BJSM - 2026-06-12 - Journal Article
Effectiveness of maintenance interventions promoting physical activity following exercise therapy for chronic conditions: an umbrella review.
Luijk A, Bricca A, Mortensen SR, Holm P, Zanger G, Simonÿ C, Skou ST, Lund T, Tang LH
Topics
Key Takeaway
Mixed-mode maintenance interventions after exercise therapy improved health-related quality of life (SMD 0.22, moderate certainty) and objective physical activity (SMD 2.14, low certainty) across chronic conditions, but in-person booster sessions showed no benefit.
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Summary
This umbrella review examined whether maintenance interventions following exercise therapy sustain physical activity and function in patients with chronic respiratory disease, cardiovascular disease, chronic low back pain, or knee/hip osteoarthritis. Digital interventions improved subjective PA (SMD 0.37, low certainty); mixed delivery improved HRQoL, objective PA, and physical function (moderate to low certainty); in-person booster sessions showed no benefit. Fitness, adverse events, hospitalization, and return-to-work outcomes were inconsistent or null.
Key Limitation
Most included reviews had unclear risk of bias, and the low certainty of evidence for the majority of outcomes limits the strength of any practice-changing recommendation.
Original Abstract
OBJECTIVE
To investigate the effectiveness of maintenance interventions postexercise therapy on physical activity (PA), physical function, fitness, health-related quality of life, adverse events, hospitalisation and return to work in people with chronic conditions.
DESIGN
In this umbrella review, a narrative synthesis was conducted. Risk of bias was assessed using the Risk of Bias in Systematic Reviews tool. The quality and certainty of evidence were evaluated using Grading of Recommendation, Assessment, Development and Evaluation.
DATA SOURCES
Medline, Embase and CINAHL were searched from inception to 20 August 2024.
ELIGIBILITY CRITERIA
Systematic reviews of randomised controlled trials (RCTs) investigating the effectiveness of maintenance interventions following exercise therapy in people with chronic conditions.
RESULTS
From 10 931 results, 19 systematic reviews (136 unique RCTs) were included. Reviews included people with chronic respiratory disease (n=64), cardiovascular disease (n=54), chronic low back pain (n=4) or knee/hip osteoarthritis (n=14). Most reviews had an unclear risk of bias (n=10). We identified three types of maintenance interventions based on delivery mode: primarily digital, primarily inperson and a mixed category comprising exclusively digital, inperson or hybrid delivery. Beneficial effects were found for digital health interventions on subjective PA (standardised mean difference (SMD) 0.37, 95% CI 0.05 to 0.69, low certainty), but no beneficial effects were found for inperson booster sessions (very low to low certainty). Mixed maintenance interventions showed beneficial effects for health-related quality of life (MD 0.28 points 95% CI 0.05 to 0.52; SMD 0.22 95% CI 0.03 to 0.41; MD -2.69 points 95% CI -4.49 to -0.9; moderate certainty), objective PA (SMD 2.14 95% CI 0.9 to 3.38, low certainty) and objective physical function (SMD 0.48 95% CI 0.19 to 0.77, low certainty). We found no effect or inconsistent effects for fitness, adverse events, hospitalisation and return-to-work (low to moderate certainty).
CONCLUSION
Maintenance interventions may help people continue to be physically active and improve physical function and health-related quality of life. However, this is based on low certainty of evidence. The remaining outcomes were generally inconsistent or indicated no effects. Digital maintenance interventions show some beneficial effects for PA but higher-quality studies are needed across various chronic conditions.
PROSPERO REGISTRATION NUMBER
CRD42024579734.