Framework of the MOBILIZE project
The project has four phases, see Figure 1.
Figure 1 Overall framework for developing and evaluating complex interventions
Phase 1
Development of a tailored exercise and education program
During the first part of the project, outcomes and biomarkers that predict better health outcome from different types of exercise therapy and exercise characteristics associated with a better outcome in people with different combinations of chronic conditions were identified through an exploratory observational cohort study of people with osteoarthritis who had undergone an 8-week exercise therapy and education program in Denmark (GLA:D®) as well as two systematic reviews and meta-analyses that summarized the existing evidence – one identified self-reported and objectively measured predictors of treatment effect and exercise associated with a better outcome in patients with multimorbidity and one investigated the behavior change techniques that underlie exercise trials that have a patient education or self-management component designed for people who live with multimorbidity.
A 12-week exercise therapy and education program was subsequently developed based on existing recommendations for exercise and strategies to facilitate behavioral changes. To ensure a high degree of patient and provider involvement, focus group interviews were conducted with patients with multimorbidity, health care providers and other relevant stakeholders to acquire their views on the program.
Phase 2
Feasibility trial
Once phase 1 was completed, the exercise therapy and education program was tested in a feasibility trial involving 20 patients with multimorbidity. The same procedures and outcomes as in the subsequent RCT were used, and data were collected at baseline and immediately after the intervention. The lessons from the feasibility trial were used to evaluate and implement adjustments that needed to be made prior to commencing the RCT.
Phase 3
Effects of the tailored exercise therapy and education program
The purpose of the RCT is to investigate the effects of a tailored exercise therapy and education program in comparison with current best practice on self-reported, objectively measured and physiological outcomes in people with multimorbidity. Two hundred and twenty-eight participants fulfilling the eligibility criteria were recruited from Region Zealand. The included patients have been randomized to either the tailored exercise therapy and education program or current best practice. Data will be collected at baseline and after 4 months and 12 months. The study hypothesis is that the tailored exercise therapy and education program will improve quality of life and physical function more than current best practice.
Phase 4
Implementation in clinical practice
If supported by study findings, a model for implementation of the tailored exercise therapy and education program in clinical practice will be developed during the last phase of the MOBILIZE project. For further information, see section on Dissemination & Impact.
OUR PUBLICATIONS
Get an overview of publications originating from research in MOBILIZE here:
| Study | Aim | Main findings | Link to article (open access) |
| Bricca et al. 2020
The benefits and harms of therapeutic exercise on physical and psychosocial outcomes in people with multimorbidity: Protocol for a systematic review |
Protocol of systematic review investigating the benefits and harms of exercise therapy for people with multimorbidity. | Bricca et al. 2020 | |
| Bricca et al. 2020
Benefits and harms of exercise therapy in people with multimorbidity: A systematic review and meta-analysis of randomised controlled trials |
To investigate the benefits and harms of exercise therapy for people with multimorbidity. | Exercise therapy appears to be safe and to have a beneficial effect on physical and psychosocial health in people with multimorbidity. Although the evidence supporting this was of low quality, it highlights the potential of exercise therapy in the management and care of this population. | Bricca et al. 2020 |
| Bricca et al. 2021
Infographic. Benefits and harms of exercise therapy in people with multimorbidity |
Infographic summarizing the systematic review Benefits and harms of exercise therapy in people with multimorbidity. | Bricca et al. 2021 | |
| Harris et al. 2021
Recruitment and retention rates in randomised controlled trials of exercise therapy in people with multimorbidity: a systematic review and meta-analysis
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To quantify recruitment, retention and differential retention rates and associated trial, participant, and intervention characteristics in randomised controlled trials (RCTs) evaluating the effect of exercise therapy in people with multimorbidity. | Three in four eligible people with multimorbidity were randomised to RCTs using exercise therapy, of which nine out of 10 provided end of treatment outcomes with no difference seen between the intervention and comparison groups. However, the results must be interpreted with caution due to large differences between the included studies. | Harris et al. 2021 |
| Pihl et al. 2021
Associations between comorbidities and immediate and one-year outcomes following supervised exercise therapy and patient education – A cohort study of 24,513 individuals with knee or hip osteoarthritis |
