Personalised exercise-rehabilitation for people with multiple long-term conditions (PERFORM): A randomised feasibility study

Rachael A. Evans; Sharon A. Simpson; James R. Manifield; Zahira Ahmed; Shaun Barber; Gwen Barwell; Sophie Eleanor Brown; Paulina Daw; Sarah G Dean; Patrick J Doherty; Heather Fraser; Nikki Gardiner; Colin Greaves; Tracy Ibbotson; Bhautesh Jani; Kate Jolly; Frances Mair; Emma McIntosh; Dimitrios Megaritis; Daniel Miller; Paula Ormandy; Susan Smith; Ioannis Vogiatzis; Ghazala Waheed; Tom M Withers; Rod S Taylor; Sally J Singh

doi:10.1136/bmjopen-2025-100195

Personalised exercise-rehabilitation for people with multiple long-term conditions (PERFORM): A randomised feasibility study

Rachael A. Evans
, Sharon A. Simpson
, James R. Manifield
, Zahira Ahmed
, Shaun Barber
, Gwen Barwell
, Sophie Eleanor Brown
, Paulina Daw
, Sarah G Dean
, Patrick J Doherty
, Heather Fraser
, Nikki Gardiner
, Colin Greaves
, Tracy Ibbotson
, Bhautesh Jani
, Kate Jolly
, Frances Mair
, Emma McIntosh
, Dimitrios Megaritis
, Daniel Miller

Paula Ormandy, Susan Smith, Ioannis Vogiatzis, Ghazala Waheed, Tom M Withers, Rod S Taylor, Sally J Singh^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

Objective: Existing exercise-based rehabilitation services, such as cardiac and pulmonary rehabilitation, are traditionally commissioned around single long-term conditions (LTCs) and therefore may not meet the complex needs of adults with multiple long-term conditions (MLTCs) or multimorbidity. The aim of this study was to assess the feasibility and acceptability of the newly developed personalised exercise-rehabilitation programme for people with multiple long-term conditions (PERFORM) and the trial methods.

Design: A parallel two-group mixed-methods feasibility randomised controlled trial (RCT) with embedded process and economic evaluation.

Setting: Three UK sites (two acute hospital settings, one community-based healthcare setting).

Participants: 60 adults with MLTCs (defined as the presence of ≥2 LTCs) with at least one known to benefit from exercise therapy were randomised 2:1 to PERFORM intervention plus usual care (PERFORM group) or usual care alone (control group).

Intervention: The intervention consisted of 8 weeks of supervised group-based exercise rehabilitation and structured self-care symptom-based support.

Primary and secondary outcome measures: Primary feasibility outcomes included: trial recruitment (percentage of a target of 60 participants recruited within 4.5 months), retention (percentage of participants with complete EuroQol data at 3 months) and intervention adherence (percentage of intervention group attending ≥60% sessions). Other feasibility measures included completion of outcome measures at baseline (pre-randomisation), 3 months post-randomisation (including patient-reported outcomes, exercise capacity and collection of health and social care resource use) and intervention fidelity.

Results: Target recruitment (40 PERFORM group, 20 control group) was met within the timeframe. Participants were 57% women with a mean (SD) age of 62 (13) years, body mass index of 30.8 (8.0) kg/m² and a median of 4 LTCs (most common: diabetes (41.7%), hypertension (38.3%), asthma (36.7%) and a painful condition (35.0%)). We achieved EuroQol outcome retention of 76.7% (95% CI: 65.9% to 87.1%; 46/60 participants) and intervention adherence of 72.5% (95% CI: 56.3% to 84.4%; 29/40 participants). Data completion for attendees was over 90% for 11/18 outcome measures.

Conclusions: Our findings support the feasibility and rationale for delivering the PERFORM comprehensive self-management and exercise-based rehabilitation intervention for people living with MLTCs and progression to a full multicentre RCT to formally assess clinical effectiveness and cost-effectiveness.

Trial registration number: ISRCTN68786622.

