CLINICAL OUTCOMES FOLLOWING EXERCISE REHABILITATION IN PEOPLE WITH MULTIMORBIDITY: A SYSTEMATIC REVIEW

Objective To determine the effectiveness of exercise rehabilitation in people with multimorbidity. Exercise capacity was the primary outcome. Secondary outcomes were: health-related quality of life, activities of daily living, cardiometabolic outcomes, mental health outcomes, symptom scores, resource utilization, health behaviours, economic outcomes, and adverse events. Data sources A search was conducted in MEDLINE, CINHAL, EMBASE, and Cochrane Central Register of Controlled Trials databases. Study selection and extraction Randomized and non-randomized controlled trials and cohort studies of exercise rehabilitation vs any comparison in people with multimorbidity. Data synthesis Forty-four reports (38 studies) were included. Rehabilitation ranged from 8 weeks to 4 years, with 1–7 sessions of rehabilitation weekly. Exercise included aerobic and resistance, limb training, aquatic exercises and tai chi. Compared with usual care, exercise rehabilitation improved 6-min walk distance (weighted mean difference (WMD) 64 m, 95% CI 45–82) and peak oxygen consumption (WMD 2.74 mL/kg/min, 95% CI –3.32 to 8.79). Effects on cardiometabolic outcomes and health-related quality of life also favoured rehabilitation; however; few data were available for other secondary outcomes. Conclusion In people with multimorbidity, exercise rehabilitation improved exercise capacity, health-related quality of life, and cardiometabolic outcomes. LAY ABSTRACT Chronic disease is a common health problem world-wide. It is increasingly common for people to have more than 1 chronic disease, which is called multimorbidity, and the interaction of their multiple health problems may worsen their health outcomes. Exercise rehabilitation is an effective and established treatment to improve health for people with different chronic diseases, such as heart and lung disease; however, the benefit of structured rehabilitation in people with multimorbidity has not been systematically reviewed. A literature search was performed to investigate the clinical outcomes following exercise rehabilitation in people with multimorbidity. Compared with usual medical care, the results showed that exercise rehabilitation improved exercise capacity, measured by walking distance in a formal test, health-related quality of life and the body’s ability to use oxygen, in people with multimorbidity. There were few data regarding the benefit of rehabilitation on other outcomes, and more well-designed robust trials are needed.

[1]  Chia-Lun Lee,et al.  Effects of Diet Control and Telemedicine-Based Resistance Exercise Intervention on Patients with Obesity and Knee Osteoarthritis: A Randomized Control Trial , 2021, International journal of environmental research and public health.

[2]  S. Chiang,et al.  Effectiveness of a Home-Based Telehealth Exercise Training Program for Patients With Cardiometabolic Multimorbidity , 2020, The Journal of cardiovascular nursing.

[3]  Walid Kamal Abdelbasset,et al.  Similar effects of low to moderate-intensity exercise program vs moderate-intensity continuous exercise program on depressive disorder in heart failure patients , 2019, Medicine.

[4]  Y. Varol,et al.  The effect of comorbidity severity on pulmonary rehabilitation outcomes in chronic obstructive pulmonary disease patients , 2018, Chronic respiratory disease.

[5]  J. M. Salge,et al.  Exercise Improves Physical Activity and Comorbidities in Obese Adults with Asthma , 2018, Medicine and science in sports and exercise.

[6]  S. Scalvini,et al.  Home-based telerehabilitation in older patients with chronic obstructive pulmonary disease and heart failure: a randomised controlled trial , 2018, Age and ageing.

[7]  E. Deci,et al.  Physical activity and motivational predictors of changes in health behavior and health among DM2 and CAD patients , 2017, Scandinavian journal of medicine & science in sports.

[8]  M. Mador,et al.  Comorbidities in Patients With Chronic Obstructive Pulmonary Disease and Pulmonary Rehabilitation Outcomes , 2017, Journal of cardiopulmonary rehabilitation and prevention.

[9]  N. Beaudoin,et al.  Combined Exercise Training Improves Glycemic Control in Adult with Cystic Fibrosis , 2017, Medicine and science in sports and exercise.

[10]  R. Arena,et al.  CARDIAC REHABILITATION IN SUBJECTS WITH PERIPHERAL ARTERIAL DISEASE: A HIGHER RISK PATIENT POPULATION WHO BENEFIT FROM ATTENDANCE , 2016 .

[11]  P. Savage,et al.  Insulin Resistance and Diabetes Mellitus in Contemporary Cardiac Rehabilitation , 2016, Journal of cardiopulmonary rehabilitation and prevention.

