Are people with chronic obstructive pulmonary disease more motivated to exercise and be physically active after pulmonary rehabilitation?

Abstract

Physical activity is highly important for the health status of people with chronic obstructive pulmonary disease (COPD) because it has shown associations with reduced risk of all-cause mortality and acute exacerbations. Pulmonary rehabilitation improves functional capacity in people with COPD, but benefits have not been consistently observed in physical activity levels. Recently, it has been shown that motivation to exercise can be a precursor to the adaptation of more active lifestyles however, it is unknown whether pulmonary rehabilitation influences the motivation to exercise of people with COPD and whether this motivation contributes to increase physical activity. Therefore, this study aimed to explore i) motivation to exercise; ii) the relationship between motivation to exercise and physical activity and iii) the distribution across the four quadrants of motivation to exercise and physical activity, in people with COPD after pulmonary rehabilitation. An observational cohort study including people with COPD who undertook a 12-week community-based pulmonary rehabilitation program was conducted. Motivation to exercise was assessed with the global rating of change scale at the end of pulmonary rehabilitation. Global rating of change scale consists in a Likert scale composed by 11 points, ranging from -5 to 5 (-5, means “much worse”; 0, means “unchanged”; 5, means “much better”). Participants who scored 2 points or more were considered “motivated to exercise” (ME). Physical activity levels were evaluated pre- and post-pulmonary rehabilitation through accelerometry data (participants wore an Actigraph during seven days, 24 hours). A minimum of 8h (480 min) per day for four days was established for wear time validation. The minimal clinically important difference of 600 steps per day was used to identify “improvers on physical activity” (IPA). Spearman’s (rs) correlation coefficient was used to determine the association between motivation to exercise and change in physical activity. We categorized participants in four motivation to exercise-physical activity quadrants: ME and IPA, ME and non-IPA, non-ME and IPA, non- ME and non-IPA, after pulmonary rehabilitation. Forty-one people with COPD (71 ± 7 years; 93% male; BMI 28 ± 6 kg/m2; 57 ± 17 FEV1%predicted) were included. After pulmonary rehabilitation, most participants were ME (n = 35; 85%), but less than half were IPA (n = 18; 44%). No correlation between these two variables (rs = 0.132, p = 0.412) was observed. Participants distribution on the motivation to exercise-physical activity quadrants was: 15 (37%) “ME and IPA”; 20 (49%) “ME and non-IPA”; 3 (7%) “non-ME and IPA” and 3 (7%) “non-ME and non-IPA”. After pulmonary rehabilitation, most participants were motivated to exercise but nearly half did not change the physical activity levels. Changing physical activity behavior is highly challenging, and research on which interventions can effectively modify it is still needed. Additionally, future studies including a more comprehensive assessment of motivation to exercise are required to confirm our results.