Strategies That Improve Physical Activity in Patients With Stable COPD

Photo Credit: Monkeybusinessimages

Researchers identified intervention components that could reduce sedentary behavior and increase physical activity in patients with moderate, stable COPD.

Goal setting, verbal education, self-monitoring, and feedback on step count trackers were promising strategies for changing sedentary behavior and physical activity in patients with chronic obstructive pulmonary disease (COPD); however, according to findings published in Physiotherapy, it remains important to tailor interventions individually.

Studies have shown that people with COPD are more sedentary than healthy controls, putting them at a greater risk for adverse outcomes such as increased mortality, cardiometabolic diseases, and hospitalizations.

“Changing physical activity in people with COPD is difficult,” wrote Sonia Wing Mei Cheng and colleagues. “No intervention has yet proven effective for increasing moderate- and vigorous-intensity physical activity (MVPA) in people with COPD… Subsequently, attention has turned to reducing sedentary behavior as an alternative and more feasible strategy for improving health outcomes in this population than targeting MVPA alone.”

Using the Capability, Opportunity, Motivation, and Behavior (COM-B) model as a framework, the researchers conducted a qualitative study to investigate which intervention components were most favorable for reducing sedentary behavior.

A Clinical Trial for COPD

The study involved 34 patients with confirmed COPD who participated in a randomized clinical trial across three outpatient pulmonary rehabilitation centers in Australia. The patients in the intervention group underwent a six-week behavior change program designed to break up prolonged sedentary behavior with light-intensity physical activity.

A physiotherapist contacted patients once weekly throughout the program. The intervention also incorporated the following:

• Verbal education about the consequences of sedentary behavior and instructions on how to perform target behaviors.
• Goal setting designed to break up prolonged sedentary behavior or replace it with light-intensity physical activity.
• Self-monitoring of and feedback on sedentary behavior and step count. Patients wore activity trackers that allowed them to view real-time feedback.
• Prompts/cues to break up sedentary behavior, which included activity tracker notifications and intrinsic prompts such as getting up and moving during TV ads.
• Environmental restructuring, wherein patients’ homes were restructured to encourage physical activity or breaks in sedentary behavior.

The participants were older, retired adults with several comorbidities, which the researchers noted were common for people with COPD in their region. The intervention reduced sedentary behavior and increased step count.

Cheng and colleagues conducted semi-structured interviews with the participants to understand which components worked best. The qualitative study included only patients who had not started pulmonary rehabilitation after the trial (n=14).

Identifying Effective Strategies

The participants favored education about the health consequences of sedentary behavior and the pacing and progression of physical activity. Knowledge about managing breathlessness, pacing, and symptom monitoring was particularly beneficial. Training in self-monitoring and coping strategies helped ease anxiety related to replacing sedentary behavior with physical activity.

However, the study found that physical challenges, such as dyspnea, fatigue, and limb pain, remained major obstacles.

Goal setting was also helpful, with participants reporting that it increased their motivation and led to higher-intensity physical activity that reduced their COPD symptoms.

The goal-setting component of the intervention showed mixed results. For many, setting goals focused on walking, climbing stairs, or home-based exercise fostered a sense of achievement, improved breathlessness, and overall well-being.

However, “sedentary behavior was considered a natural and inevitable part of aging by some participants, which reduced engagement in the goal setting process,” Cheng and colleagues noted.

Participants overwhelmingly favored tracking their step count over receiving feedback on prolonged sedentary behavior. The real-time feedback on steps provided a tangible sense of progress, directly boosting their motivation to stay active. In contrast, few participants used the device to monitor periods of inactivity, suggesting that movement awareness was more meaningful than tracking sedentary time.

While prompts to break up sedentary behavior were helpful for some participants, others found them disruptive, especially during leisure or occupational activities.

Support from family and clinicians played a significant role in encouraging physical activity, with participants reporting increased involvement in household tasks and social activities. However, the participants resisted changing their home environment to break up enjoyable sedentary activities like screen time or reading. Many participants felt that being active during other parts of the day offset their sedentary periods, underscoring a potential gap in patients’ understanding of the risks for prolonged sedentary behavior, regardless of overall physical activity levels.

Individualizing Approaches to Sedentary Behavior

The study authors concluded that the mixed responses underscored the importance of personalizing interventions for sedentary behavior and physical activity.

The researchers noted that longer intervention periods (e.g., 12 weeks or more) may be necessary to achieve meaningful behavior change in patients with COPD. Shorter interventions may not provide enough time to develop self-efficacy or fully integrate new habits into daily routines.

“Improvements in functional capacity may first be necessary to enable changes in sedentary behavior. Interventions targeting sedentary behavior may be better timed after pulmonary rehabilitation when disease symptoms and exercise tolerance have been optimized through exercise training and optimal symptom management, rather than delivered opportunistically,” the researchers wrote.

The researchers noted several limitations to their study, including potential bias from missing data on participants who withdrew from the study, a small sample size, and the use of convenience sampling.

“Since a convenience sampling strategy was used, the study sample may not be representative of all people with COPD attending pulmonary rehabilitation, including those with mild or very severe disease or on long-term oxygen therapy. Subsequently, caution should be taken when generalizing the findings to subgroups of people with COPD and contexts outside pulmonary rehabilitation,” Cheng and colleagues said.