The PERFORM trial

About the project

Rehabilitation, ‘the action of restoring someone to health or normal life illness’ remains a core component of health service provision. A substantive body of evidence has demonstrated improvements in functional capacity and health-related quality of life and reduction in hospital admissions following exercise-based rehabilitation for single index diseases, notably, chronic obstructive pulmonary disease, post-myocardial infarction/ revascularisation, heart failure (i.e. ‘pulmonary and cardiac rehabilitation’ (CR/PR). However, it is increasingly recognised that such rehabilitation programmes do not meet the needs the increasing number of people presenting with long-term conditions or NHS where they are managed. Continuing to develop single indication rehabilitation programmes despite accumulating evidence for diverse disease groups is unlikely to be attractive or efficient for health services or for patients. The recent NHS long term plan highlighted the urgent need for innovative approaches to address the needs of people with multimorbidity.

Project leads

  • Professor Sally Singh, University of Leicester/University Hospitals Leicester
  • Professor Rod Taylor, University of Glasgow

Aims and objectives

The overarching aim of the Personalised Exercise Rehabilitation FOR people with Multiple LTCs (PERFORM) research programme is to better understand the impact of living with multiple LTCs and develop and evaluate a rehabilitation intervention for this population.

Our PERFORM programme consists of five linked work packages (WPs) with following specific objectives:

  1. To identify patient populations with common clusters of LTCs with evidence that at least one of the conditions would benefit from an exercise-based rehabilitation programme (WP1).
  2. Identify clusters of LTCs and other modifiable factors (e.g. obesity, smoking) that are associated with the worst quality of life and health care outcomes (mortality/ hospitalisations) and greatest economic consequences (WP1).
  3. Work with stakeholders to integrate, adapt and transform existing CR and PR programmes into a novel integrated rehabilitation programme ( ‘PERFORM intervention’) to treat a wide range of people with multiple LTCs (WP2).
  4. Develop a training package to support workforce development and training to deliver PERFORM intervention (WP2).
  5. Implement the PERFORM intervention and conduct a feasibility trial to inform the planning of a full-scale randomised trial (WP3).
  6. Conduct a full-scale randomised trial in people with multiple LTCs to assess the clinical and cost-effectiveness of PERFORM compared to usual care (WP4).
  7. Conduct a cohort study in people with multiple LTCs to assess the clinical and cost-effectiveness of PERFORM compared to standard cardiac or pulmonary rehabilitation (WP4).
  8. Assess the impact of social media (SoMe) as intervention to promote trial retention through a study within a trial (SWAT) (WP5).
  9. Identify barriers and facilitators to future wide scale implementation and develop an implementation toolkit (all WPs).


For more information about the project: 


This study/project is funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference number NIHR202020). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

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