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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 …

Background To investigate the effect of behavioural interventions targeting lifestyle behaviours on physical activity, weight loss, physical function, health-related quality of life and depression in people with multimorbidity and to investigate which Behaviour Change Techniques (BCTs) are associated with better outcomes.Methods Systematic review of randomised controlled trials targeting lifestyle behaviours in people with multimorbidity following the Cochrane recommendations. Data sources included MEDLINE, EMBASE, CENTRAL and CINAHL up to June 19th, 2020 and screening reference list of Cochrane reviews including people with multimorbidity, ongoing systematic reviews of the MOBILIZE project, the WHO registry and citation tracking of included studies. Meta-analyses using random-effects model to assess the effect of behavioural interventions on physical activity, weight loss, physical function and health-related quality of life and depression. Meta-regression analyses and effectiveness ratios 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 Fourteen papers involving 1,378 people. Behavioural interventions had little to no effect on physical activity (standardised mean difference 0.38, 95%CI -0.12 to 0.61 – very low certainty) and the effect on weight loss is uncertain (BMI mean difference -0.17, 95%CI -1.17 to 0.83 – very low certainty) at the end-treatment follow-up (mean duration 23 weeks, SD 15). Small improvements were seen in health-related quality of life (SMD 0.29, 95% CI 0.17 to 0.42 – moderate certainty) and physical function (SMD 0.42, 95% CI 0.12 to 0.73 – low certainty), and moderate improvements were seen for depression symptoms (SMD -0.70, 95%CI -0.98 to -0.42 – moderate certainty). Studies using the BCTs ‘action planning’ and ‘social support (practical)’ reported greater physical activity and weight loss. The effects of behavioural interventions diminished for all the outcomes at long-term follow-ups (mean duration of 36 weeks, SD 15).Conclusions Behavioural interventions targeting lifestyle behaviours improve health-related quality of life and physical function, and reduce depression symptoms, whereas little to no effect was achieved on physical activity and weight loss in people with multimorbidity. However, the evidence for physical activity and weight loss were of low quality and the end-treatment benefits diminished over time.Systematic review protocol Open Science Framework: https://osf.io/r7pm5/

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.

Aim:The aim of this study is to investigate the benefits and harms of therapeutic exercise in people with multimorbidity defined as the combination of two or more of the following conditions: knee and hip osteoarthritis, hypertension, diabetes type 2, depression, heart failure, ischaemic heart disease and chronic obstructive pulmonary disease, by performing a systematic review of randomized controlled trials (RCTs).Methods:This study will be performed according to the recommendations from the Cochrane Collaboration and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We will search for RCTs investigating the effect of therapeutic exercise in multimorbidity, as defined above, in MEDLINE, EMBASE, CENTRAL and CINAHL from 1990. Cochrane reviews on the effect of therapeutic exercise for each of the aforementioned conditions and references of the included studies will be checked for eligible studies and citation tracking will be performed in Web of Science. We will assess the risk of bias of the included studies using the Cochrane ‘Risk of Bias Tool’ 2.0 and the Grading of Recommendations Assessment, Development and Evaluation assessment for judging the overall quality of evidence. Meta-analyses will be performed, if possible, using a random-effects model as heterogeneity is expected due to differences in interventions and participant characteristics and outcome measures. Subgroup and meta-regression analyses will be performed to explore potential predictors of outcomes.Dissemination:The results of this systematic review will be published in a peer-review journal, presented at national and international conferences and made available to end users via infographics, podcasts, press releases and videos.

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.

Background To investigate the effect of in-person delivered behavioural interventions in people with multimorbidity and which behaviour change techniques (BCTs), targeting lifestyle behaviours, are associated with better outcomes. Methods Systematic review of randomised controlled trials. We searched MEDLINE, EMBASE, CENTRAL, and CINAHL and screened reference list of reviews including people with multimorbidity, registries, and citation tracking of included studies. Meta-analyses using random-effects model to assess the effect of behavioural interventions and meta-regression analyses and effectiveness ratios to investigate the impact of mediators on effect estimates. Cochrane ‘Risk of Bias Tool’ 2.0 and the GRADE assessment to evaluate the overall quality of evidence. Results Fourteen studies involving 1,378 people. Behavioural interventions had little to no effect on physical activity (standardised mean difference 0.38, 95% CI −0.12–0.87) and the effect on weight loss was uncertain (BMI mean difference −0.17, 95% CI −1.1–0.83) at the end-treatment follow-up. Small improvements were seen in health-related quality of life (SMD 0.29, 95% CI 0.17–0.42) and physical function (SMD 0.42, 95% CI 0.12–0.73), and moderate improvements were seen for depression symptoms (SMD −0.70, 95% CI −0.97–0.42). Studies using the BCTs ‘action planning’ and ‘social support (practical)’ reported greater physical activity and weight loss. Conclusions Behavioural interventions targeting lifestyle behaviours may improve health-related quality of life and physical function, and reduce depression, whereas little to no effect was achieved on physical activity and weight loss in people with multimorbidity. However, the evidence for physical activity and weight loss were of low quality and the end-treatment benefits diminished over time.