Barriers to and enablers of physical activity and its association with daily steps after hospitalisation for a COPD exacerbation: what patients say matters

Abstract

Introduction: Exacerbations of COPD decrease physical activity. Physical activity interventions after these events are desirable but have had mixed results. Understanding the barriers to and enablers of physical activity may help to improve the results of these interventions. We aimed to assess the barriers to and enablers of physical activity after COPD exacerbation and their association with daily steps.

Methods: We carried out a cross-sectional analysis of patients with COPD enrolled during a hospitalisation for an exacerbation. Physical activity was measured with an accelerometer for 7 days after discharge. Patients completed an ad hoc 6-point Likert scale questionnaire about 13 barriers to and nine enablers of physical activity. We analysed the association between each item and patients' daily step counts.

Results: 46 patients with a mean±sd forced expiratory volume in 1 s of 48.6±15.9% predicted completed the assessments. They were 65±10 years old, spent 8±2 days hospitalised and walked 5633±3314 steps·day^-1 after discharge. The patients who reported "breathlessness" as a barrier (≥2 out of 6 points on the Likert scale) took statistically fewer daily steps (median (25th-75th centile) 3813 steps·day^-1 (2664-5639 steps·day^-1) versus 5549 steps·day^-1 (3692-9984 steps·day^-1), p=0.034). There was a similar finding for those who reported "low mood" as a barrier (≥2 out of 6 points) (3813 steps·day^-1 (2456-5471 steps·day^-1) versus 5426 steps·day^-1 (3612-8942 steps·day^-1), p=0.047). If they considered "physical activity as healthy" as an enabler, they walked statistically more (5085 steps·day^-1 (3538-8703 steps·day^-1) versus 2760 steps·day^-1 (2271-5298 steps·day^-1), p=0.031).

Conclusion: Some barriers to and enablers of physical activity reported by patients after a COPD exacerbation relate to daily steps. Assessing physical activity barriers and enablers could be useful to improve future physical activity interventions after these events.

FIGURE 1

Prevalence of reported physical activity (PA) barriers (a) and enablers (b), ordered by frequency of response.

FIGURE 2

Physical activity (PA) of patients with COPD according to their response to the a) barriers to and b) enablers of PA questionnaire after a COPD exacerbation (n=46). Red and green bars represent patients who responded ≥2 in the barriers and enablers questionnaire, respectively (“yes” responders). *: p<0.05.