title: Maintenance of a physically active lifestyle after pulmonary rehabilitation in patients with COPD: a qualitative study toward motivational factors.
abstract: OBJECTIVE
  To explore determinants of behavior change maintenance of a physically active lifestyle in patients with chronic obstructive pulmonary disease (COPD) 8-11 months after completion of a 4-month outpatient pulmonary rehabilitation program.
  
  
  METHODS
  A qualitative descriptive study of semistructured interviews.
  
  
  METHODS
  Pulmonary rehabilitation assessment center.
  
  
  METHODS
  Patients with COPD.
  
  
  METHODS
  Semistructured interviews until data saturation, coded by 2 independent researchers. Patients were classified as responder (maintenance or improvement) or nonresponder (relapse or decrease), based on 3 quantitative variables reflecting exercise capacity (Constant Work Rate Test), health-related quality of life (Short-Form health survey [SF-36]), and self-management abilities (Self-Management Ability Scale [SMAS-30/Version 2]).
  
  
  RESULTS
  Mean (SD) forced expiratory volume in the first second (FEV1) among interviewees was 52.5% (14.4%) predicted and the mean age was 63.5 years (range: 45-78). The group consisted of 15 responders and 7 nonresponders. Physical limitations reduced competence to engage in an active lifestyle and responders appeared to experience higher levels of perceived competence. Social support was found important and the experienced understanding from fellow patients made exercising together enjoyable. Particularly, responders expressed autonomous motivation and said they exercised because of the benefits they gain from it. Unexpectedly, only responders also experienced controlled motivation.
  
  
  CONCLUSIONS
  Perceived competence and autonomous motivation are important determinants for maintenance of an active lifestyle in patients with COPD. In contrast to common theoretical assumptions, a certain threshold level of controlled motivation may remain important in maintaining a physically active lifestyle after a pulmonary rehabilitation program.
authors.affiliation: Department of Respiratory Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands. Electronic address: k.stewart@maastrichtuniversity.nl.
authors.forename: Kelly F J
authors.initials: KF
authors.lastname: Stewart
authors.affiliation: Department of Health Promotion, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands.
authors.forename: Jessie J M
authors.initials: JJ
authors.lastname: Meis
authors.affiliation: Department of Respiratory Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands; Department of Research and Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands.
authors.forename: Coby
authors.initials: C
authors.lastname: van de Bool
authors.affiliation: Department of Research and Education, CIRO+, Center of Expertise for Chronic Organ Failure, Horn, The Netherlands.
authors.forename: Daisy J A
authors.initials: DJ
authors.lastname: Janssen
authors.affiliation: Department of Health Promotion, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands.
authors.forename: Stef P J
authors.initials: SP
authors.lastname: Kremers
authors.affiliation: Department of Respiratory Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands.
authors.forename: Annemie M W J
authors.initials: AM
authors.lastname: Schols
mesh_terms: D000368:Aged; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008019:Life Style; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology* / Q000534:rehabilitation*; D036301:Qualitative Research; D040242:Risk Reduction Behavior; D012648:Self Care; D016896:Treatment Outcome
keywords: Chronic obstructive pulmonary disease; autonomous motivation; behavior maintenance; pulmonary rehabilitation