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People with multimorbidity (two or more medical conditions) have poorer physical and psychosocial health and higher risk of hospital admission and premature death.1 The complexity and increased burden of multimorbidity presents challenges for healthcare systems.2 Therefore, the current standard of care for patients with multimorbidity includes visiting many healthcare professionals and reviewing different pharmacological treatments with inherent risk of side effects. This is often unsatisfactory for the patients.3 Exercise is considered a core treatment for at least 26 chronic conditions. However, little is known about its effects in people with multimorbidity. To fill this gap, we performed a systematic review of randomised controlled trials to investigate the benefits and harms of exercise therapy (ie, a regimen or plan of physical activities designed and prescribed …

We found two typesetting errors in the paper. The errors are insignificant and do not influence the results or interpretation of the study. The inclusion criteria for studies including people with hypertension (paragraph 2.2.1. Study design and participants) are “systolic blood pressure ≥140 and diastolic blood pressure ≥90” and not (systolic blood pressure >90 and diastolic blood pressure >140). The paragraph 3.2. Participants contains a sentence repeated twice consecutively, that is "The most common conditions reported in the 23 RCTs (3363 people). The authors would like to apologize for any inconvenience caused.

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 multimorbidity, 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.