The "can do, do do" concept in individuals with chronic obstructive pulmonary disease: an exploration of psychological mechanisms

Background

The “can do, do do” concept aims at identifying subgroups among persons with chronic obstructive pulmonary disease (COPD). Following a two-dimensional categorization, individuals are binarily classified with respect to their levels of physical capacity (“can’t do” or “can do”) and physical activity (“don’t do” or “do do”), resulting in four disjunct quadrants. The approach has been debated recently and the latest articles have concluded that the quadrants should be specifically examined in terms of psychological aspects of physical activity. Therefore, the goal of the present study was to explore the role of psychological variables in physical activity in the context of the “can do, do do” quadrant concept.

Methods

Within the scope of secondary data analyses of the “Stay Active After Rehabilitation” (STAR) randomized controlled trial, a total of 298 COPD rehabilitants of an inpatient pulmonary rehabilitation program were grouped into the suggested quadrants. We set fixed cut-offs at 70% of relative 6-min walking test performances for healthy individuals (physical capacity dimension) and 5.000 steps per day (physical activity dimension). Univariate and multivariate logistic regression analyses served to analyze whether depression scores, fear avoidance behaviors, disease-specific anxiety, self-concordance for physical activity, and five indicators of physical activity-related health competence (PAHCO) effectively discriminated between the “don’t do” and “do do” groups.

Results

Among persons with lower relative physical capacity, depression scores, fear avoidance behaviors, and disease-specific anxiety (univariate case) significantly differentiated between the more and the less active. Among persons with higher relative physical capacity, fear avoidance behaviors, disease-specific anxiety, as well as three PAHCO indicators (physical activity-specific self-efficacy, self-control, and affect regulation) significantly separated the more and the less active. In multivariate analyses, only fear avoidance behaviors and affect regulation discriminated among individuals with better relative physical capacity.

Conclusion

The findings identified important psychological and competence-oriented variables that explain discrepancies in the quadrant concept. Based on this, we discuss implications for physical activity promotion in individuals with COPD. Respiratory research can benefit from future studies complementing the quadrant concept through further behavioral analyses.

Trial registration Clinicaltrials.gov, ID: NCT02966561. Registered 17 November, 2016, https://clinicaltrials.gov/ct2/show/NCT02966561.

[Behaviour-orientated exercise therapy--initiating and maintaining a physically active lifestyle]

BACKGROUND

The promotion of a physically active lifestyle has become an important issue in exercise therapy. Exercise-only interventions are frequently used for the rehabilitation of individuals with chronic diseases. These do indeed improve functional and physical performance, but they are not alone sufficient to initiate long lasting changes in physical-activity behaviour. Behaviour-related aspects are rarely integrated into exercise-therapy interventions.

OBJECTIVE

Based on theories of health behaviour change, effective techniques for changing physical-activity behaviour in the context of exercise therapy will be identified.

METHODOLOGY

The starting point is a theory-driven definition of individual behavioural determinants of physical activity and the identification of techniques for influencing the determinants. Subsequently, the potential of the techniques for enhancing physical activity is evaluated. The available evidence was reviewed on the basis of international reviews and control-group studies from the German rehabilitation setting. Finally, recommendations are offered for designing exercise-based interventions to promote participation in and adherence to physical activity.

RESULTS

A total of 28 techniques for the promotion of physical activity behaviour were identified. An approach that proved particularly effective was self-monitoring of physical activity behaviour in a variety of combinations with other techniques, such as contracting, feedback, rewards, generating one's own varied exercise experience, action planning and barrier management.

DISCUSSION

The integration of behaviour-related techniques in the context of exercise therapy interventions shows great promise as a means of initiating and promoting a physically active lifestyle.