Effect of behavioural interventions in people with multimorbidity: a systematic review of randomised controlled trials
Creators: name: Brica, Alessio
name: Jäger, Madalina
name: Johnston, Marie
name: Zangger, Graziella
name: Harris, Lasse
name: Midtgaard, Julie
name: Skou, Søren
Publisher: name: The Health & Fitness Journal of Canada
Year: 2022

description: Background: More than half of the elderly population lives with multiple chronic conditions (i.e. multimorbidity). Physical activity is low in people with multimorbidity, although being a key behaviour for survival and overall health, alongside other lifestyle behaviours. However, the effect of behavioural interventions on behavioural, physical and psychosocial outcomes have not been summarised systematically in people with multimorbidity. Purpose: 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 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. 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 0.87 – very low certainty) and the effect on weight loss was 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) (Figure 1). 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/. Funding: European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (MOBILIZE, grant agreement No 801790), Næstved, Slagelse and Ringsted Hospitals’ Research Fund and The Association of Danish Physiotherapists Research Fund. The funding source was not involved in any aspect of this systematic review protocol.
description: The Health &amp; Fitness Journal of Canada, Vol. 14 No. 3 (2021): Proceedings from the 8th International Society for Physical Activity and Health Congress