Pulmonology · Medical Literature
Sustaining physical activity in chronic obstructive pulmonary disease: a qualitative study of perspectives on a personalized community-based physical activity program.
Abstract
Sustaining pulmonary rehabilitation (PR) benefits in community-dwelling individuals with chronic obstructive pulmonary disease (COPD) is challenging. The objective of this study was to explore the experiences of individuals with COPD participating in a PersonalIzed CommUnity-based Physical Activities program (PICk UP) and to identify which behavioral change techniques (BCTs) supported sustained physical activity (PA). This was a qualitative pre-post intervention study (NCT04223362|NCT04711057). The study was conducted in a community setting. This study recruited individuals with COPD assigned to the PICk UP intervention. Participants enrolled in a 6-month, post-PR, community-based program comprising gym, senior exercise classes, pool exercise classes, or Chi Kung. Participants' perspectives on impacts of the PICk UP program, motivators, facilitators, and barriers to adherence were collected through pre-post focus groups. Data were analyzed using deductive and inductive reflexive thematic analysis. The "capability, opportunity, motivation, behavior" framework was used to identify BCTs. Fifteen individuals with COPD participated (14 male, 70 [8] years, FEV1 57.1% [18.1%] predicted). Five main themes emerged, focusing on PA choice, barriers, facilitators, effects, and suggestions: (1) one size doesn't fit all; (2) organizational factors and system-level support enabling adherence; (3) it doesn't come easy; (4) a positive feedback cycle sustained physical, psychological, and social benefits; and (5) the more, the merrier. The PICk UP intervention supported PA through 13 BCTs, across 5 intervention types (education, persuasion, training, environmental restructuring, and enablement), collectively addressing all 6 components influencing behavior. Individuals with COPD reported lasting PR benefits after the PICk UP and were willing to remain physically active. Participants emphasized the importance of diverse PA options and support from peers, health, and fitness professionals. To sustain PA beyond PR, interventions should prioritize intersectoral partnerships and embed ongoing social support. These findings underscore PICk UP's effectiveness, positioning it as a promising and replicable model for promoting long-term PA in individuals with COPD.
Clinical relevance
What are the experiences, perceived impacts, motivators, facilitators, and barriers of individuals with COPD participating in a 6-month post-pulmonary-rehabilitation personalized community-based physical activity program (PICk UP), and which behavioral change techniques (BCTs) best supported sustained physical activity? __SNAPSHOT__ {"studyDesign":"Qualitative pre-post intervention study nested within a registered clinical trial (NCT04223362 | NCT04711057); data collected via pre- and post-intervention focus groups analyzed using deductive and inductive reflexive thematic analysis, with findings mapped to the Capability, Opportunity, Motivation, Behavior (COM-B) framework to identify BCTs","setting":"Community setting (Portugal — affiliated with Lab3R, University of Aveiro, and community health centers in the Baixo Vouga region); institution type: academic-community partnership","sampleSize":"n=15 individuals with COPD (all assigned to the PICk UP intervention arm)","population":"Adults with confirmed COPD; mean age 70 (SD 8) years; predominantly male (14/15, 93%); mean FEV1 57.1% (SD 18.1%) predicted, consistent with moderate airflow limitation (GOLD grade 2); all had completed a prior pulmonary rehabilitation (PR) program","intervention":"PICk UP: a 6-month, post-PR, personalized community-based physical activity program offering participant choice of modality — gym training, senior exercise classes, pool exercise classes, or Chi Kung — with individualized activity selection","comparator":"Not applicable (qualitative study of the intervention arm only; no control group data were generated in this analysis)","primaryOutcome":"Participants' perspectives on the impacts of the PICk UP program, motivators, facilitators, and barriers to physical activity adherence; BCTs supporting sustained PA, organized using the COM-B framework","followUp":"6 months (pre- and post-intervention focus groups bracketing the program duration)","fundingSource":"Not reported in the abstract"}
Key findings
This study was qualitative in design; no quantitative effect sizes, p-values, confidence intervals, or NNT/NNH values were generated or are reportable. The analysis used deductive and inductive reflexive thematic analysis applied to focus group data collected before and after the 6-month PICk UP program, with BCTs mapped to the COM-B (Capability, Opportunity, Motivation, Behavior) framework. Specific themes, BCTs identified, or thematic categories are not detailed in the available abstract and cannot be reported without the full text. No adverse events were mentioned in the abstract. Results are inherently descriptive and interpretive, not inferential.
Practice implications
This study provides patient-generated, qualitative evidence about which behavioral change techniques and program features are perceived to support sustained physical activity in community-dwelling adults with moderate COPD following pulmonary rehabilitation — a clinically important and persistently challenging problem. The study established that the COM-B framework can be applied to characterize the behavioral dynamics of post-PR community exercise participation from the patient perspective. It did not establish causal efficacy or effectiveness of specific BCTs, quantify changes in physical activity, or compare outcomes to a control group. Findings are directly applicable only to older, predominantly male patients with moderate COPD who have already completed a structured PR program and are willing to participate in community exercise programs; women (n=1), patients with severe or very severe COPD (GOLD 3–4), those who declined or could not access PR, and non-Portuguese populations are not adequately represented. The companion RCT (Rebelo et al., Pulmonology 2025) demonstrated that the PICk UP program improved physical activity levels and sit-to-stand performance at 6 months post-PR, lending external plausibility to the qualitative findings but not replacing them. Clinicians should interpret qualitative themes as hypothesis-generating rather than practice-defining. Because only an abstract was available for review, the completeness and nuance of the thematic analysis, credibility strategies (e.g., member checking, reflexivity), and full BCT taxonomy cannot be assessed — this is a critical limitation of this summary. __LIMITATIONS__ Very small sample (n=15), homogeneous by sex (93% male), limiting transferability to women and to patients with severe or very severe COPD.,Single-arm qualitative design with no comparator group; cannot attribute participant perspectives to the PICk UP intervention versus natural history, disease progression, or selection effects.,Selection bias is likely: participants were those who enrolled and remained in the community program; perspectives of non-completers or those who declined are absent.,Cultural and geographic specificity (Portuguese community setting) limits generalizability to health systems with different community infrastructure, cultural norms around exercise, or post-PR care pathways.,Focus groups, as opposed to individual interviews, may introduce social desirability bias and suppress minority viewpoints within the group.,BCT identification via COM-B is a post-hoc deductive mapping exercise; it does not confirm that specific BCTs caused behavior change.,Only an abstract was available for review; thematic saturation, researcher reflexivity, confirmability procedures, and full thematic categories cannot be evaluated.,Funding source not reported; potential conflicts of interest cannot be assessed.,Qualitative findings cannot be generalized statistically; sample size is not a validity criterion in this design but does constrain theoretical saturation and transferability claims. __BOTTOM_LINE_CATEGORY__ promising_but_preliminary __BOTTOM_LINE__ This qualitative pre-post study used the COM-B framework and reflexive thematic analysis to characterize the experiences, motivators, and barriers of 15 predominantly older male patients with moderate COPD participating in a 6-month community-based personalized physical activity program (PICk UP) following pulmonary rehabilitation. Findings are hypothesis-generating and should inform, but not yet independently change, clinical practice around post-PR community exercise prescription. Clinicians managing COPD patients who have completed PR may use this evidence to structure patient-centered discussions about community activity choices and behavioral supports, while awaiting replication in more diverse populations.