Original language	English
Article number	e100195
Number of pages	13
Journal	BMJ Open
Volume	15
Issue number	9
DOIs	https://doi.org/10.1136/bmjopen-2025-100195
Publication status	Published - 17 Sept 2025

Bibliographical note

Copyright:
© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Multimorbidity
Rehabilitation Medicine
Self-Management

ASJC Scopus subject areas

General Medicine

Access to Document

10.1136/bmjopen-2025-100195Licence: Creative Commons: Attribution (CC BY)

EvansR2025Personalised Final published version, 2.59 MBLicence: Creative Commons: Attribution (CC BY)

Personalised Exercise-Rehabilitation for people with multiple long term conditions (multi-morbidity) The PERFORM trial
Greaves, C. (Principal Investigator) & Jolly, K. (Co-Investigator)
NIHR
1/01/22 → 31/03/27
Project: Other Government Departments

Cite this

Evans, R. A., Simpson, S. A., Manifield, J. R., Ahmed, Z., Barber, S., Barwell, G., Brown, S. E., Daw, P., Dean, S. G., Doherty, P. J., Fraser, H., Gardiner, N., Greaves, C., Ibbotson, T., Jani, B., Jolly, K., Mair, F., McIntosh, E., Megaritis, D., ... Singh, S. J. (2025). Personalised exercise-rehabilitation for people with multiple long-term conditions (PERFORM): A randomised feasibility study. BMJ Open, 15(9), Article e100195. https://doi.org/10.1136/bmjopen-2025-100195

@article{eb4b36e9bbb64b73bc2c344ae15b47fd,

title = "Personalised exercise-rehabilitation for people with multiple long-term conditions (PERFORM): A randomised feasibility study",

abstract = "Objective: Existing exercise-based rehabilitation services, such as cardiac and pulmonary rehabilitation, are traditionally commissioned around single long-term conditions (LTCs) and therefore may not meet the complex needs of adults with multiple long-term conditions (MLTCs) or multimorbidity. The aim of this study was to assess the feasibility and acceptability of the newly developed personalised exercise-rehabilitation programme for people with multiple long-term conditions (PERFORM) and the trial methods. Design: A parallel two-group mixed-methods feasibility randomised controlled trial (RCT) with embedded process and economic evaluation. Setting: Three UK sites (two acute hospital settings, one community-based healthcare setting). Participants: 60 adults with MLTCs (defined as the presence of ≥2 LTCs) with at least one known to benefit from exercise therapy were randomised 2:1 to PERFORM intervention plus usual care (PERFORM group) or usual care alone (control group). Intervention: The intervention consisted of 8 weeks of supervised group-based exercise rehabilitation and structured self-care symptom-based support. Primary and secondary outcome measures: Primary feasibility outcomes included: trial recruitment (percentage of a target of 60 participants recruited within 4.5 months), retention (percentage of participants with complete EuroQol data at 3 months) and intervention adherence (percentage of intervention group attending ≥60\% sessions). Other feasibility measures included completion of outcome measures at baseline (pre-randomisation), 3 months post-randomisation (including patient-reported outcomes, exercise capacity and collection of health and social care resource use) and intervention fidelity. Results: Target recruitment (40 PERFORM group, 20 control group) was met within the timeframe. Participants were 57\% women with a mean (SD) age of 62 (13) years, body mass index of 30.8 (8.0) kg/m2 and a median of 4 LTCs (most common: diabetes (41.7\%), hypertension (38.3\%), asthma (36.7\%) and a painful condition (35.0\%)). We achieved EuroQol outcome retention of 76.7\% (95\% CI: 65.9\% to 87.1\%; 46/60 participants) and intervention adherence of 72.5\% (95\% CI: 56.3\% to 84.4\%; 29/40 participants). Data completion for attendees was over 90\% for 11/18 outcome measures. Conclusions: Our findings support the feasibility and rationale for delivering the PERFORM comprehensive self-management and exercise-based rehabilitation intervention for people living with MLTCs and progression to a full multicentre RCT to formally assess clinical effectiveness and cost-effectiveness. Trial registration number: ISRCTN68786622.",

