Physical Activity, Exercise-Related Measures and Multimorbidity: A Narrative Review
DOI:
https://doi.org/10.33700/jhrs.5.2.297Keywords:
physical activity, exercise, multimorbidity, multiple chronic conditionsAbstract
Introduction: Multimorbidity, commonly defined as the coexistence of two or more chronic conditions, is associated with poorer health outcomes, reduced quality of life, and greater healthcare needs. Physical activity and structured exercise may contribute to its prevention and management.
Aim: To examine and critically summarise evidence on physical activity and structured exercise in relation to multimorbidity development, progression, and health outcomes in adults.
Methods: A selective narrative review was conducted using PubMed, Scopus, and Web of Science. Searches were performed in June 2026 and updated in September 2026. Twelve original, peer-reviewed studies published in English between 2015 and 2026 were included. Methodological quality and risk of bias were assessed using design-specific tools. The synthesis distinguished baseline multimorbidity status, habitual physical activity, and structured exercise.
Results: Higher physical activity was associated with lower mortality and longer modelled life expectancy. Findings for multimorbidity onset and progression, physical and cognitive function, and mental health were mixed. One randomised trial found improved health-related quality of life with combined exercise and self-management, although clinical importance was unclear and other outcomes showed inconsistent improvements. Predominantly observational evidence, heterogeneity, and potential bias limited causal inference and study comparisons.
Conclusion: The clearest observational evidence concerned lower mortality. Evidence for other outcomes and the independent effects of structured exercise was less conclusive. Further studies should identify effective and safe activity types and doses for different multimorbidity profiles.
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Agress, S., Sheikh, J. S., Ramos, A. A. P., Kashyap, D., Razmjouei, S., Kumar, J., Singh, M., Lak, M. A., Osman, A., & Zia Ul Haq, M. (2024). The interplay of comorbidities in chronic heart failure: Challenges and solutions. Current Cardiology Reviews, 20(3), 13–29. https://doi.org/10.2174/011573403X289572240206112303 DOI: https://doi.org/10.2174/011573403X289572240206112303
Anderson, E., & Durstine, J. L. (2019). Physical activity, exercise, and chronic diseases: A brief review. Sports Medicine and Health Science, 1(1), 3–10. https://doi.org/10.1016/j.smhs.2019.08.006 DOI: https://doi.org/10.1016/j.smhs.2019.08.006
Baethge, C., Goldbeck-Wood, S., & Mertens, S. (2019). SANRA—a scale for the quality assessment of narrative review articles. Research Integrity and Peer Review, 4, Article 5. https://doi.org/10.1186/s41073-019-0064-8 DOI: https://doi.org/10.1186/s41073-019-0064-8
Bricca, A., Harris, L. K., Jäger, M., Smith, S. M., Juhl, C. B., & Skou, S. T. (2020). Benefits and harms of exercise therapy in people with multimorbidity: A systematic review and meta-analysis of randomised controlled trials. Ageing Research Reviews, 63, Article 101166. https://doi.org/10.1016/j.arr.2020.101166 DOI: https://doi.org/10.1016/j.arr.2020.101166
Chudasama, Y. V., Khunti, K. K., Zaccardi, F., Rowlands, A. V., Yates, T., Gillies, C. L., Davies, M. J., & Dhalwani, N. N. (2019). Physical activity, multimorbidity, and life expectancy: A UK Biobank longitudinal study. BMC Medicine, 17, Article 108. https://doi.org/10.1186/s12916-019-1339-0 DOI: https://doi.org/10.1186/s12916-019-1339-0
Chudasama, Y. V., Khunti, K., Gillies, C. L., Dhalwani, N. N., Davies, M. J., Yates, T., & Zaccardi, F. (2020). Healthy lifestyle and life expectancy in people with multimorbidity in the UK Biobank: A longitudinal cohort study. PLOS Medicine, 17(9), Article e1003332. https://doi.org/10.1371/journal.pmed.1003332 DOI: https://doi.org/10.1371/journal.pmed.1003332
Dhalwani, N. N., Zaccardi, F., O’Donovan, G., Carter, P., Hamer, M., Yates, T., Davies, M., & Khunti, K. (2017). Association between lifestyle factors and the incidence of multimorbidity in an older English population. The Journals of Gerontology: Series A, 72(4), 528–534. https://doi.org/10.1093/gerona/glw146 DOI: https://doi.org/10.1093/gerona/glw146
Hacker, K. (2024). The burden of chronic disease. Mayo Clinic Proceedings: Innovations, Quality & Outcomes, 8(1), 112–119. https://doi.org/10.1016/j.mayocpiqo.2023.08.005 DOI: https://doi.org/10.1016/j.mayocpiqo.2023.08.005
Joanna Briggs Institute. (2017). Checklist for analytical cross sectional studies. https://jbi.global/sites/default/files/2019-05/JBI_Critical_Appraisal-Checklist_for_Analytical_Cross_Sectional_Studies2017_0.pdf
Liu, B. P., Zhu, J. H., Wan, L. P., Zhao, Z. Y., Wang, X., & Jia, C. X. (2023). The impact of physical activity intensity on the dynamic progression of cardiometabolic multimorbidity: Prospective cohort study using UK Biobank data. JMIR Public Health and Surveillance, 9, Article e46991. https://doi.org/10.2196/46991 DOI: https://doi.org/10.2196/46991
