Benefits and harms of exercise therapy in people with multimorbidity: A systematic review and meta-analysis of randomised controlled trials

Abstract

Objectives To investigate the benefits and harms of exercise therapy on physical and psychosocial health in people with multimorbidity. Design Systematic review of randomised controlled trials (RCTs). Data sources MEDLINE, EMBASE, CENTRAL and CINAHL from 1990 to April 20th, 2020 and Cochrane reviews on the effect of exercise therapy for each of the aforementioned conditions, reference lists of the included studies, the WHO registry and citation tracking on included studies in Web of Science. Eligibility criteria for study selection RCTs investigating the benefit of exercise therapy in people with multi-morbidity, defined as two or more of the following conditions: osteoarthritis (of the knee or hip), hypertension, type 2 diabetes, depression, heart failure, ischemic heart disease, and chronic obstructive pulmonary disease on at least one of the following outcomes: Health-related quality of life (HRQoL), physical function, depression or anxiety. Summary and quality of the evidence Meta-analyses using a random-effects model to assess the benefit of exercise therapy and the risk of non-serious and serious adverse events according to the Food and Drug Administration definition. Meta-regression analyses to investigate the impact of pre-specified mediators of effect estimates. Cochrane ‘Risk of Bias Tool’ 2.0 and the GRADE assessment to evaluate the overall quality of evidence. Results Twenty-three RCTs with 3363 people, testing an exercise therapy intervention (mean duration 13.0 weeks, SD 4.0) showed that exercise therapy improved HRQoL (standardised mean difference (SMD) 0.37, 95 % CI 0.14 to 0.61) and objectively measured physical function (SMD 0.33, 95 % CI 0.17 to 0.49), and reduced depression symptoms (SMD -0.80, 95 % CI -1.21 to -0.40) and anxiety symptoms (SMD -0.49, 95 % CI -0.99 to 0.01). Exercise therapy was not associated with an increased risk of non-serious adverse events (risk ratio 0.96, 95 % CI 0.53-1.76). By contrast, exercise therapy was associated with a reduced risk of serious adverse events (risk ratio 0.62, 95 % CI 0.49 to 0.78). Meta-regression showed that increasing age was associated with lower effect sizes for HRQoL and greater baseline depression severity was associated with greater reduction of depression symptoms. The overall quality of evidence for all the outcomes was downgraded to low, mainly due to risk of bias, inconsistency and indirectness. Conclusions Exercise therapy appears to be safe and to have a beneficial effect on physical and psychosocial health in people with multimorbidity. Although the evidence supporting this was of low quality, it highlights the potential of exercise therapy in the management and care of this population.

Effects of Individualized Aerobic Exercise Training on Physical Activity and Health-Related Physical Fitness among Middle-Aged and Older Adults with Multimorbidity: A Randomized Controlled Trial

“…This study has several unavoidable limitations including the relatively small sample size, the short follow up duration, and the limited human physiological parameters that were measured. Although the effectiveness of the aerobic exercise training can be evaluated after 12 weeks in most studies [ 15 ], we designed an intervention wherein we combined the training program with motivational interviewing; hence, follow-up on adherence to physical activity recommendations and behavioral change-related outcomes in a longer period (24–48 weeks) with more repeat measures is recommended [ 26 ]. Moreover, although we had evaluated the gold standard outcomes of the cardiorespiratory fitness, other parameters such as physical functioning and quality of life are also important to be addressed.…”

“…Previous evidence showed that the benefits of individualized aerobic exercise training or therapy could be beneficial for not only healthy middle-aged and older adults [ 11 ], patients with hemodialysis [ 12 ], cancer [ 13 ], but also of those with other chronic diseases [ 14 ]. Based on a systematic review, for patients with multimorbidity, exercise interventions could improve physical function, reduce depression and anxiety symptoms, and improve health-related quality of life [ 15 ]. However, these studies rarely discussed the outcomes of physical activity (PA) and health-related physical fitness.…”

“…Aerobic exercise is safer and can lower the susceptibility to certain preventable chronic diseases, decrease mortality, and improve health in middle-aged and older adults [ 15 ]. Aerobic exercise training should be individualized and tailored to the physiological and psychological status of each individual with multimorbidity [ 16 ].…”

Synergistic effects of hip/knee osteoarthritis and comorbidities on mobility and self-care limitations among older adults: Cross-sectional analysis of the Oxford pain, Activity and Lifestyle study

“…Physical therapy interventions should focus on increasing physical activity and structured, supervised exercise programs as these have been shown to benefit both hip/knee OA and anxiety or depressive symptoms. 19,20,51,52 Evidence suggests that many types of exercise are beneficial for both hip/knee OA and anxiety or depression, so choice should be guided by patient preference and goals. 19,20,51,53 Patients with anxiety or depressive symptoms may particularly lack motivation to exercise.…”

“…19,20,51,52 Evidence suggests that many types of exercise are beneficial for both hip/knee OA and anxiety or depression, so choice should be guided by patient preference and goals. 19,20,51,53 Patients with anxiety or depressive symptoms may particularly lack motivation to exercise. 54 Incorporating principles of behaviour change including social support, self-efficacy, active choices, goal setting and positive reinforcement may be beneficial for maximizing patient participation and adherence to exercise long-term.…”