keywords = "Multimorbidity, Rehabilitation Medicine, Self-Management",

author = "Evans, \{Rachael A.\} and Simpson, \{Sharon A.\} and Manifield, \{James R.\} and Zahira Ahmed and Shaun Barber and Gwen Barwell and Brown, \{Sophie Eleanor\} and Paulina Daw and Dean, \{Sarah G\} and Doherty, \{Patrick J\} and Heather Fraser and Nikki Gardiner and Colin Greaves and Tracy Ibbotson and Bhautesh Jani and Kate Jolly and Frances Mair and Emma McIntosh and Dimitrios Megaritis and Daniel Miller and Paula Ormandy and Susan Smith and Ioannis Vogiatzis and Ghazala Waheed and Withers, \{Tom M\} and Taylor, \{Rod S\} and Singh, \{Sally J\}",

note = "Copyright: {\textcopyright} Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group.",

year = "2025",

month = sep,

day = "17",

doi = "10.1136/bmjopen-2025-100195",

language = "English",

volume = "15",

journal = "BMJ Open",

issn = "2044-6055",

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Evans, RA, Simpson, SA, Manifield, JR, Ahmed, Z, Barber, S, Barwell, G, Brown, SE, Daw, P, Dean, SG, Doherty, PJ, Fraser, H, Gardiner, N, Greaves, C, Ibbotson, T, Jani, B, Jolly, K, Mair, F, McIntosh, E, Megaritis, D, Miller, D, Ormandy, P, Smith, S, Vogiatzis, I, Waheed, G, Withers, TM, Taylor, RS & Singh, SJ 2025, 'Personalised exercise-rehabilitation for people with multiple long-term conditions (PERFORM): A randomised feasibility study', BMJ Open, vol. 15, no. 9, e100195. https://doi.org/10.1136/bmjopen-2025-100195

TY - JOUR

T1 - Personalised exercise-rehabilitation for people with multiple long-term conditions (PERFORM)

T2 - A randomised feasibility study

AU - Evans, Rachael A.

AU - Simpson, Sharon A.

AU - Manifield, James R.

AU - Ahmed, Zahira

AU - Barber, Shaun

AU - Barwell, Gwen

AU - Brown, Sophie Eleanor

AU - Daw, Paulina

AU - Dean, Sarah G

AU - Doherty, Patrick J

AU - Fraser, Heather

AU - Gardiner, Nikki

AU - Greaves, Colin

AU - Ibbotson, Tracy

AU - Jani, Bhautesh

AU - Jolly, Kate

AU - Mair, Frances

AU - McIntosh, Emma

AU - Megaritis, Dimitrios

AU - Miller, Daniel

AU - Ormandy, Paula

AU - Smith, Susan

AU - Vogiatzis, Ioannis

AU - Waheed, Ghazala

AU - Withers, Tom M

AU - Taylor, Rod S

AU - Singh, Sally J

PY - 2025/9/17

Y1 - 2025/9/17

N2 - Objective: Existing exercise-based rehabilitation services, such as cardiac and pulmonary rehabilitation, are traditionally commissioned around single long-term conditions (LTCs) and therefore may not meet the complex needs of adults with multiple long-term conditions (MLTCs) or multimorbidity. The aim of this study was to assess the feasibility and acceptability of the newly developed personalised exercise-rehabilitation programme for people with multiple long-term conditions (PERFORM) and the trial methods. Design: A parallel two-group mixed-methods feasibility randomised controlled trial (RCT) with embedded process and economic evaluation. Setting: Three UK sites (two acute hospital settings, one community-based healthcare setting). Participants: 60 adults with MLTCs (defined as the presence of ≥2 LTCs) with at least one known to benefit from exercise therapy were randomised 2:1 to PERFORM intervention plus usual care (PERFORM group) or usual care alone (control group). Intervention: The intervention consisted of 8 weeks of supervised group-based exercise rehabilitation and structured self-care symptom-based support. Primary and secondary outcome measures: Primary feasibility outcomes included: trial recruitment (percentage of a target of 60 participants recruited within 4.5 months), retention (percentage of participants with complete EuroQol data at 3 months) and intervention adherence (percentage of intervention group attending ≥60% sessions). Other feasibility measures included completion of outcome measures at baseline (pre-randomisation), 3 months post-randomisation (including patient-reported outcomes, exercise capacity and collection of health and social care resource use) and intervention fidelity. Results: Target recruitment (40 PERFORM group, 20 control group) was met within the timeframe. Participants were 57% women with a mean (SD) age of 62 (13) years, body mass index of 30.8 (8.0) kg/m2 and a median of 4 LTCs (most common: diabetes (41.7%), hypertension (38.3%), asthma (36.7%) and a painful condition (35.0%)). We achieved EuroQol outcome retention of 76.7% (95% CI: 65.9% to 87.1%; 46/60 participants) and intervention adherence of 72.5% (95% CI: 56.3% to 84.4%; 29/40 participants). Data completion for attendees was over 90% for 11/18 outcome measures. Conclusions: Our findings support the feasibility and rationale for delivering the PERFORM comprehensive self-management and exercise-based rehabilitation intervention for people living with MLTCs and progression to a full multicentre RCT to formally assess clinical effectiveness and cost-effectiveness. Trial registration number: ISRCTN68786622.

