Evidence for exercise-based interventions across 45 different long-term conditions: an overview of systematic reviews.

Background: Almost half of the global population face significant challenges from long-term conditions (LTCs) resulting in substantive health and socioeconomic burden. Exercise is a potentially key intervention in effective LTC management.
Methods: In this overview of systematic reviews (SRs), we searched six electronic databases from January 2000 to October 2023 for SRs assessing health outcomes (mortality, hospitalisation, exercise capacity, disability, frailty, health-related quality of life (HRQoL), and physical activity) related to exercise-based interventions in adults (aged >18 years) diagnosed with one of 45 LTCs. Methodological quality was assessed using AMSTAR-2. International Prospective Resister of Systematic Reviews (PROSPERO) ID: CRD42022319214.
Findings: Forty-two SRs plus three supplementary RCTs were included, providing 990 RCTs in 936,825 people across 39 LTCs. No evidence was identified for six LTCs. Predominant outcome domains were HRQoL (82% of SRs/RCTs) and exercise capacity (66%); whereas disability, mortality, physical activity, and hospitalisation were less frequently reported (≤25%). Evidence supporting exercise-based interventions was identified in 25 LTCs, was unclear for 13 LTCs, and for one LTC suggested no effect. No SRs considered multimorbidity in the delivery of exercise. Methodological quality varied: critically-low (33%), low (26%), moderate (26%), and high (12%).
Interpretation: Exercise-based interventions improve HRQoL and exercise capacity across numerous LTCs. Key evidence gaps included limited mortality and hospitalisation data and consideration of multimorbidity impact on exercise-based interventions.
Funding: This study was funded by the National Institute for Health and Care Research (NIHR; Personalised Exercise-Rehabilitation FOR people with Multiple long-term conditions (multimorbidity)-NIHR202020).
Competing Interests: GOD is co-author of one, and RST is co-author of two of the SRs included in this overview. LG is currently in receipt of/undertaking a Wellcome Trust doctoral fellowship (UNS144807) and declares receipt of payment for lecture on pulmonary rehabilitation (University College London, annual), Council of Allied Health Professions Research (CAHPR)/National Institute for Health and Care Research (NIHR) Research Champion: West Midlands (unpaid), British Thoracic Society (BTS): Pulmonary Rehabilitation (PR) Specialist Advisory Group (SAG) member (unpaid), Association of Chartered Physiotherapists in Respiratory Care (ACPRC) committee (honoraria received). HMLY is funded by the NIHR Advanced Fellowship (NIHR202926). SJS is Clinical Lead for National Respiratory Audit Programme—Pulmonary Rehabilitation. KJ declares funding from NIHR Applied Research Collaboration West Midlands and Sub-committee chair for NIHR Programme Grants for Applied Health Research (payment to institution). RAE declares receipt of speaker fees (Boeringher June 2021; Moderna April 2023) and ERS Group 01.02 Pulmonary Rehabilitation and Chronic Care Secretary (unpaid), and ATS Pulmonary Rehabilitation Assembly Chair (unpaid). SD declares NIHR Applied Research Collaboration: South West Peninsula (PenARC; payment to institution), receipt of the following NIHR grants (payment to institution): NIHR151938; NIHR204099; RP-PG-0514-20002; NIHR201038; NIHR201070; NIHR200428, receipt of grants (payment to institution): Gillings Family foundation (ID 943008); The Stroke Association (ID 901902); NIHR School for Primary Care Research—Exeter internal fund (ID 856766); Academic Health Science Network South West (ID 1355693), receipt of textbook royalties (John Wiley & Sons), support for meeting attendance from NIHR (p-PG-0514-20002) and Health Research Council New Zealand (21/826; 18/254), and membership of NIHR Programme Grant for Applied Research funding panel committee and The Stroke Association research funding panel. SJK declares receipt of conference funding from School of Health and Wellbeing, University of Glasgow. SAS declares presidency of the UK Society of Behavioural Medicine, membership of HTA Clinical Evaluations and Trials Committee (2016–2020), membership of Commissioning Panel for the National Institute of Health Research (NIHR) Policy Research Programme (2019–2022), and membership of Chief Scientist Office HIPS committee (2018–2023).
(© 2024 The Authors.)