Original Study
Maintenance of a Physically Active Lifestyle After Pulmonary Rehabilitation in Patients With COPD: A Qualitative Study Toward Motivational Factors

https://doi.org/10.1016/j.jamda.2014.05.003Get rights and content

Abstract

Objectives

To explore determinants of behavior change maintenance of a physically active lifestyle in patients with chronic obstructive pulmonary disease (COPD) 8–11 months after completion of a 4-month outpatient pulmonary rehabilitation program.

Design

A qualitative descriptive study of semistructured interviews.

Setting

Pulmonary rehabilitation assessment center.

Participants

Patients with COPD.

Measurements

Semistructured interviews until data saturation, coded by 2 independent researchers. Patients were classified as responder (maintenance or improvement) or nonresponder (relapse or decrease), based on 3 quantitative variables reflecting exercise capacity (Constant Work Rate Test), health-related quality of life (Short-Form health survey [SF-36]), and self-management abilities (Self-Management Ability Scale [SMAS-30/Version 2]).

Results

Mean (SD) forced expiratory volume in the first second (FEV1) among interviewees was 52.5% (14.4%) predicted and the mean age was 63.5 years (range: 45–78). The group consisted of 15 responders and 7 nonresponders. Physical limitations reduced competence to engage in an active lifestyle and responders appeared to experience higher levels of perceived competence. Social support was found important and the experienced understanding from fellow patients made exercising together enjoyable. Particularly, responders expressed autonomous motivation and said they exercised because of the benefits they gain from it. Unexpectedly, only responders also experienced controlled motivation.

Conclusion

Perceived competence and autonomous motivation are important determinants for maintenance of an active lifestyle in patients with COPD. In contrast to common theoretical assumptions, a certain threshold level of controlled motivation may remain important in maintaining a physically active lifestyle after a pulmonary rehabilitation program.

Section snippets

Methods

A qualitative descriptive method was used to address the research question.

Results

Out of 22 interviewees, 14 were men and ages ranged from 45 to 78 years. Most patients were categorized as Global Initiative for Chronic Obstructive Lung Disease grade 2 (54.5%). The mean (SD) forced expiratory volume in the first second (FEV1) was 52.5% (14.4%) of the predicted value for a person of similar height, weight, and age (Table 3). Dividing patients based on the MCIDs yielded a group of 15 responders and 7 nonresponders. The mean values of each variable, as well as the average

Discussion

This study explored determinants that may be important for maintenance of lifestyle changes in patients with COPD after pulmonary rehabilitation. A feeling of perceived competence to be physically active, as well as exercising with fellow patients, seemed to facilitate exercise. Furthermore, a certain threshold level of controlled motivation in addition to autonomous motivation seemed to promote exercise adherence.

Conclusion

The current study has contributed to insights in successful behavior change maintenance after pulmonary rehabilitation. Perceived competence and relatedness may be of great importance in both an exercise setting as well as during activities of daily living. Furthermore, a certain threshold level of controlled motivation, in addition to autonomous motivation, may be important in ensuring the continuous engagement in physical activity by patients with COPD. These findings can be used to optimize

Acknowledgments

This study was financially supported by Nutricia Research and Lung Foundation Netherlands (3.4.09.003).

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    The authors declare no conflicts of interest.

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