gms | German Medical Science

Background: Osteoarthritis (OA), diabetes mellitus type 2 (DMT2), overweight (OW), obesity (OB) and cardio-vascular diseases (CVD) are amongst the most prevalent lifestyle-associated diseases in industrial countries. Simultaneous occurrence of several diagnoses is common. Physical activity (PA) has many positive effects on chronic conditions and should be prescribed as a cost-effective therapy. Little research has been done on the effects of PA in the treatment of multimorbidity. Also, there is a shortfall of PA-focused lifestyle interventions for this specific population at both a structural and organisational level.

Study aim: This study seeks to establish and evaluate a pilot model for patients with multimorbidity with the primary goal to increase PA.

Methods: Inactive participants (<75% of the national PA recommendations) with at least two major risk factors or manifest disease signs for: OA of hip and/or knee, DMT2, OW/OB, CVD without end organ damage were included. The study consists of a 12-week basic intervention, comprising a systematic aerobic and strength training. Background information on training science, nutrition and behavioral change techniques as well as individual counselling is included to empower independent activity of the participants. After the basic part, subjects are encouraged to maintain the same level of PA. Data are assessed before (t0), after the 12 weeks (t3) and after the follow-up phase of three months (t6). The study is conducted in two waves. Wave 1 is completed. Wave 2 is ongoing until July 2020. Primary outcome is the PA status and the patients’ rating of general health (GH) from excellent to poor. Statistical analyses were done via analysis of variance with repeated measures.

Results: N= 39 (f=27,m=12) with a mean age of 55.2± 10.3 years and a BMI of 31.1 ± 3.0 kg/m² were included. 11 Participants suffered from hip (n=3) or knee (n=8) OA, 28 had been diagnosed with CVD. 27 participants were at high risk for, while 4 had already been diagnosed with DMT2.Preliminary results (t0-t6, wave 1, n=20) showed an increase in overall PA (in minutes: t0: m=38.6 ± 144.1; t3: 377.2 ± 596.6; t6: 188.5± 209.4) between t0 and t3 as well as t0 and t6 (p=0.09, F=3.01, ŋ²= 0.18, n=15). Specifically, at t3, n=16 and at t6, n=7 met at least the minimal requirement of the national recommendation of 150 minutes of PA per week. In addition, individual perception of GH (t0: m=53.13 ± 21.00; t3: m=71.88 ± 17.02; t6: m= 56.25 ± 21.79) increased significantly (p=0.02, F=4.8, ŋ²=0.24, n=16). Bonferroni-adjusted post-hoc analysis revealed no significant difference between the three measurements.

Discussion: Participants in the study showed an increase in overall PA, especially between t0 and t3. Even though a decrease between t3 and t6 was found, mean level of PA was still higher than the national PA recommendations. Subjects’ subjective perception of their GH increased throughout the intervention, but decreased at t6.

Practical implications: Supervised PA can help multimorbid individuals to maintain regular PA and increase their perception of GH. There are indications that others may need further support in community settings. Results of this study will be the basis for a larger, confirmatory analysis in the field of health service research.