Effectiveness of maintenance interventions promoting physical activity following exercise therapy for chronic conditions: an umbrella review

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.