Physical activity in COPD

July 9, 2018

Facilitators and barriers to physical activity following pulmonary rehabilitation for COPD

We screened 2392 papers and included 14 primary qualitative studies in the synthesis.
We found that the main facilitators to patients’ maintenance of physical activity were centred around patients’ beliefs, social support and environment.

Veronika Williams is a Senior Researcher at the Centre for Evidence Based Medicine, University of Oxford and Course Director for the DPhil Evidence Based Health Care programme.


Chronic Obstructive Pulmonary Disease (COPD) is a chronic lung condition affecting more than 3 million people in the UK. The condition is associated with persistent cough, breathlessness (particularly on exertion), fatigue, worsening mental health and higher unplanned hospital admission rates.

Since there is no cure for COPD, treatment focuses on limiting the impact of symptoms and maintaining functional ability. There is evidence that pulmonary rehabilitation – typically a 6-8 week outpatient course which includes physical activity, education and relaxation techniques – improves quality of life and exercise capacity in the short term. However, we are less clear on how to maintain these improvements over time, and what the barriers and facilitators are to physical activity uptake in the longer term.

In order to answer this, we undertook a qualitative systematic review, published in NPJ Primary Care Respiratory Medicine.

What did we find?

Our main objective was to identify the main barriers and facilitators to physical activity from the patient’s perspective. We screened 2392 papers and included 14 primary qualitative studies in the synthesis.

We found that the main facilitators to patients’ maintenance of physical activity were centred around patients’ beliefs, social support and environment.

Forming routines and habits were key to continuing physical activity post rehabilitation. Part of this included opportunities to access physical activity maintenance groups. Continued peer interaction, the sense of accomplishment gained through self-monitoring and feedback, also appear crucial.

Other important factors included: the strength of relationships with healthcare professionals; pre-existing exercise regimes (prior to COPD diagnosis); self-efficacy and social support. Although intention to maintain physical activity can be a factor in continuing physical activity regimes, positive intentions did not always translate into behaviour change highlighting an intention-behaviour gap.

What does this mean?

Our findings suggest that physical activity behaviours post pulmonary rehabilitation are complex, and a single ‘one size fits all’ approach to increasing uptake is unlikely to be successful.

Instead, we should consider individually tailored approaches to support long-term behaviour change, taking into account patients’ existing routines and beliefs, as well as external factors, such as access to activity maintenance programmes. Health care professionals can play a key role in providing on-going support and encouragement, through continued contact with patients. This may be supplemented by harnessing the potential of digital health apps to monitor and provide feedback on patients’ improvements.

Our findings also have implications for future research in this area. In particular, how we assess long-term behaviour change after pulmonary rehabilitation – highlighting the need for high quality mixed-methods evaluations of complex interventions. Such methodological approaches will allow us to understand, not only if such interventions are effective, but also how they are best implemented into routine patient care.

Robinson, H., Williams, V., Curtis, F., Bridle, C. and Jones, A.W., 2018. Facilitators and barriers to physical activity following pulmonary rehabilitation in COPD: a systematic review of qualitative studies. NPJ primary care respiratory medicine28(1), p.19.

Veronika Williams is a Senior Researcher at the Centre for Evidence Based Medicine, University of Oxford and Course Director for the DPhil Evidence Based Health Care programme.

This study was undertaken as part of H. Robinson’s PhD thesis and the authors declare no conflict of interest.

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CEBM Centre Manager Responsible for maintaining the Centre's ability to respond to new initiatives. Facilitating the development and dissemination of research to improve clinical practice and patient care. Elevating the position of all EBM and EBHC learning related activities globally. Follow CEBM on twitter @CebmOxford and facebook cebm.oxford

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