Barriers and motivational factors towards physical activity in daily life living with COPD – an interview based pilot study

Abstract

Background: In Denmark, few people with Chronic Obstructive Pulmonary Disease (COPD) engage in physical activity although it is evident that pulmonary rehabilitation has positive effects on physical activity, dyspnoea, anxiety, fatigue and quality of life. Objective: The purpose of this pilot study was to explore why people with COPD do not engage in physical activity and to explore motivational factors and barriers towards physical activity. Furthermore, to explore the role general practitioners have in this matter. Design: We conducted fieldwork among five people with COPD and three general practitioners using qualitative semi-structured interviews. We made a thematic analysis and our analytical perspective was based on The Health Belief Model and Self Determination Theory. Results: Findings revealed that people with COPD was not active because they did not receive the necessary information from the general practitioners about the benefits of physical activity neither about the negative consequences of an inactive lifestyle. Motivational factors were knowledge about COPD and benefits of physical activity. Experiencing the benefits on their own bodies, feeling that it was not dangerous to feel breathless and being successful coping with breathlessness were motivational. Functional tests like walking tests were very important and motivational for the participants because they outlined the progress achieved during activity and provided evidence of progress that was easy to comprehend compared with spirometry tests. General practitioners did not inform about the benefits of physical activity because they felt that medication was more important than physical activity and that people with COPD would not be motivated to be active. Conclusions: The main reason for people with COPD not being physically active in our study was lack of sufficient information from their general practitioners. This study described some barriers, enablers and motivational factors for a physically active lifestyle and the general practitioners’ role in this. Thus, it is important that people with COPD receive early information about physical activity - and it should start with the general practitioners, who are the gate keepers in the health care system. We recommend that lung function test results are never used as a single indicator of disease progression and that more focus should be paid to functional tests like The Shuttle Walking Test or The Six Minute Walking Test.Further studies to identify barriers to, and facilitators for referral people with COPD to physical activity in daily life from the perspective of Danish general practitioners are required.

Disease self-management in patients with moderate COPD: a thematic analysis

“…Following our discussion and considering the patients' illness needs in terms of improving selfmanagement, another issue in our study was the GPs narrow focus on medication and smoking cessation to the exclusion of other health-promoting activities, experienced by the informants. This finding has been highlighted in other studies where GPs describe COPD treatment as limited to smoking cessation [28] and medical treatment [22,28]. This narrow treatment regime does not meet the recommendations in national and international guidelines that stress the importance of the three main pillars of COPD treatment consisting of smoking cessation, medical treatment, and physical activity [19,46].…”

“…Selfmanagement is defined here as the processes focusing on illness needs, activation of resources, and living with chronic illness [20]. Existing literature on daily life with moderate COPD suggests that patients lack disease knowledge [17,18,[21][22][23]. This knowledge gap might have consequences for the patients [21], including an insufficient understanding of the effect of selfmanagement strategies [17], the importance of treatment and self-management of COPD, and of the long-term perspective [18,22].…”

“…Existing literature on daily life with moderate COPD suggests that patients lack disease knowledge [17,18,[21][22][23]. This knowledge gap might have consequences for the patients [21], including an insufficient understanding of the effect of selfmanagement strategies [17], the importance of treatment and self-management of COPD, and of the long-term perspective [18,22]. Further, the access to healthcare and the extent of self-management of COPD is challenged by low priority of COPD [18].…”

Towards a better understanding of physical activity in people with COPD: predicting physical activity after pulmonary rehabilitation using an integrative competence model

“…Although the PAHCO framework has been developed as a generic model, it may be applied particularly in the context of noncommunicable diseases such as COPD 21 because patients with COPD often show characteristics indicating lower movement compentence, 22 decreased control competence, 23 , 11 and reduced self-regulation competence. 24 , 11 …”

Motivational regulations and lifestyle in muscle-wasted COPD patients undergoing pulmonary rehabilitation

“…Transfer of a healthy lifestyle during PR towards actual health behaviors in daily life requires longlasting behavior change. However, internal and external barriers such as lack of perceived benefit [29,30], financial [29,31e33] or transportation issues [29,32,33], lack of information provision from healthcare providers [29,30], the weather [31,34], lack of social support [33,34], dyspnea [29,30,32] or not having an exercise partner [34] can significantly affect patients' ability and willingness to sustain behavior change. Motivation may be essential in overcoming these barriers [29,33,34].…”