To investigate if comorbidities are associated with change in health outcomes following an 8-week exercise and education program in knee and hip osteoarthritis. | Health outcomes improved regardless of coexisting comorbidities. This means that comorbidities are not associated with worse nor better health outcomes following an 8-week exercise and education program in individuals with osteoarthritis, suggesting exercise as a viable treatment option for individuals with osteoarthritis, irrespective of comorbidities. | Pihl et al. 2021
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| Aagaard 2021
Living with multiple chronic conditions: how exercise helps me self-manage my conditions |
Gregers Aagaard, one of our patient partners in MOBILIZE, shares his story and the strategies he uses to self-manage his chronic conditions. | Through his training, he is able to increase his quality of life, both mentally and functionally. | Aagaard 2021 |
| Pihl et al. 2022
Prognostic Factors for Health Outcomes After Exercise Therapy and Education in Individuals With Knee and Hip Osteoarthritis With or Without Comorbidities: A Study of 37,576 Patients Treated in Primary Care |
To identify prognostic factors for health outcomes following an 8-week supervised exercise therapy and education program for individuals with knee and hip osteoarthritis alone or with concomitant hypertension, heart or respiratory disease, diabetes, or depression. | Age, self-efficacy, self-rated health, and pain intensity may be prognostic of change in health outcomes following an 8-week exercise therapy and patient education program for individuals with OA, irrespective of comorbidities. | Pihl et al. 2022 |
| Jäger et al. 2022
Putting the pieces together: A qualitative study exploring perspectives on self-management and exercise behavior among people living with multimorbidity, healthcare professionals, relatives, and patient advocates |
The aim of this study was to qualitatively explore the perspectives of people living with multimorbidity, healthcare professionals, relatives, and patient advocates in relation to self-management and exercise behavior. | Overall, the four groups shared common understandings while also expressing unique challenges. Conclusions Future interventions and/or policies targeting exercise behavior in people living with multimorbidity should address some of the barriers identified in this study. | Jäger et al. 2022 |
| Bricca et al. 2022
Personalised exercise therapy and self-management support for people with multimorbidity: Development of the MOBILIZE intervention |
To give a detailed report of the development of the intervention, which can serve as a model for future development papers to increase transparency and reduce research waste. | We developed a personalized exercise therapy and self-management support program for people with multimorbidity. The intervention will be tested for its safety and effectiveness in a randomized controlled trial. | Bricca et al. 2022 |
| Jäger et al. 2022
Mapping interventional components and behavior change techniques used to promote self-management in people with multimorbidity: a scoping review |
To map the literature on patient-centered interventions for people living with multimorbidity that supports self-management. | The results pointed to an extensive use of cognitive behavioral therapy as a basis for interventions, as well as behavior change theories and chronic disease management frameworks. The most coded Behavior Change Techniques (BCTs) stemmed from the categories Social Support, Feedback and Monitoring, and Goals and Planning. | Jäger et al. 2022 |
| Bricca et al. 2022
Effect of In-Person Delivered Behavioural Interventions in People with Multimorbidity: Systematic Review and Meta-analysis |
To investigate the effect of behavioral interventions in people with multimorbidity and to identify Behavior Change Techniques (BCTs) associated with better outcomes. | Behavioral interventions targeting lifestyle behaviors may 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 was of low quality and the end-treatment benefits diminished over time. Yet, studies using the BCTs ‘action planning’ and ‘social support (practical)’ reported greater physical activity and weight loss. | Bricca et al. 2022 |
| Skou et al. 2023
Personalised exercise therapy and self-management support for people with multimorbidity: feasibility of the MOBILIZE intervention |
To evaluate the feasibility of exercise therapy and self-management in people with multimorbidity prior to a randomized, controlled trial (RCT). | Exercise therapy and self-management are feasible in people with multimorbidity. The subsequent RCT, amended according to progression criteria and feedback from this study, will determine whether the intervention is superior to usual care alone. | Skou et al. 2023 |
| Skou et al. 2023
Study protocol for a multicenter randomized controlled trial of personalized exercise therapy and self-management support for people with multimorbidity: The MOBILIZE study |
To describe the design of MOBILIZE, a pragmatic, assessor-blinded, multicenter, parallel-group RCT (1:1 ratio) conducted at five intervention sites across the health care Region of Zealand, one of five health-care regions in Denmark.
