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SP0088 New drugs, but still comorbidity
  1. A Häkkinen
  1. Health Sciences, University of Jyväskylä, 40014 Jyväskylä University, Finland

Abstract

As the population ages the simultaneous presence of multiple pathological conditions in the form of comorbidity and multimorbidity is more a rule than an exception. Comorbidity is reported in 35 to 80% of all ill people (Taylor et al. 2010). Comorbidity and multimorbidity are challenging researchers, clinicians and policy makers as these persons require more frequent appointments and hospitalizations and are at a greater risk for drug interactions, disability and mortality (Slater 2011).

Although numerous chronic disease prevention strategies and treatment guidelines have been developed, they mainly address single conditions and ignore the presence of co-existing conditions (van der Noyen 2016). Especially physical activity in its different forms has numerous preventive and curative effects in most of the diseases in addition to drugs. These benefits are such as increased muscle force and aerobic capacity, maintenance of bone and cardiovascular health, decreased inflammation and pain, improved function and well-being.

Studies reveal that more than 80% of rheumatoid arthritis (RA) patients carry two or more comorbid conditions (Krisnan et al. 2005). However, according to the QUEST-RA study (5,235 patients from 21 countries), only 14% of all patients reported to perform physical exercise at least 3 times weekly. Physical inactivity was associated with female sex, older age, obesity, comorbidity, disability, disease activity, pain and fatigue (Sokka et al. 2008). Traditionally, patients with RA were advised to limit physical exercises due to a fear that exercises might increase disease activity and be harmful for joints but more recent studies show that they benefit from exercise (Baillet et al. 2012).

Compared to RA, osteoarthritis (OA) is more common with prevalence of ∼150 million people world-wide. In OA comorbidity rates vary between 68–85% in different studies. The most frequently occurring co-morbidities are diabetes, hypertension, cardiovascular disorders, obesity and back pain. De Rooij et al. (2016) have developed tailored exercise therapy for knee OA and comorbidity. In their study during the 20-week program 76% of the participants needed adaptations to frequency, type, intensity or duration of exercise sessions. In addition, 96% needed education and coaching related to comorbidities.

In our study group-based strength and balance training for two years was offered for community-dwelling participants aged >75 years. The results showed that those who did not start in the group had more comorbidities, lower cognition, higher sedative load, higher risk of malnutrition, and poorer self-reported health than those who started in the gym. Despite of multimorbidity and hospital admissions, many older adults were capable of long-term regular training (Aartolahti et al. 2015).

With multimorbidity multi-drug therapies are common and they increase the risk of side effects. Exercise is also beneficial for health and it should be considered as a non-pharmacological drug. As for any other drugs, individual dosing of exercise is very important as well.

References

  1. Aartolahti E et al. Gerontol Geriatr.2015;61:452–7.

  2. Baillet A et al. Rheumatology 2012;51:519–527.

  3. de Rooij M et al. Arthritis Care Res. 2016 Aug 26.

  4. Krishnan E et al Ann Rheum Dis. 2005;64:1350–2.

  5. Slater M, BMC Public Health 2011:11:77.

  6. Sokka T et al Arthritis Rheum. 2008:15;59:42–50.

  7. Taylor A et al. BMC Public Health 2010;10:718.

  8. van der Zee-Neuen A Arthritis Care & Research 2016:68,1823–183.

References

Disclosure of Interest None declared

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