Accelerometer-assessed physical activity patterns in people with multiple long-term conditions: a nested sub-study of the PERFORM (Personalised Exercise-Rehabilitation FOR people with Multiple long-term conditions) randomised trial.
Around 40% of UK adults live with two or more long-term health conditions, yet almost nothing is known about how physically active they actually are. This sub-study will give 214 participants wrist-worn accelerometers to track their movement patterns for nine consecutive days, before and after an exercise-rehabilitation programme called PERFORM. Physical activity is known to help manage individual conditions like heart disease or diabetes, but its role in people with multiple conditions—who face higher risks of disability, frailty, and poor quality of life—remains a blind spot. Without this data, clinicians cannot tailor exercise interventions effectively, and trials cannot measure whether a programme actually changes behaviour. If this research succeeds, it will reveal which activity patterns predict whether someone sticks with rehabilitation, and whether changes in movement drive improvements in quality of life. The findings could reshape how the NHS designs and targets exercise programmes for the growing number of people with multiple long-term conditions, moving beyond generic advice to personalised, evidence-based prescriptions.
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Background: Physical activity (PA) can be a key behaviour in the management of many individual long-term conditions (LTCs), but little is currently known about PA in people with multiple LTCs (MLTCs, or multimorbidity), or the impact of PA on interventions. In the UK, up to 40% of adults have MLTCs, which is associated with increased risks of mortality, disability, frailty, poor health-related quality of life (HRQoL) and high healthcare costs. Our research aims to address this current gap in understanding of PA in MLTCs by using innovative techniques to assess novel PA patterns and explore their associations with health outcomes of people with MLTCs undergoing an exercise-rehabilitation intervention. Aims and objectives: The overarching aim of this sub-study is to understand how objectively assessed PA can inform the future targeting of effective intervention delivery for people living with MLTCs. Specific proposed research objectives to achieve this are: 1. To characterise PA patterns at baseline (pre-PERFORM intervention) in people with MLTCs using novel metrics. 2. To determine if PA at baseline is a predictor of intervention adherence. 3. To quantify the change in PA in people with MLTCs participating in the PERFORM exercise-rehabilitation intervention compared to control. 4. To examine to what extent PA is a mechanism for change in HRQoL with participation in the PERFORM exercise-rehabilitation intervention. Methods: This sub-study is nested within the PERFORM randomised controlled trial, which aims to assess the clinical and cost effectiveness of a novel rehabilitation programme plus usual care (intervention arm) versus usual care alone (control) in individuals with MLTCs. The sub-study requires 214 patients (107 per arm) which represents ~35% of the total RCT sample across the 20 UK sites. Accelerometer data will be collected from participants using wrist-worn GENEActiv devices, worn for 24 hours over nine consecutive days at three time points: baseline (pre-intervention) and 3- and 12-months follow-up. Data will be processed and analysed using cutting-edge machine learning techniques to derive detailed PA patterns and mobility metrics, including novel gait-related outcomes. Statistical analyses will include descriptive summaries of baseline characteristics and PA, and various regression-based models designed to directly assess each research objective. Timelines for delivery: The sub-study will be conducted over 24 months and align with the PERFORM main trial. Patient recruitment begins in July 2025 for a 9-month period. Data follow-up will be completed by March 2027, followed by data analysis and completion of report writing by June 2027. Anticipated impact and dissemination: We will employ a multifaceted dissemination strategy, presenting results at key scientific meetings and PERFORM s annual dissemination events, submitting 2-3 papers to high-impact journals, and collaborating with the patient advisory group to ensure results are accessible to stakeholders, including people with MLTCs. We believe results will inform future policy on managing MLTCs with PA, and methods for assessing PA in future trials. This project provides Dr Dibben-Santillan a timely and valuable opportunity to take on the PI role for a study of this magnitude for the first-time and contribute to her development as a future research leader.
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