Mechanisms associated with increased physical activity in patients undergoing self-management behaviour modification in the randomised PHYSACTO trial

Abstract

IntroductionIn this analysis of the PHYSACTO® study, we assessed the efficacy of a self-management behaviour modification (SMBM) programme to improve physical activity (PA) levels, and the extent to which effects were mediated by readiness to change, motivation and confidence.MethodsPHYSACTO® was a randomised, partially double-blind, parallel-group, 12-week trial to evaluate the effects of treatment on exercise capacity and PA. COPD patients received placebo, tiotropium 5 µg or tiotropium/olodaterol 5/5 µg, with or without exercise training, all with an SMBM intervention (the Living Well with COPD programme). Changes were assessed in readiness to change (Stage of Change Visual Analogue Scale [VAS]), motivation (Treatment Self-Regulation Questionnaire [TSRQ]), and confidence (Perceived Competence Scale [PCS]) to engage in PA.ResultsPA was increased in all patients with complete PA data at Week 12 (n=262; +6038 steps·week−1, p<0.001). Significant increases were observed in patients' readiness to change (VAS 0.7 [0.6–0.8]), autonomous regulation (TRSQ 0.2 [0.1–0.3]) and confidence (PCS 0.5 [0.3–0.6]) (all p<0.01). Of note, 23% of the total effect of SMBM on steps·week−1 was found to be mediated by increases in readiness to change, 5% by TSRQ autonomous regulation and 12% by PCS.ConclusionOur study demonstrated that an SMBM programme delivered to COPD patients increased PA, mediated by an improvement of three key hypothesised mechanisms of change: readiness to change, autonomous motivation and confidence. For the first time, this study shows that an SMBM programme can be successful in changing the mechanisms of change targeted by the intervention.

The Influence of Pulmonary Rehabilitation and Counselling on Perceptions of Physical Activity in Individuals with COPD – A Qualitative Study

“…Type 1 persons need support to initiate specific actions or to maintain regular PA. Counselling is focused on the application of strategies to cope with barriers that hamper planned PA behavior, such as goal setting, action planning, or developing strategies. 48 However, differences in the perceptions of counselling intervention and the willingness to engage were revealed in this study. In Type 1 individuals, the interaction between patients, rehabilitation, and counselling became clear.…”

Behavioural modification interventions alongside pulmonary rehabilitation improve COPD patients’ experiences of physical activity

“…study [40] presented greater baseline levels of PA and 6MWD than the current study, which has previously been documented to influence the effectiveness of interventions to improve PA [18]. With this in mind, it is plausible that the incorporation of PA behavioural modification and confidence to engage in PA and were associated with significant improvements in PA behaviour [42]. Furthermore, the initial motivation interview stimulated a discussion between patient and researcher regarding preferred and non-preferred activities, allowing the researcher to tailor weekly PA goals around activities that the patient enjoyed, encouraging selfmotivation within the patient [12].…”

Cognitive behavioural therapy combined with physical activity behavioural modification strategies during pulmonary rehabilitation in patients with COPD

“…As a result, patients begin to change their physical activity behaviour, choosing a sedentary lifestyle over greater levels of physical activity in response to the symptoms associated with their condition [ 48 ]. Therefore, the addition of BPA, including education on the benefits of physical activity and incorporation of behaviour change techniques such as goal setting, action planning and self-monitoring, alongside CBT and PR, may empower and motivate anxious/depressed patients with COPD to engage in more daily physical activities [ 8 , 49 ].…”

“…Within this, two vicious cycles, characterised by dyspnea and/or deconditioning, lead to worsening of anxiety and/or breathing sensations during PA. As a result, patients begin to change their PA behaviour, choosing a sedentary lifestyle over greater levels of PA in response to the symptoms associated with their condition (49). Therefore, the addition of PA behavioural modification strategies, including education on the benefits of PA and incorporation of behaviour change techniques such as goal setting, action planning and self-monitoring, alongside CBT and PR, may empower and motivate anxious/depressed patients with COPD to engage in more daily physical activities (8,50).…”