A longitudinal study of physical activity behaviour in chronic disease: The example of chronic obstructive pulmonary disease | Posted on:2010-10-29 | Degree:Ph.D | Type:Thesis | University:McGill University (Canada) | Candidate:Soicher, Judith Eileen | Full Text:PDF | GTID:2444390002982070 | Subject:Epidemiology | Abstract/Summary: | | In chronically ill adults, involvement in physical activity is associated with reduced mortality and better quality of life. In chronic obstructive pulmonary disease (COPD), exercise training within a pulmonary rehabilitation program leads to improvements in dyspnea, exercise capacity and quality of life measured immediately after the program. These gains diminish within 6--18 months of program completion, in part due to patients' difficulty in sustaining physical activity behaviour. The global objective of this thesis was to examine behavioural and disease-related aspects of physical activity over 1 year among individuals with COPD.;In the second study, logistic longitudinal modelling showed that adherence to exercise (≥3 days per week for endurance exercise and ≥2 days per week for strength exercise) declined progressively between 4 and 12 months after rehabilitation start. Adherence to endurance exercise was higher during spring/summer, and if individuals had exercised prior to rehabilitation (past habits); more severe airway obstruction at baseline and reporting a COPD exacerbation during rehabilitation predicted worse adherence. Greater baseline self-efficacy for carrying out strength exercise predicted better adherence to this, type of exercise.;Patterns of physical activity, defined as weekly time of endurance activity, were examined from 4--12 months in the third study. Heterogeneity was detected within the sample, as trajectory modelling identified 3 distinct sub-groups: 55% of individuals started at a low activity level and stayed low; 30% started high and stayed high; 15% started high and declined. The strongest discriminating baseline variables between sub-groups were past exercise habits, 6-minute walk distance and barriers to exercise. Individuals in the high/decline group had the greatest barriers, which are potentially modifiable.;In summary, rehabilitation programs impact positively on behavioural aspects of exercise, however adherence to exercise declines after a structured rehabilitation program when individuals must sustain the behaviour independently. There is, however, heterogeneity in physical activity patterns among patients with COPD. Results were synthesized across the 3 studies and a preliminary set of recommendations for pulmonary rehabilitation practice were developed. Recommendations emphasize that behavioural, disease-related and seasonal factors, associated with physical activity, should be addressed within rehabilitation programs through behavioural and self-management interventions. Future research will be required to develop and test these interventions.;A longitudinal behavioural study was embedded within a randomized multicentre trial comparing the effectiveness of home-based versus hospital-based outpatient pulmonary rehabilitation. The first study of this thesis assessed behavioural aspects of exercise before and after a 3-month rehabilitation program. Exercise habits, self-efficacy for exercise and barriers to exercise improved significantly following rehabilitation. In cross-sectional path analysis, past exercise habits and greater exercise capacity had a positive effect On self-efficacy for endurance exercise (measured pre-rehabilitation), while external barriers, depression and female sex had a negative effect. | Keywords/Search Tags: | Physical activity, Exercise, Rehabilitation, Chronic, Pulmonary, Behaviour, Longitudinal, Barriers | | Related items |
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