Exercise Adherence in Chronic Obstructive Pulmonary Disease: Review of Current Evidence from the Netherlands

Abstract

Chronic obstructive pulmonary disease is one highly prevalent chronic disease that demands increasing care; it is already the third leading cause of death worldwide. There is accumulating evidence that in patients with chronic obstructive pulmonary disease pulmonary rehabilitation is effective in improving the prognostic risk factor profile and in delaying mortality. In order to benefit from pulmonary rehabilitation, exercise adherence plays a crucial role. The present review discusses the current evidence on exercise adherence in chronic obstructive pulmonary disease and provides practical tips for assessing and adopting strategies to improve adherence in the Dutch context. Studies from the Netherlands identify varying rates of exercise adherence depending on the complexity of the disease, such as comorbidities, and its treatment. Multiple factors determine exercise adherence in chronic obstructive pulmonary disease. In the Netherlands, factors such as perceived behavioral control, self-efficacy, exercise history, motivation, education, physical health, comorbidities, depressive symptoms and fatigue determine exercise adherence. The Dutch version of the Rehabilitation Adherence Measure for Athletic training and a prediction model, the Predicting Adherence in paTients with CHronic diseases tool, can be used to identify poor adherence. Improving exercise adherence requires a multifaceted approach with strategies targeting healthcare providers, patients and healthcare systems. In the Dutch context, raising awareness of the patient’s context, emphasizing the importance of the patient-therapist relationship, providing clearer information, and enhancing social support within the patient’s environment are essential for improving exercise adherence and chronic obstructive pulmonary disease control.