Even a mild case of COVID-19 can result in higher odds of decreased mobility and physical function for adults aged 50 years and older, according to a new national study, putting a spotlight on how hundreds of thousands could need physical rehabilitation due to this pandemic.
The study, published in the journal JAMA Network Open on Wednesday, looked at data on the mobility of more than 24,000 older Canadians across the country during 2020.
And there was a marked difference between those who contracted COVID-19 and those who hadn’t, Marla Beauchamp, an assistant professor at McMaster University and lead author of the study, told CTVNews.ca.
“People that had COVID-19 had about a twofold higher odds of having a worsening of their mobility or their physical function from their COVID-19,” Beauchamp, who is also a Canada Research Chair in mobility and aging and chronic disease, said. “And this was above and beyond what we saw in the background population.”
This ranged from experiencing difficulty performing household activities, to walking up and down stairs, to even just standing up from a chair.
And 94 per cent of those who had COVID-19 in the study didn’t have a serious case — only seven people reported that they had been hospitalized at some point due to the virus.
“Our data does show that in people that have mild to moderate COVID-19, there is still a risk for mobility problems, physical function problems that persist after the COVID-19 diagnosis,” Beauchamp said. “And so a substantial proportion of people might in fact need some kind of support to get back to their […] physical functioning levels that they were at before they contracted COVID-19.”
There can be a sense that mild cases of COVID-19 are nothing to worry about. But this research indicates that for some, it can have lasting effects.
“If about 18 per cent of people that had COVID-19 in our study had a worsening ability to move around in their home, I mean, that's pretty serious, when people can't even do their day to day activities,” Beauchamp said.
Previous studies have largely focused on those with severe cases of COVID-19 and older adults living in congregate settings such as long-term care, she pointed out, while this study looked at older adults living independently in their communities.
Researchers used data from the Canadian Longitudinal Study on Aging (CLSA) COVID-19 study, which originally recruited participants aged 45-85 years in 2011-2015 to form a cohort that they could follow in order to study the various effects of aging. In April 2020, the CLSA launched a COVID-19-specific survey to study its effects among this population, collecting data over a nine month period. This data is what researchers in Wednesday’s study accessed to measure whether those with COVID-19 saw a drop in mobility and physical activity that exceeded what we would expect naturally with aging.
More than 24,000 people participated in the CLSA COVID-19 survey. Out of this group, 2,748 participants had confirmed or probable or suspected COVID-19, the overwhelming majority of whom had mild to moderate cases of COVID-19 that did not require hospitalizations.
The survey had participants report whether they had a case of COVID-19, with a suspected case being a person who had a close contact with someone with COVID-19 and experienced symptoms, but hadn’t received a test to confirm.
Beauchamp said that they had anticipated that the virus would have an impact on the mobility of those who contracted it, which is why they sought to study it in the first place.
“What we didn't expect probably was the extent of it and that it was sort of consistent across the different mobility domains that we looked at,” she said. “Especially given that our sample was predominantly non-hospitalized.”
The pandemic brought with it challenges to everyone’s general mobility, she said, with a quarter of all participants reporting that their physical function had declined. But those with COVID-19 saw a bigger decline across all of the specific functions the survey asked about.
“What we showed is that there was a higher proportion of people that had an onset of difficulty after receiving a COVID diagnosis than general onset of difficulty that we would observe anyways with aging and because of public health restrictions and things like that,” Beauchamp said.
One question asked about participants’ ability to walk 2-3 blocks, and 19 per cent of those who had COVID-19 reported increased difficulty, compared to 10 per cent of those who didn’t have it, she explained.
The study suggests that quarantining in order to try to contain the virus is something that may contribute to a decline in mobility. Beauchamp clarified that while this is something that could be adding to the problem, it’s not something we should be seeking to change, just a reality that we need to take into account.
“Those are completely necessary requirements from a public health perspective to control the spread of the virus,” she said. “[But] especially for an older person, if you spend a lot of time in isolation, and you're not moving much, you can become weak quite quickly, which we already know from other work.”
If a person is going through quarantine and feels well enough to move around, that is something that could help keep their mobility up, she said.
“This could be, for example, getting in and out of a chair a few times, going up and down the stairs, if you can do that safely, there are some things you could do inside your home just to make sure that you're getting some exercise and you're moving your muscles a little bit,” she said.
She added that it was a little worse for those who were older and who had chronic conditions, or were of lower income, providing a hint of where to start in terms of planning how to target rehabilitation efforts.
“But those factors in and of themselves don't explain all of it,” she said. “We still don't know why some people have these sort of persisting deficits and some people don’t.”
It’s something that needs to be researched more in order to build up the supports that will be needed to help people recover from these lingering effects of the pandemic, she said.
"We definitely don't have the resources across Canada,” she said. “We hardly have enough rehabilitation for example, for existing patients that have chronic lung disease. So it's definitely a shortage.”
While more research is starting to come out about long COVID and the lingering impacts of the virus, there needs to be more that focuses on the actual effects on the quality of life of the patients involved, she suggested.
“I do think that we need to sort of go beyond persistence of symptoms,” she said. “And this study is one example, because we know that people's ability to move and to get to the places they value is a really critical aspect of health.
“There is a non-trivial proportion of people that might need rehabilitation or some form of support to get back to their preexisting functioning levels. And so we need to study more ways to do that and we need to have more services available for these kinds of patients.”