Mou, C., Wang, Z., & Ke, Z. (2025). Association between physical activity and multimorbidity: A population-based cohort study. Archives of Public Health, 83(1), Article 71. https://doi.org/10.1186/s13690-025-01562-y DOI: https://doi.org/10.1186/s13690-025-01562-y
Ojijieme, N. G., Feng, T., Chui, C. M., Qi, X., & Liu, Y. (2024). Physical activity dynamically moderates the impact of multimorbidity on the trajectory of healthy aging over sixteen years. BMC Geriatrics, 24(1), Article 565. https://doi.org/10.1186/s12877-024-05067-1 DOI: https://doi.org/10.1186/s12877-024-05067-1
Petrie, J. R., Guzik, T. J., & Touyz, R. M. (2018). Diabetes, hypertension, and cardiovascular disease: Clinical insights and vascular mechanisms. Canadian Journal of Cardiology, 34(5), 575–584. https://doi.org/10.1016/j.cjca.2017.12.005 DOI: https://doi.org/10.1016/j.cjca.2017.12.005
Ryan, A., Murphy, C., Boland, F., Galvin, R., & Smith, S. M. (2018). What is the impact of physical activity and physical function on the development of multimorbidity in older adults over time? A population-based cohort study. The Journals of Gerontology: Series A, 73(11), 1538–1544. https://doi.org/10.1093/gerona/glx251 DOI: https://doi.org/10.1093/gerona/glx251
Savikangas, T., Savolainen, T., Tirkkonen, A., Alén, M., Hautala, A. J., Laukkanen, J. A., Rantalainen, T., Törmäkangas, T., & Sipilä, S. (2024). The impact of multimorbidity patterns on changes in physical activity and physical capacity among older adults participating in a year-long exercise intervention. Journal of Aging and Physical Activity, 32(2), 213–224. https://doi.org/10.1123/japa.2022-0397 DOI: https://doi.org/10.1123/japa.2022-0397
Schmidt, C. W., Agnew, M., Malecki, K., Gangnon, R., Schultz, A., Peppard, P. E., & Cadmus-Bertram, L. (2025). Physical activity and mental health in patients with multimorbidity. Mental Health and Physical Activity, 28, Article 100673. https://doi.org/10.1016/j.mhpa.2025.100673 DOI: https://doi.org/10.1016/j.mhpa.2025.100673
Skou, S. T., Mair, F. S., Fortin, M., Guthrie, B., Nunes, B. P., Miranda, J. J., Boyd, C. M., Pati, S., Mtenga, S., & Smith, S. M. (2022). Multimorbidity. Nature Reviews Disease Primers, 8(1), Article 48. https://doi.org/10.1038/s41572-022-00376-4 DOI: https://doi.org/10.1038/s41572-022-00376-4
Skou, S. T., Nyberg, M., Dideriksen, M., Rasmussen, H., Overgaard, J. A., Bodilsen, C., Soja, A. M. B., Attarzadeh, A. P., Bieder, M. J., Dridi, N. P., Heltberg, A., Gæde, P. H., Reventlow, J. L., Arnfred, S., Bodtger, U., Brønd, J. C., Thygesen, L. C., Møller, S. P., Jäger, M., & Bricca, A. (2025). Exercise therapy and self-management support for individuals with multimorbidity: A randomized and controlled trial. Nature Medicine, 31(9), 3176–3182. https://doi.org/10.1038/s41591-025-03779-4 DOI: https://doi.org/10.1038/s41591-025-03779-4
Sterne, J. A. C., Savović, J., Page, M. J., Elbers, R. G., Blencowe, N. S., Boutron, I., Cates, C. J., Cheng, H.-Y., Corbett, M. S., Eldridge, S. M., Emberson, J. R., Hernán, M. A., Hopewell, S., Hróbjartsson, A., Junqueira, D. R., Jüni, P., Kirkham, J. J., Lasserson, T., Li, T., … Higgins, J. P. T. (2019). RoB 2: A revised tool for assessing risk of bias in randomised trials. BMJ, 366, Article l4898. https://doi.org/10.1136/bmj.l4898 DOI: https://doi.org/10.1136/bmj.l4898
Vancampfort, D., Koyanagi, A., Ward, P. B., Rosenbaum, S., Schuch, F. B., Mugisha, J., Richards, J., Firth, J., & Stubbs, B. (2017). Chronic physical conditions, multimorbidity and physical activity across 46 low- and middle-income countries. International Journal of Behavioral Nutrition and Physical Activity, 14, Article 6. https://doi.org/10.1186/s12966-017-0463-5 DOI: https://doi.org/10.1186/s12966-017-0463-5
Veronese, N., Ragusa, F. S., Hajek, A., Stubbs, B., Smith, L., Barbagallo, M., Dominguez, L. J., Fontana, L., Soysal, P., Sabico, S., & Al-Daghri, N. M. (2025). Long-term impact of physical activity on mortality in adults with multimorbidity: A 12-year cohort longitudinal study from the Survey of Health, Ageing and Retirement in Europe. Journal of Cachexia, Sarcopenia and Muscle, 16(1), Article e13695. https://doi.org/10.1002/jcsm.13695 DOI: https://doi.org/10.1002/jcsm.13695
Wells, G. A., Shea, B., O’Connell, D., Peterson, J., Welch, V., Losos, M., & Tugwell, P. (n.d.). The Newcastle–Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa Hospital Research Institute. https://ohri.ca/en/who-we-are/core-facilities-and-platforms/ottawa-methods-centre/newcastle-ottawa-scale
World Health Organization. (2024). Physical activity. https://www.who.int/news-room/fact-sheets/detail/physical-activity
World Health Organization. (2025). Cardiovascular diseases (CVDs). https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
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