A personalised exercise and self-management rehabilitation programme for adults living with multimorbidity is both acceptable and deliverable, according to a feasibility study, paving the way for fuller clinical evaluation.
Traditional exercise-based rehabilitation services, such as cardiac and pulmonary programmes, are designed for single long-term conditions and often fail to address the complex needs of adults living with multimorbidity.
Aiming to address these unmet needs, the personalised exercise-rehabilitation for people with multiple long-term conditions (PERFORM) study recruited 60 ambulatory adults (mean age 62 years; 57% female) with two or more long-term conditions, including at least one known to benefit from exercise therapy.
Participants were randomised 2:1 to receive the PERFORM intervention plus usual care (n=40) or usual care alone (n=20). The intervention consisted of eight weeks of supervised group-based exercise combined with structured self-care support, delivered across sites in two acute hospitals and one community setting in the UK.
Positive signals from the rehabilitation intervention
Recruitment targets were met within 4.5 months, with 76.7% retention at three months and 72.5% adherence to the intervention (≥60% session attendance). Participants had a median of four long-term conditions, with diabetes (41.7%), hypertension (38.3%), asthma (36.7%) and painful conditions (35.0%) most common.
Data completion exceeded 90% for 11 of 18 outcome measures. Improvements were seen across patient-reported outcomes and physical performance measures, including EQ-5D-5L index scores, fatigue, anxiety and exercise capacity. No serious adverse events were reported during rehabilitation.
Retention rates fell slightly below the pre-specified ‘green’ threshold, and only 44.7% of participants had complete datasets for all outcomes, highlighting outcome burden. Fidelity assessments identified areas for improvement, including inconsistent action planning and limited engagement of social support.
The centre-based format may also limit rehabilitation accessibility for some participants, particularly those with transport or mental health challenges, the researchers said.
Next steps for scaling up
The PERFORM programme had a co-designed, disease-agnostic approach, which offered a scalable model for rehabilitation in patients with multimorbidity, potentially addressing a critical gap in current service provision.
The researchers proposed several adaptations for progression to a future full randomised controlled trial, including refining eligibility criteria and enhancing retention strategies collection of outcome measures.
If scale-up proves effective, the researchers said it could inform the commissioning of inclusive, symptom-focused rehabilitation services across the NHS, with potential socioeconomic benefits, including improved work participation.
Reference
Evans RA et al. Personalised exercise-rehabilitation for people with multiple long-term conditions (PERFORM): a randomised feasibility study. BMJ Open 2025;15:e100195.
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