Abstract
Pulmonary rehabilitation has short-term benefits on dyspnea, exercise capacity and quality of life in COPD, but evidence suggests these do not always translate to increased daily physical activity on a patient level. This is attributed to a limited understanding of the determinants of physical activity maintenance following pulmonary rehabilitation. This systematic review of qualitative research was conducted to understand COPD patients’ perceived facilitators and barriers to physical activity following pulmonary rehabilitation. Electronic databases of published data, non-published data, and trial registers were searched to identify qualitative studies (interviews, focus groups) reporting the facilitators and barriers to physical activity following pulmonary rehabilitation for people with COPD. Thematic synthesis of qualitative data was adopted involving line-by-line coding of the findings of the included studies, development of descriptive themes, and generation of analytical themes. Fourteen studies including 167 COPD patients met the inclusion criteria. Seven sub-themes were identified as influential to physical activity following pulmonary rehabilitation. These included: intentions, self-efficacy, feedback of capabilities and improvements, relationship with health care professionals, peer interaction, opportunities following pulmonary rehabilitation and routine. These encapsulated the facilitators and barriers to physical activity following pulmonary rehabilitation and were identified as sub-themes within the three analytical themes, which were beliefs, social support, and the environment. The findings highlight the challenge of promoting physical activity following pulmonary rehabilitation in COPD and provide complementary evidence to aid evaluations of interventions already attempted in this area, but also adds insight into future development of interventions targeting physical activity maintenance in COPD.
Highlights
Chronic obstructive pulmonary disease (COPD) is a common and preventable condition, characterised by persistent respiratory symptoms and airflow limitation that is caused by significant exposure to noxious particles or gases.[1]
People with COPD have significantly lower levels of daily physical activity (PA) compared with agematched healthy individuals,[2–7] an avoidance of PA often related to exertional dyspnea which leads to increasing inactivity, muscle weakness and reduced exercise capacity
Strength of this review and suggest systematic reviews of qualitative studies that do not adopt this approach are at risk of throughout Pulmonary rehabilitation (PR) has been identified as a facilitator to PA during PR,[24] but the results from this study suggest that family, friends, publication bias and excluding data relevant to their research partners, and peers interaction are important in the question
Summary
Chronic obstructive pulmonary disease (COPD) is a common and preventable condition, characterised by persistent respiratory symptoms and airflow limitation that is caused by significant exposure to noxious particles or gases.[1]. Pulmonary rehabilitation (PR) is defined as “a comprehensive intervention based on a thorough patient assessment followed by patient-tailored therapies that include, but are not limited to, exercise training, education, and behaviour change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviour”.15. The key benefits of PR include clinically important improvements in dyspnoea, physical capacity, and quality of life.[16]. Increased exercise capacity following PR does not directly translate to an increase in daily PA15,18 and long-term behaviour change in COPD
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