AB - Objective: Existing exercise-based rehabilitation services, such as cardiac and pulmonary rehabilitation, are traditionally commissioned around single long-term conditions (LTCs) and therefore may not meet the complex needs of adults with multiple long-term conditions (MLTCs) or multimorbidity. The aim of this study was to assess the feasibility and acceptability of the newly developed personalised exercise-rehabilitation programme for people with multiple long-term conditions (PERFORM) and the trial methods. Design: A parallel two-group mixed-methods feasibility randomised controlled trial (RCT) with embedded process and economic evaluation. Setting: Three UK sites (two acute hospital settings, one community-based healthcare setting). Participants: 60 adults with MLTCs (defined as the presence of ≥2 LTCs) with at least one known to benefit from exercise therapy were randomised 2:1 to PERFORM intervention plus usual care (PERFORM group) or usual care alone (control group). Intervention: The intervention consisted of 8 weeks of supervised group-based exercise rehabilitation and structured self-care symptom-based support. Primary and secondary outcome measures: Primary feasibility outcomes included: trial recruitment (percentage of a target of 60 participants recruited within 4.5 months), retention (percentage of participants with complete EuroQol data at 3 months) and intervention adherence (percentage of intervention group attending ≥60% sessions). Other feasibility measures included completion of outcome measures at baseline (pre-randomisation), 3 months post-randomisation (including patient-reported outcomes, exercise capacity and collection of health and social care resource use) and intervention fidelity. Results: Target recruitment (40 PERFORM group, 20 control group) was met within the timeframe. Participants were 57% women with a mean (SD) age of 62 (13) years, body mass index of 30.8 (8.0) kg/m2 and a median of 4 LTCs (most common: diabetes (41.7%), hypertension (38.3%), asthma (36.7%) and a painful condition (35.0%)). We achieved EuroQol outcome retention of 76.7% (95% CI: 65.9% to 87.1%; 46/60 participants) and intervention adherence of 72.5% (95% CI: 56.3% to 84.4%; 29/40 participants). Data completion for attendees was over 90% for 11/18 outcome measures. Conclusions: Our findings support the feasibility and rationale for delivering the PERFORM comprehensive self-management and exercise-based rehabilitation intervention for people living with MLTCs and progression to a full multicentre RCT to formally assess clinical effectiveness and cost-effectiveness. Trial registration number: ISRCTN68786622.

KW - Multimorbidity

KW - Rehabilitation Medicine

KW - Self-Management

UR - https://www.scopus.com/pages/publications/105016322049

U2 - 10.1136/bmjopen-2025-100195

DO - 10.1136/bmjopen-2025-100195

M3 - Article

AN - SCOPUS:105016322049

SN - 2044-6055

VL - 15

JO - BMJ Open

JF - BMJ Open

IS - 9

M1 - e100195

ER -

Personalised exercise-rehabilitation for people with multiple long-term conditions (PERFORM): A randomised feasibility study

Abstract

Bibliographical note

UN SDGs

Keywords

ASJC Scopus subject areas

Access to Document

Fingerprint

Projects

Personalised Exercise-Rehabilitation for people with multiple long term conditions (multi-morbidity) The PERFORM trial

Cite this