Table 4 Details of the MOBILIZE intervention: Personalised exercise therapy and self-management support programme

1. Brief name

MOBILIZE Personalised exercise therapy and self-management support programme (RCT version)

2. Why

There are no interventions, including personalised exercise therapy and self-management support for people with multimorbidity, as highlighted by the evidence synthesys we performed, although such interventions are recommended by clinical guidelines for people with single long-term conditions.

3. What-materials

For the exercise therapy sessions, elastic bands, treadmills, stationary bikes, kettlebells, gym balls, step boards and mats were used. For the self-management programme, a PowerPoint presentation supported by a manual for clinicians describing the intervention and including links, references and materials for patients to support self-management were used. The programme only required exercise equipment available in most gyms of hospitals and municipalities, ensuring the feasibility of the future implementation of the intervention. The material will be made publicly available once finalised and evaluated in the randomised, controlled trial. The What-materials was informed by the evidence sysnthesys and qualitative interviews.

4. What-procedures

The programme consists of 24 supervised exercise therapy sessions and 24 self-management sessions during the 12 weeks. This was deemed feasible and acceptable by patients and physiotherapists delivering the intervention. Before commencing the 12-week exercise programme, the patients are invited for a one-to-one assessment lasting 60 minutes where the physiotherapist delivering the intervention introduces the participant to the exercise therapy programme and sets the starting level for the exercises and the targeted intensity. The 12-week programme is supervised to ensure that the patients learn a certain skill set to self-manage their conditions and to initiate the behaviour change when it comes to for example physical activity (i.e., supporting them in understanding how and why they should continue exercising and being physically active).

The exercise therapy consists of a warm-up phase (e.g., on a stationary bike), followed by PART 1 (all together); Balance exercises and strengthening exercises for the lower and upper body, then PART 2 (participant's own choice); Aerobic training, strength training or functional exercises, and finally a cool-down phase. The self-management programme combines individual and group activities and includes educational materials and videos, experiential exercises, and group discussions to equip patients with knowledge about chronic conditions and enable them to develop better self-management skills, set personal goals, and make action plans, identify challenges, and overcome them. At the end of the 12 weeks, the patients receive a video message on how to stay physically active and have a healthy lifestyle. This complements the self-management session ‘After MOBILIZE’.

5. Who-provided

The exercise therapy and self-management programme are facilitated by physiotherapists, who received specific one-day training session and three online half-day sessions in study procedures, supported by the MOBILIZE team. This is in line with what is delivered in clinical practice in Denmark, for people with single chronic conditions.

6. How

Delivered face to face (in-person) in small groups (max five patients) and individually and using different materials and videos as described under section 4.

7. Where

In Region Zealand, Denmark: the Department of Physiotherapy and Occupational Therapy at Slagelse and Næstved Hospitals, a private practice physiotherapy clinic in Holbæk and at rehabilitation centres in the municipalities of Roskilde and Lolland.

8. When and how much

24 (30-minute) self-management sessions followed by 24 (60-minute) supervised exercise therapy sessions delivered across 12 weeks with two sessions per week. Dosage (e.g., frequency, duration, intensity, level of severity) of the exercises were adapted to the patient’s abilities throughout the programme to support progression and continuous improvements in symptoms during the 12 weeks. The progression is guided using established tools such as the Borg scale of perceived exertion for aerobic exercise and the American College of Sports Medicine guidelines for strengthening exercises (e.g., the number of repetitions was added before increasing the number of sessions).

During the exercise therapy programme, patients and physiotherapists discussed subjects related to self-management and individual participant goals, including a session supporting long-term self-management and behaviour change.

9. Tailoring

The programme is tailored to the characteristics, progression and improvements of the individual patient. Furthermore, the patients supported by the physiotherapists involved in the programme set individual goals that are followed up during the 12-week program.

10. Modifications

Not applicable, however, we will record whether modifications are needed during the testing of the intervention in the RCT as well as the type of modifications.

11. How well (planned)

The facilitators of the programme attended a specific one-day course to be certified to deliver the treatment programme to ensure programme fidelity. While there is no clear recommendation on how to train the facilitators, the physios delivering MOBILIZE are expert in delivering exercise therapy and self-management, therefore one day course was deemed appropriate and sufficient to deliver the intervention as intended. The programme focused on how to deliver and supervise the exercise therapy and self-management programme and support self-management and behaviour change in the individual. Adherence to the exercise and self-management sessions is measured by dividing the number of sessions attended by the total number of sessions offered. Monthly online fidelity meetings and in-person visits to the sites delivering the interventions are scheduled to assess fidelity. The focus of the fidelity meetings is to meet with the facilitators delivering the intervention to discuss the programme, including how it is being delivered at the sites and the success and the barriers/challenges that have been experienced

12. How well (actual)

Not applicable, however, we will record this as described in point 11.