title: Community-based exercise programs as a strategy to optimize function in chronic disease: a systematic review.
abstract: BACKGROUND
  Chronic diseases are the leading cause of death and disability worldwide. Preliminary evidence suggests that community-based exercise (CBE) improves functional capacity (FC) and health-related quality of life (HRQL).
  
  
  OBJECTIVE
  To describe the structure and delivery of CBE programs for chronic disease populations and compare their impact on FC and HRQL to standard care.
  
  
  METHODS
  Randomized trials examining CBE programs for individuals with stroke, chronic obstructive pulmonary disease, osteoarthritis, diabetes, and cardiovascular disease were identified. Quality was assessed using the Cochrane risk of bias tool. Meta-analyses were conducted using Review Manager 5.1. The protocol was registered on PROSPERO (CRD42012002786).
  
  
  RESULTS
  Sixteen studies (2198 individuals, mean age 66.8±4.9 y) were included to describe program structures, which were comparable in their design and components, irrespective of the chronic disease. Aerobic exercise and resistance training were the primary interventions in 85% of studies. Nine studies were included in the meta-analysis. The weighted mean difference for FC, evaluated using the 6-minute walk test, was 41.7 m (95% confidence interval [CI], 20.5-62.8). The standardized mean difference for all FC measures was 0.18 (95% CI, 0.05-0.3). The standardized mean difference for the physical component of HRQL measures was 0.21 (95% CI, 0.05-0.4) and 0.38 (95% CI, 0.04-0.7) for the total score.
  
  
  CONCLUSIONS
  CBE programs across chronic disease populations have similar structures. These programs appear superior to standard care with respect to optimizing FC and HRQL in individuals with osteoarthritis; however, the effect beyond this population is unknown. Long-term sustainability of these programs remains to be established.
authors.affiliation: *Graduate Department of Rehabilitation Science, Faculty of Medicine, University of Toronto †Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada ‡Department of Physical Medicine and Rehabilitation, Harvard University, Cambridge, MA Departments of §Physical Therapy ∥Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Desveaux
authors.forename: Marla
authors.initials: M
authors.lastname: Beauchamp
authors.forename: Roger
authors.initials: R
authors.lastname: Goldstein
authors.forename: Dina
authors.initials: D
authors.lastname: Brooks
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D002318:Cardiovascular Diseases / Q000628:therapy; D002908:Chronic Disease / Q000628:therapy*; D003153:Community Health Services / Q000458:organization & administration*; D003920:Diabetes Mellitus / Q000628:therapy; D015444:Exercise; D006801:Humans; D010003:Osteoarthritis / Q000628:therapy; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000628:therapy