which is “designed to reduce unmet needs, address health inequities, and improve the overall health of the residents of Bernalillo County.” Together, the two organizations agreed that offering WWE in the group format would be better for the target audience and established protocols that included testing participants for COVID-19 and helping participants maintain a safe distance from each other. Bernalillo purchased 30 books as well as stretch bands and, as far as NACDD is aware, was the first grantee to initiate an in-person group cohort during the spring/summer of 2020.

Grantee contact Julia Chevan from Springfield College Department of Physical Therapy (Springfield College) in Springfield, Massachusetts is a very active partner in the greater Springfield community and serves as a member of the local age-friendly advisory council. Springfield is a John A. Hartford Foundation-designated age-friendly city, meaning it demonstrates a commitment to improving quality of life for all residents — with a focus on the older population. As the coronavirus pandemic derailed Springfield College’s initial plans of working through the state’s library system, Julia found a new opportunity to market the program by including a WWE book in “social isolation kits” being compiled and distributed by the age-friendly advisory council.  The social isolation kit contents aimed to link seniors with access to health, food, and safety resources, as well as information about healthy living and COVID-19.  

Based on the success of its new online lesson, South Dakota is considering offering an entirely virtual WWE program in the future. The team envisions that participants would log in to the online sessions or watch a recorded version of it and then walk on their own. South Dakota is considering this as an approach for offering the program in more remote, rural areas of the state where hosting a group class would likely not be feasible.

While Bernalillo was able to get 34 people to view and join the Meetup group, no one wanted to engage further by enrolling in WWE. Bernalillo canceled the subscription and regrouped. Even though its attempt at virtual sessions was unsuccessful, Bernalillo proved that with the right partner and safety protocols in place, WWE can still be provided in a small group setting during a pandemic.

To date, the WWE books distributed through the Springfield social isolation kits were not well received.  Feedback to Julia was that participants were more interested in information about food distribution and other services, but NACDD was proud of the innovative approach to marketing the program during an unprecedented time. If a similar effort were undertaken in the future, Julia recommends adding a flyer about the program as opposed to the book. That being said, now that the fall semester has begun and students have returned to campus, Julia has engaged more than 42 student health coaches to make follow-up calls to the participating community members who received social isolation kits. Perhaps with a health coaching call, seniors may be more interested in the program.

As the pandemic continues to impede standard operations, the NACDD Arthritis Team will continue to offer technical assistance and guidance to grantees as they implement their revised work plans and offer WWE in creative ways.