[12]  Maged Hassan,et al.  Effect of comorbidities on response to pulmonary rehabilitation in patients with chronic obstructive pulmonary disease , 2016 .

[13]  D. Brooks,et al.  Comparison of cardiac rehabilitation outcomes in individuals with respiratory, cardiac or no comorbidities: A retrospective review , 2016, Canadian journal of respiratory therapy : CJRT = Revue canadienne de la therapie respiratoire : RCTR.

[14]  E. Wouters,et al.  Objectively identified comorbidities in COPD: impact on pulmonary rehabilitation outcomes , 2015, European Respiratory Journal.

[15]  S. Anderssen,et al.  Effects of exercise training on HbA1c and VO2peak in patients with type 2 diabetes and coronary artery disease: A randomised clinical trial , 2015, Diabetes & vascular disease research.

[16]  C. Castro,et al.  SP450CHANGING DIABETIC DIALYSIS PATIENTS PHYSICAL FUNCTIONING WITH EXERCISE TRAINING , 2015 .

[17]  G. Bell,et al.  Improved Functional Status Following the Aquatic Physical Exercise for Arthritis and Diabetes (APEXD) Study , 2014 .

[18]  J. Hardin,et al.  Adjunctive Tai Chi in Geriatric Depression With Comorbid Arthritis: A Randomized, Controlled Trial , 2014 .

[19]  T. Arakawa,et al.  Impact of cardiac rehabilitation on renal function in patients with and without chronic kidney disease after acute myocardial infarction. , 2014, Circulation journal : official journal of the Japanese Circulation Society.

[20]  O. Al-Jiffri,et al.  Impact of weight loss on markers of systemic inflammation in obese Saudi children with asthma. , 2013, African health sciences.

[21]  O. Al-Jiffri,et al.  Weight reduction improves markers of hepatic function and insulin resistance in type-2 diabetic patients with non-alcoholic fatty liver. , 2013, African health sciences.

[22]  J. Wang Effect of aerobic interval training on erythrocyte rheological and hemodynamic functions in heart failure patients with anemia , 2013, International journal of cardiology.

[23]  W. Kraus,et al.  Clinical characteristics, response to exercise training, and outcomes in patients with heart failure and chronic obstructive pulmonary disease: findings from Heart Failure and A Controlled Trial Investigating Outcomes of Exercise TraiNing (HF-ACTION). , 2013, American heart journal.

[24]  D. McKenzie,et al.  Water-based exercise in COPD with physical comorbidities: a randomised controlled trial , 2012, European Respiratory Journal.

[25]  J. Shubrook,et al.  Can Lifestyle Interventions Do More Than Reduce Diabetes Risk? Treating Depression in Adults With Type 2 Diabetes With Exercise and Cognitive Behavioral Therapy , 2012, Current Diabetes Reports.

[26]  D. Almeida,et al.  Effects of home-based exercise training for patients with chronic heart failure and sleep apnoea: a randomized comparison of two different programmes , 2012, Clinical rehabilitation.

[27]  T. Brown,et al.  Cardiac Rehabilitation Outcomes: IMPACT OF COMORBIDITIES AND AGE , 2011, Journal of cardiopulmonary rehabilitation and prevention.

[28]  M. Zwerink,et al.  Safety, Feasibility And Effectiveness Of A Community-based Physiotherapy Exercise Program For Patients With Both COPD And Chronic Heart Failure, A Pilot Study , 2010, Asian Test Symposium.

[29]  L. Fabbri,et al.  Efficacy of standard rehabilitation in COPD outpatients with comorbidities , 2010, European Respiratory Journal.

[30]  Nagaraja Haleagrahara,et al.  Increase in the heart rate variability with deep breathing in diabetic patients after 12-month exercise training. , 2010, The Tohoku journal of experimental medicine.

[31]  S. Abbasi,et al.  Effect of gender and type 2 diabetes mellitus on heart rate recovery in patients with coronary artery disease after cardiac rehabilitation. , 2009, Endokrynologia Polska.

[32]  Maree Barnes,et al.  A diet and exercise program to improve clinical outcomes in patients with obstructive sleep apnea--a feasibility study. , 2009, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[33]  M. Cohen,et al.  Effects of cardiac rehabilitation on exercise capacity in Type 2 diabetic patients with coronary artery disease , 2004, Diabetic medicine : a journal of the British Diabetic Association.

[34]  W. Rejeski,et al.  Exercise Training in Patients With Cardiovascular Disease and Coexistent Knee Arthritis , 1994 .