Improving physical activity, sedentary behaviour and sleep in COPD: perspectives of people with COPD and experts via a Delphi approach

Abstract

BackgroundLittle is known about how to achieve enduring improvements in physical activity (PA), sedentary behaviour (SB) and sleep for people with chronic obstructive pulmonary disease (COPD). This study aimed to: (1) identify what people with COPD from South Australia and the Netherlands, and experts from COPD- and non-COPD-specific backgrounds considered important to improve behaviours; and (2) identify areas of dissonance between these different participant groups.MethodsA four-round Delphi study was conducted, analysed separately for each group. Free-text responses (Round 1) were collated into items within themes and rated for importance on a 9-point Likert scale (Rounds 2–3). Items meeting a priori criteria from each group were retained for rating by all groups in Round 4. Items and themes achieving a median Likert score of ≥7 and an interquartile range of ≤2 across all groups at Round 4 were judged important. Analysis of variance with Tukey’s post-hoc tested for statistical differences between groups for importance ratings.ResultsSeventy-three participants consented to participate in this study, of which 62 (85%) completed Round 4. In Round 4, 81 items (PA n = 54; SB n = 24; sleep n = 3) and 18 themes (PA n = 9; SB n = 7; sleep n = 2) were considered important across all groups concerning: (1) symptom/disease management, (2) targeting behavioural factors, and (3) less commonly, adapting the social/physical environments. There were few areas of dissonance between groups.ConclusionOur Delphi participants considered a multifactorial approach to be important to improve PA, SB and sleep. Recognising and addressing factors considered important to recipients and providers of health care may provide a basis for developing behaviour-specific interventions leading to long-term behaviour change in people with COPD.

Importance of the relationship between symptoms and self-reported physical activity level in stable COPD based on the results from the SPACE study

“…Additionally, a longer sitting time seems to correlate with an increased risk of mortality, independent of leisure time physical activity undertaken [37]. Thus, clinicians should be encouraged to investigate the patterns of inactivity in COPD patients and educate inactive individuals with regard to interrupting their sitting times [20, 38, 39].…”

“…A large prospective study [41] has found that the introduction of lower levels of activity, such as 15 min walking 6 days per week, might be beneficial in reducing all-cause mortality. These results are more realistic for COPD patients, in whom replacing sedentary behavior with light activities would be much more feasible than increasing the time spent in moderate to vigorous activities [20, 39, 42]. Nevertheless, all these findings serve to underline the unmet need for a set of standardized tools and guidance for physicians to evaluate, promote and monitor physical activity in COPD patients in everyday clinical practice.…”

Recommendations for older adults’ physical activity and sedentary behaviour during hospitalisation for an acute medical illness: an international Delphi study

“…However, there were some occasions where patient participants indicated they felt unqualified to answer particular questions. Each survey was pilot tested, but separate surveys or questions for different stakeholder groups could have been used [78].…”

The Improving Outcomes of UTI Management in Long-Term Care Project (IOU) Consensus Guidelines for the Diagnosis of Uncomplicated Cystitis in Nursing Home Residents

“…We used a modified Delphi approach involving an extensive background literature search and a series of structured surveys completed by a panel of practicing experts in geriatric, post-acute, and long-term care medicine. [ 26 – 33 ] We then created an algorithm to aid nursing home clinicians in the diagnosis of uncomplicated cystitis.…”