Barriers to and enablers of physical activity in patients with COPD following a hospital admission: a qualitative study

Abstract

BackgroundChronic obstructive pulmonary disease (COPD) is characterized by a persistent blockage of airflow, prompting episodes of shortness of breath, commonly leading to hospitalization. Hospitalization may lead to a decline in physical activity following discharge. Physical activity has been shown to improve symptoms of COPD and reduce readmissions, and to decrease morbidity and mortality. This study aims to explore, from the perspectives of people with COPD, the barriers to and enablers of participation in physical activity following hospitalization for COPD.MethodsThis study had a qualitative descriptive design and included semistructured interviews with 28 adult COPD patients who had been admitted to hospital with a primary diagnosis of exacerbation of COPD.ResultsA plethora of barriers to but fewer enablers of participation in physical activity and pulmonary rehabilitation were identified for this cohort of people. The main barriers identified were health-related (comorbidities, COPD symptoms, and physical injury or illness) environment-related (weather, transport, and finance), and self-related. The main enabling factors reported were access to health professionals and equipment, social support, routine and extracurricular activities, personal goals and motivation, and the effect of physical activity and “feeling better”.ConclusionThis research provides a snapshot of the barriers to and enablers of physical activity and pulmonary rehabilitation in people with COPD. It is evident that there are significant barriers which hinder the ability of people with COPD to undertake and continue participation in physical activity and pulmonary rehabilitation. While there are some enablers that may counter these barriers, it is clear that health professionals dealing with people suffering from COPD need to actively recognize and address barriers to physical activity and pulmonary rehabilitation. Hospital admission may create an opportunity for implementation of interventions promoting physical activity (such as referral to pulmonary rehabilitation), which may assist in reducing hospital readmission, as well as decreasing morbidity and mortality.

Working with primary care clinicians and patients to introduce strategies for increasing referrals for pulmonary rehabilitation

“…Free text responses also demonstrated that health and logistical concerns can cause patients to reject a referral for PR. Such findings are in keeping with previous research (Harris et al, 2008b;Keating et al, 2011;Moore et al, 2012;Thorpe et al, 2014). Ways of persuading such 'hard to reach' groups could be a focus of further training and awareness events as survey findings demonstrated that it is possible to encourage individuals with these characteristics to accept a referral for PR (e.g., 32.2% of those who accepted a referral lived alone).…”

“…The survey questionnaires were designed by the study team and covered issues that past research has shown affects the uptake of PR by patients (Keating et al, 2011;Moore et al, 2012;Thorpe et al, 2014). There were two variations of the questionnaire.…”

“…These findings were re-iterated in a study by Moore et al (2012) and a systematic review by Thorpe et al (2014) which also found that patients were concerned that they would be unable to meet the physical demands of the PR programme. It has also been found that current smokers and people who live alone or who are widowed or divorced are less likely to accept the offer of a referral for PR (Keating et al, 2011;Moore et al, 2012).…”

“…PR = pulmonary rehabilitation Discussion PR can improve the health and quality of life of patients and reduce their unplanned demands for health services (NICE, 2011;GOLD, 2013). However, referral rates are low relative to need due to both clinician and patient related factors (Keating et al, 2011;Moore et al, 2012;Thorpe et al, 2014;Johnston et al, 2013). The developmental project described here aimed to provide an increased understanding of factors that were affecting patient access to PR as a means of Increasing access for pulmonary rehabilitation 233 generating local strategies to increase referral rates.…”

Bedeutung von Depression und Angst im Krankheitsmanagement von pneumologischen Berufskrankheiten

“…In einem systematischen Review über webbasierte Interventionen zur Verbesserung der körperlichen Aktivität sowie des Empowerments der Patienten mit chronischen Erkrankungen schlussfolgern die Autoren, dass sowohl Wissensvermittlung, Selbstbeobachtung und Kommunikation mit medizinischen Personal oder Betroffenen als auch Selbstmanagementtraining und individuelle Übungsprogramme förder-liche Interventionsinhalte sind [26]. Thorpe et al [48] analysierten Barrieren und Benefits für die Aufrechterhaltung der körperlichen Aktivität bei COPDPatienten und leiten aus den Ergebnissen ab, dass gesundheitsbezogene (wie Komorbiditäten, krankheitsspezifische Symptome), umweltbezogene (wie Wetter, Finanzen) sowie persönliche (wie Sauerstofftherapie) Barrieren die Patienten von körperlichen Aktivitäten abhalten. Gleichzeitig unterstützen folgende Faktoren die Aufrechterhaltung der körperlichen Aktivität: soziale Unterstützung beispielsweise durch Gesundheitsexperten, persönliche Zielsetzung und Motivation, Wahrnehmung positiver Effekte auf körperlicher und emotionaler Ebene.…”