Danish trial reveals how structured exercise and guidance affect life with chronic conditions

A new study reveals that combining tailored exercise therapy with self-management support can safely improve the quality of life for individuals managing multiple chronic conditions​​​​​​.

Study: Exercise therapy and self-management support for individuals with multimorbidity: a randomized and controlled trial. Image Credit: Halfpoint / Shutterstock

In a recent article published in Nature Medicine, researchers investigated whether a program combining support for self-management with personalized exercise therapy would enhance the quality of life for adults living with multimorbidity.

The findings from their research indicate that this intervention could statistically significantly improve the quality of life for individuals living with multimorbidities, without increasing their risk of experiencing adverse events.

Background

Multimorbidity, which occurs when individuals have at least two long-term health conditions, affects over one-third of adults worldwide and is projected to increase by 84% by 2050. It tends to develop 10-15 years earlier in socially disadvantaged populations, worsening health inequalities.

People with multimorbidity often experience reduced mental and physical functioning, lower quality of life, and a higher risk of early death. As chronic conditions increase, so do healthcare costs, hospital visits, and sick leave, placing a growing burden on healthcare systems.

Despite its widespread impact, effective treatments for managing multimorbidity are lacking. Current healthcare approaches often treat each disease separately, resulting in fragmented, conflicting, or inefficient care that can frustrate both patients and providers.

Experts emphasize the need to move towards person-centered care and have identified self-management support and exercise therapy as promising strategies for achieving this goal.

Exercise has proven benefits for a range of chronic illnesses, including depression, diabetes, and heart disease, conditions that commonly co-occur. Similarly, supporting individuals in managing their health has shown promise in reducing healthcare utilization and enhancing quality of life.

However, high-quality evidence has been limited. As a result, robust studies are needed to confirm their effectiveness in real-world settings.

About the Study

This multicenter randomized controlled trial (RCT) was part of a five-year project called MOBILIZE. It compared a self-management support and personalized exercise therapy program with usual care in adults with multimorbidity, defined as having at least two of six specified long-term conditions: knee or hip osteoarthritis, chronic obstructive pulmonary disease, heart disease, hypertension, type 2 diabetes, and depression.

Conducted in Denmark over 12 weeks, participants were randomly assigned to either the intervention or control groups.

The intervention consisted of 24 supervised sessions, combining 30 minutes of self-management support with 60 minutes of personalized exercise. Exercise intensity was adjusted based on participants’ perceived exertion, and physiotherapists were trained to deliver the program. The control group continued with standard medical care.

Outcomes were assessed at baseline and after 4, 6, and 12 months using validated questionnaires and physical performance tests.

The primary outcome was health-related quality of life (HRQoL) measured after 12 months. Secondary outcomes included physical function, disease burden, mental health, and self-efficacy.

Key Findings

Of the 632 screened individuals with multimorbidity, 228 were randomized: 115 received the 12-week support program in addition to usual care, while 113 received only usual care.

After 12 months, 197 participants (86%) completed the follow-up, with similar retention rates between groups. Adherence to the program was high, with approximately 75% of participants attending at least 18 sessions.

The primary outcome, HRQoL, improved significantly more in the intervention group than in the control group, as determined by the intention-to-treat analysis. Within-group analysis revealed that the intervention group’s HRQoL score improved by 0.050 points, whereas the control group’s score declined slightly by 0.014 points. More participants in the support group also achieved a patient-acceptable symptom state (55% vs. 40%).

Among the secondary outcomes, self-rated health (measured on the EQ-VAS) showed a significant between-group difference, favoring the intervention. Within the intervention group, participants demonstrated statistically significant improvements in physical function (as measured by both the 30-second chair-stand test and the 6-minute walk test), self-rated health, disability, illness burden, and depression. However, these improvements were not statistically significant compared to those seen in the usual care group.

Crucially, in the per-protocol analysis (which included only participants who fully adhered to the program), the between-group difference in HRQoL was not statistically significant.

Safety analyses showed no significant differences in serious or non-serious adverse events between groups, indicating that the intervention was well tolerated. Overall, the results support the potential benefit of the combined program in improving quality of life without increased risk.

Conclusions

This trial demonstrated a statistically significant improvement in HRQoL after 12 months for adults with multiple morbidities who received personalized self-management support and exercise therapy, without increasing the risk of adverse events.

However, the observed improvement of 0.064 points was modest and did not reach the 0.074-point threshold for what is considered a ‘minimum important difference’ in some patient populations, raising questions about its clinical relevance. Only one secondary outcome, self-rated health, showed a statistically significant benefit compared to usual care.

The study’s strengths include its pragmatic, real-world design, high participant adherence, and comprehensive co-design process involving stakeholders.

Limitations include potential bias due to unblinded participants, the potential treatment burden of the intensive 24-session intervention, and limited generalizability resulting from the specific definition of multimorbidity used. The heterogeneity in participants’ conditions and baseline health status may also have influenced the findings. The paper also notes that the additional attention from healthcare professionals in the intervention group could have contributed to the effect.

In conclusion, while the results support the safety and potential value of personalized self-management and exercise programs in improving quality of life for people living with multimorbidity, further large-scale trials are needed to confirm these findings and clarify their long-term clinical significance.