Textbook of Pulmonary Rehabilitation by Enrico Clini Anne E. Holland Fabio Pitta & Thierry Troosters

Author:Enrico Clini, Anne E. Holland, Fabio Pitta & Thierry Troosters
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

15.7 The Fun Factor Is Important

Successful PA coaching programs should not only focus on barriers toward physical activity but should also identify enablers that can facilitate behavioral change. Enabling factors that are typically reported by patients with COPD include sufficient social support, the opportunity to be active with others, the subjective feeling that one benefits from the physical activity, goal-setting to improve self-motivation, and the possibility to communicate with healthcare professionals [35]. One basic enabler that is too often forgotten is the fun factor: the chances of inducing a long-term PA behavior change increase if patients endorse physical activity as a hobby.

Austrian researchers have investigated to what extent a 3-month Nordic walking training program enhances exercise tolerance and physical activity behavior in patients with moderate to severe COPD [49]. This low-cost intervention consisted of three one-hour outdoor walking sessions per week at 75% of maximal heart rate. As expected, the Nordic Walkers improved their six-minute walking distance as compared to a control group. The Nordic Walkers also improved the daily time spent walking (+15 min/day) and standing (+129 min/day) as well as the intensity of walking, while daily sitting time decreased (−128 min/day). Interestingly, these positive effects were sustained at 3 and 6 months follow-up, making this one of few studies that are able to show long-term PA changes after a PA coaching or exercise intervention. This can be largely explained by the observation that 63% of patients in the Nordic Walking group reported to have adopted as regular physical exercise into weekly routine 6 months after the research period.

Pleguezuelos et al. developed 32 urban walking circuits in the city of Mataró, a Spanish city with 124,000 inhabitants, which were collected in a leaflet [50]. Each circuit had a different distance, slope, and general difficulty. The availability of cultural attractions and commercial areas along the track was also described. Patients received initial support in interpreting these circuits. The researchers conducted a randomized trial comparing patients that did or did not get access to these walking circuits after a short 2-week rehabilitation period. Nine months after the completion of rehabilitation, patients that had access to the walking circuits were significantly more active (+34 min/day of physical activity compared to the control group). The large variability in physical activity in the circuit group indicates that these urban walking circuits were a very successful enabler of long-term PA behavior change in some patients while they might not be the best PA coaching tool in others.

These successful examples illustrate that PA coaching strategies should always focus on triggering “the fun factor” in individual patients, regardless of the used approach.

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