Chronic disease (CD) is an umbrella term that describes long-term progressive illnesses including cardiovascular disease (CVD), cancer, type 2 diabetes mellitus (T2DM) and chronic obstructive lung disease (COPD). These are conditions lasting at least 1 year, require continuous medical attention and can limit activities of daily living (World Health Organization, 2013). Chronic disease is the leading cause of mortality globally, (Roberts et. al, 2005) and accounted for >60% of all adult deaths in Ireland in 2018 (Department of Health, 2019). Almost 30% of the adult population in Ireland are living with one or more CD (Department of Health, 2019). With that in mind, the burden of CD on the Irish Healthcare system is substantial, the management of CD accounts for 70 – 90% of healthcare budgets in Europe and the US. (Skelly, 2021).
The four CDs that are prioritized in the W.H.O’s Global Action Plan for prevention and control of Noncommunicable Diseases 2013 – 2020 are
Cardiovascular disease
Cancer
Diabetes
Chronic respiratory disease (Wilkinson et. al, 2019).
All these diseases are linked by preventable risk factors including, high blood pressure, high cholesterol, being overweight, unhealthy diet, physical inactivity and tobacco use. (W.H.O. , 2021) Many of these chronic diseases are also important risk factors for falls in the elderly (Kiik et. al, 2020)
With the number of people over the age of 65 increasing every year, the population of people living with one or more CDs is increasing. A 40% increase in the number of adults in Ireland living with a CD is expected in the next decade (Skelly, 2021). This worldwide increase may potentially overwhelm the current health care systems (Kehoe et. al, 2020).
Along with increased mortality and morbidity, skeletal muscle atrophy (wasting) and skeletal muscle dysfunction are consequences of CD’s. (Wilkinson et. al, 2019). Disease related muscle atrophy is a significant issue, as loss of muscle mass and assosciated weakness can result in functional limitations and a reduced quality of life. (Wilkinson et. al, 2019) The progressive decline of skeletal muscle mass and strength with ageing is called sarcopenia and has been reported as a risk factor for mobility disabilities and chronic disease. (McLeod et. al, 2019) (Ciccolo et. al, 2010) Skeletal muscle atrophy is independently assosciated with increased mortality in patients with chronic disease. (Wilkinson et. al, 2019)
Unfortunately, chronic disease does not only limit life expectancy, it may also reduce the number of quality of life years. (Roberts et. al, 2005) For a successful and sustainable approach to chronic disease management and prevention, we cannot rely solely on pharmaceutical intervention but, must also focus on implementing behaviours that encourage a healthy lifestyle (Roberts et. al, 2005) Regular physical activity and exercise have become cornerstones in the primary and secondary prevention of chronic diseases (McLeod et al, 2019).
The effectiveness of physical activity and exercise in reducing the morbidity and mortality related to chronic disease has been widely established. (Skelly, 2021). The benefits of exercise in the treatment and prevention of chronic disease has been widely reported. For many CDs, the health benefits of exercise / physical activity are more than what could be achieved with conventional medication therapy. (Skelly, 2021) It is assosciated with reductions in recurrent events, future complications, hospital readmissions, and mortality in several chronic diseases. (Kehoe et. al, 2020). Skelly 2021, noted that for people with CD exercise therapy can improve physical function, decrease symptoms, enhance quality of life, decrease future use of healthcare and reduce the risk of mortality. This is supported by an umbrella review by Pasanen et. al, 2017 which shows that exercise improves functional capacity and reduces disability in those living with chronic diseases (Pasanen et. al, 2017) and a study by Kujala et. al, (2009). Kehoe et. al (2020) note that there are very few chronic diseases in which exercise has not been shown to have a positive effect on the burden of disease, the comorbidities and the disease – related quality of life. (Kehoe et. al, 2020) Improved functional capacity allows improved ability in activities of daily life. Pansanen et. al, 2017, suggest that this ability to complete activities of daily living has important psychological and economic benefits as it reduces the need for care and allows people living with CDs to live at home.
It has been shown in a review and subsequent study by Skelly (2021) that regardless of the disease, CD populations participate in lower levels of physical activity (as measured by;
Daily step count
Light intensity physical activity (minutes)
Moderate to vigorous physical activity (minutes))
They have more sedentary behaviours than their healthy counterparts (Skelly et. al, 2021). To gain optimal health – related benefits for the secondary prevention of CD is it recommended that people living with CD participate in 150 min/week of moderate to vigorous physical activity (US Department of Health and Human Services, 2018)(Skelly, 2021)
Physical activity or exercise therapy is now routinely prescribed by health care providers in the management of CD. However, there is still some debate over what the most appropriate type of programme / approach is advised. Kehoe et. al, 2020 found that it is unnecessary to have separate programmes for single chronic conditions and that an integrated approach is as effective and more resource efficient. This is supported by Pasanen et. al, 2017 who conducted an overview of meta-analysis of randomised controlled trials regarding exercise therapy for functional capacity in chronic diseases. They found that both resistance exercise training and aerobic training interventions are more effective than condition specific interventions. (Pasanen et. al, 2017). The importance of an element of resistance training is clear in the literature with McLeod et. al (2019) finding that resistance training (either alone or combined training program) had greater strength in gains in older adults than exercise programs without an element RET. Overall, they suggest that a multicomponent exercise programme (consisting of RET, AET, and balance training) is the best strategy for attenuating declines in physical functioning for older adults (McLeod et. al, 2019).
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