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.

中文翻译：

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运动疗法对多种疾病患者的益处和危害：随机对照试验的系统回顾和荟萃分析。

目标

调查运动疗法对多病患者身体和心理健康的益处和危害。

设计

随机对照试验 (RCT) 的系统评价。数据来源 MEDLINE、EMBASE、CENTRAL 和 CINAHL（1990 年至 2020 年 4 月 20 日）以及 Cochrane 关于运动疗法对上述每种疾病的效果的评论、纳入研究的参考文献列表、WHO 注册表以及 Web 中纳入研究的引文跟踪科学。

研究选择的资格标准

随机对照试验研究运动疗法对患有多种疾病的患者的益处，多种疾病被定义为以下两种或多种疾病：骨关节炎（膝关节或髋关节）、高血压、2 型糖尿病、抑郁症、心力衰竭、缺血性心脏病和慢性阻塞性肺病疾病对以下至少一项结果的影响：健康相关的生活质量 (HRQoL)、身体机能、抑郁或焦虑。

证据的摘要和质量

根据美国食品和药物管理局的定义，使用随机效应模型进行荟萃分析来评估运动疗法的益处以及非严重和严重不良事件的风险。元回归分析研究预先指定的效应估计中介变量的影响。Cochrane“偏倚风险工具”2.0 和 GRADE 评估来评估证据的整体质量。

结果

涉及 3363 人的 23 项随机对照试验测试了运动疗法干预（平均持续时间 13.0 周，SD 4.0），结果表明运动疗法改善了 HRQoL（标准化平均差 (SMD) 0.37，95% CI 0.14 至 0.61）并客观测量了身体功能（ SMD 0.33，95 % CI 0.17 至 0.49），并减少抑郁症状（SMD -0.80，95 % CI -1.21 至 -0.40）和焦虑症状（SMD -0.49，95 % CI -0.99 至 0.01）。运动疗法与非严重不良事件风险增加无关（风险比 0.96，95% CI 0.53-1.76）。相比之下，运动疗法可降低严重不良事件的风险（风险比 0.62，95% CI 0.49 至 0.78）。荟萃回归显示，年龄的增加与 HRQoL 的效应值降低相关，基线抑郁严重程度越高，抑郁症状的减轻程度越大。所有结果的证据总体质量被降级为低，主要是由于偏倚、不一致和间接风险。

结论

运动疗法似乎是安全的，并且对患有多种疾病的人的身体和心理健康有有益的影响。尽管支持这一点的证据质量较低，但它凸显了运动疗法在该人群管理和护理方面的潜力。