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The pragmatic, multicenter RCT will provide high-quality evidence on the benefits and harms of exercise therapy and self-management support and, if the results support it, lead to the development of a plan for implementation in clinical practice. | Skou et al. 2023 |
| Find non-peer-reviewed blog articles here: | |||
| Skou et al. 2019
MOBILIZE – Bedre sundhed for mennesker med multimorbiditet gennem individualiseret træning og uddannelse |
Article describing the MOBILIZE project. | The MOBILIZE project will provide new insight into which treatment is the most effective for people with multimorbidity. This insight is essential to ensure the best possible treatment for this large and growing group of patients. | Skou et al. 2019 |
| Bricca et al. 2020
Exercise as therapy: its surprising potential to treat people with multiple chronic conditions |
Blog summarizing the findings of the systematic review Benefits and harms of exercise therapy in people with multimorbidity: A systematic review and meta-analysis of randomised controlled trials. | As such, exercise could be a safe and effective therapy instead of increasing drug prescription in people with multiple chronic conditions. The benefits were similar across all the combinations of chronic conditions | Bricca et al. 2020 |
| Bricca et al. 2021
Træning som behandling til mennesker med multisygdom |
Article summarizing the findings of the systematic review Benefits and harms of exercise therapy in people with multimorbidity: A systematic review and meta-analysis of randomized controlled trials. | People with multimorbidity may benefit mentally and physically from exercise therapy two to three times a week, irrespective of the combinations of chronic conditions. | Bricca et al. 2021
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| Jäger et al. 2022
Exercise Behavior Change for People Living with Multimorbidity |
Blog summarizing the findings of the qualitative study Putting the pieces together: A qualitative study exploring perspectives on self-management and exercise behavior among people living with multimorbidity, healthcare professionals, relatives, and patient advocates | Having identified many of the barriers to exercise that people with multimorbidity commonly experience, we put together a short guide for healthcare professionals that provides some practical strategies and resources to help people overcome these barriers. | Jäger et al. 2022
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Here you can get an overview of publications relating to MOBILIZE:
| Study | Aim | Main findings | Link to article (open access) |
| Bricca et al. 2022
The Quality of Health Apps and Their Potential to Promote Behavior Change in Patients With a Chronic Condition or Multimorbidity: Systematic Search in App Store and Google Play |
To assess the quality of health Apps and their potential to promote behavior change. | Apps for patients with a chronic condition or multimorbidity appear to be of acceptable quality but have low to moderate potential for promoting behavior change. Our results provide a useful overview for patients and clinicians who would like to use apps for managing chronic conditions and indicate the need to improve health apps in terms of their quality and potential for promoting behavior change. | Bricca et al. 2022 |
| Jørgensen et al. 2022
Objectively measured physical activity levels and adherence to physical activity guidelines in people with multimorbidity—A systematic review and meta-analysis |
To determine levels of objectively measured physical activity (PA) and the proportion of adults with multimorbidity that adheres to PA guidelines.
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PA levels and adherence varied from low to above guideline recommended levels for adults with chronic conditions, depending on PA intensity. The very low certainty of evidence calls for high quality studies focusing on detailed descriptions of PA behavior in people with multimorbidity. | Jørgensen et el. 2022 |
| Skou et al. 2022
Multimorbidity |
To provide a global overview of the epidemiology, potential underlying mechanisms and pathophysiology, diagnosis, prevention, management and outcomes of multimorbidity. | Multimorbidity is a major global health challenge that is increasing in prevalence. The need for improved management and enhanced support to primary care and public health is highlighted. Further evidence to support effective management and improve patient outcomes is needed. | Skou et al. 2022 |
| Zangger et al. 2023
Benefits and Harms of Digital Health Interventions Promoting Physical Activity in People With Chronic Conditions: Systematic Review and Meta-Analysis |
To assess the effect of digital health solutions promoting physical activity among people with one or more chronic conditions. | Overall, using a digital health solution shows a small improvement in physical activity, physical function, quality of life, and a small reduction in depressive symptoms, but no change in anxiety symptoms compared to usual care. | Zangger et al. 2023 |
| Bricca et al. 2023
Management of multimorbidity |
To highlight management approaches that have potential to improve outcomes for patients with multimorbidity. | Expert guidelines and available evidence suggest that clinicians managing multimorbidity should consider the appropriateness of medicines and deprescribing; referral to exercise therapy and screening and treatment for comorbid depression. | Bricca et al. 2023 |
| Bricca et al. 2023
Fysisk aktivitet og træning som behandling ved multisygdom |
To highlight the role of physical activity and the benefits and harms of exercise therapy for people with multimorbidity and implications for clinical practice.
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Based on the existing evidence, clinicians should encourage and motivate patients to integrate physical activity into their daily lives, for instance through provision of social support or action plans. Moreover, to get started, patients could be referred to physiotherapists or municipal rehabilitation centers. | Bricca et al. 2023 |
| Find non-peer-reviewed blog articles here: | |||
| Bricca et al. 2021
Don’t judge an App by its cover! |
Blog to give an overview of the quality and potential to promote behavior change of the most downloaded Apps for people with one or more chronic conditions. | We suggest patients and clinicians who would like to use Apps for managing chronic conditions:
To use and recommend Apps with higher quality and potential for behavior change and to use and recommend Apps based on patient skills, needs and preferences. |
Bricca et el. 2021 |
| Bricca et al. 2023
Can digital health help solve the global pandemic of physical inactivity and chronic conditions? |
Blog summarizing the systematic review titled Benefits and Harms of Digital Health Interventions Promoting Physical Activity in People With Chronic Conditions. | Digital health interventions hold promise in promoting physical activity among people living with one or more chronic conditions.
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Bricca et al. 2023 |