title: Barriers and enablers to physical activity participation in patients with COPD: a systematic review.
abstract: OBJECTIVE
  Physical activity (PA) has been shown to improve symptoms in people with chronic obstructive pulmonary disease (COPD). Despite the high health and financial costs, the uptake of management strategies, particularly participation in PA and pulmonary rehabilitation (PR), are low. The review objective here was to identify potential barriers and enablers, which people with COPD report being associated with their participation in PA programs, including PR.
  
  
  METHODS
  A systematic search was undertaken to identify studies (published Jan 2000 to Aug 2011) reporting any barriers and enablers experienced by people with COPD regarding participation in PA and PR. Methodological quality of the studies was appraised using McMaster critical appraisal tools. A narrative summary of findings was undertaken reporting on individual study characteristics, country of origin, participants, and potential barriers and enablers.
  
  
  RESULTS
  Eleven studies (8 qualitative and 3 quantitative) met the inclusion criteria for this systematic review. Several methodological issues (small sampling, poor description of data collection and analysis, issues with generalizability of the research findings) were common among included studies. Barriers identified included changing health status, personal issues, lack of support, external factors, ongoing smoking, and program-specific barriers. Enablers identified included social support, professional support, personal drivers, personal benefit, control of condition, specific goals, and program-specific enablers.
  
  
  CONCLUSIONS
  The findings from this review may assist health professionals, patients, care givers and the wider community to develop effective strategies to promote participation in PA and PR among people with COPD.
authors.affiliation: International Centre for Allied Health Evidence, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia. Olivia.Thorpe@unisa.edu.au
authors.forename: Olivia
authors.initials: O
authors.lastname: Thorpe
authors.forename: Kylie
authors.initials: K
authors.lastname: Johnston
authors.forename: Saravana
authors.initials: S
authors.lastname: Kumar
mesh_terms: D015984:Causality; D006801:Humans; D009043:Motor Activity; D010358:Patient Participation / Q000523:psychology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000534:rehabilitation*