Exercise Prescription Considerations for Individuals with Multiple Chronic Diseases: Systematic Review

Abstract

Background: Although the benefits of exercise are well-known, guidelines often target the general public or individuals living with single pathologies. Currently, there is no systematic exercise prescription approach for individuals with multiple chronic diseases. Objective: To determine overlapping physiological and subjective markers for use by clinicians to define safe exercise for individuals with multiple chronic diseases. Methods: Eight databases were used to complete a comprehensive systematic review. Thirty-nine articles met the inclusion criteria for chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD) and type two diabetes mellitus (T2DM). Four reviewers extracted all qualitative and quantitative data. Results: Findings show that: 1) aerobic and resistance training done 2-3 times per week is beneficial for individuals with chronic diseases, and 2) overlapping ranges of physiological and subjective markers can be used to determine safe exercise prescription. Exercise for the chronic diseases searched is safe with overlapping markers including: systolic and diastolic blood pressure, Borg scale, VO2Max, and heart rate. Each disease state did have unique markers that must be monitored to ensure safety during exercise. Specifically, with COPD SpO2 should be kept above 90%, for CAD exercise heart rate should be kept 10 bpm below causing angina symptoms, and for diabetes blood glucose should be kept between 100-300 mg/dl. Conclusion: This review shows initial evidence for a multi-system approach to exercise prescription, which suggests screening key physiological markers from various body systems in order to safely prescribe exercise to individuals with multiple chronic diseases.