Physical activity promotion for persons with multiple chronic diseases in the interface of health care, sport and leisure: a longitudinal pilot study

Abstract

Purpose: Osteoarthritis (OA) as well as Diabetes mellitus type 2 (DMT2), overweight (OW), obesity (OB) and cardio-vascular diseases (CVD) are amongst the most prevalent civil diseases in industrial nations and the simultaneous occurrence of several diagnoses is often the rule. As an example: overweight is one main risk factor in the development of knee OA. OA is most often combined with hypertension and second most often with DMT2. Physical activity (PA) and exercise have many positive effects on chronic conditions and should be prescribed as a cost-effective therapy for all these disorders. But so far little research is conducted on the effects of PA in the treatment of multimorbidity. It must be further stated, that there is a shortfall of lifestyle interventions such as PA and exercise for this specific population on a structural and organisational level.This study therefore seeks to establish and evaluate a pilot model for patients with multimorbidity with the primary goal to increase PA in this patient group. Methods: The study includes only participants with at least two major risk factors or manifest disease signs for: OA of hip and/or knee, DMT2, OW/OB, CVD. End organ damage is an exclusion criteria. Only inactive participants, means fulfilling only less than 75% of the national PA recommendations, are included in the study. The study consists of a 12-week basic intervention, comprising a systematic aerobic and strength-oriented training intervention by use of different types of activity. The training intervention is based on national PA recommendations and complemented by theoretical background information on training science, nutrition and behavioral change techniques. Personal counselling is included to empower independent activity of the participants. After the basic intervention persons are encouraged to maintain the same level of PA in sport and leisure time. Data are assessed before (t0) and after the basic intervention (t3), and after the follow-up phase of three months (t6). The primary outcome is the physical activity status of the patients at t6 (binary: national recommendations are fulfilled/not fulfilled); secondary outcomes relate to general and disease specific objectives (reduction of: medication, pain etc.), physiological endpoints (i.e. blood pressure, Hba1c, triglycerides, cortisol levels etc.), as well as self-reported measures (i.e. WOMAC, exercise related self-efficacy etc.) and adherence to intervention. The study is still ongoing. Results refer to the basic intervention of the first of two waves and will be completed in April 2020. Results: Overall 26 participants were screened for the first study wave. 4 participants were excluded due to too less risk factors for the manifestation of the investigated diseases. Further two participants restrained from the study without giving reasons. Thus, 20 participants (14 female, 6 male) participated. The mean age was 53.8 ± 11.2 years. 9 Participants suffered from hip (n=2) or knee OA (n=7). Further 8 participants showed a WOMAC score >15 points for pain and function and were therefore classified as high-risk. 17 of the participants suffered from OV/OB, with a mean BMI of 30.7 ± 3.5 kg/m2. 14 persons had a diagnosis of hypertension of which 13 used medication on a regular basis. 15 participants were at high risk for DMT2 (Diabetes risk score ≥ 57 points), 1 already suffered from DMT2. 50% of the participants showed 2 manifested diseases and further 6 had one manifested disease and at least one risk factor for another disease. Interim analysis showed an increase in PA in all participants. On average 1 strength training and 2 cardio training sessions were completed during the first 12 weeks. One participant dropped-out of the study in week 11 due to persistent hip pain. The overall adherence for the instructed sessions (n=10) was 84%. 20% of the participants completed all instructed sessions. Further results will be evaluated and can be presented soon. Conclusions: Participants in the study showed a very good compliance and adherence throughout the first 12 weeks of the intervention. Further data analysis will provide information on whether this lifestyle change leads to subjective and objective health benefits and if PA can be sustained in succession of a supervised intervention period in a self-regulatory way.