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Cognitive behavioural therapy combined with physical activity behavioural modification strategies during pulmonary rehabilitation in patients with COPD

Lookup NU author(s): Dr Graham Burns, Dr Karen Marshall

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).

Abstract

© The authors 2023.Introduction Patients with COPD who exhibit elevated levels of anxiety and/or depression are typically less able to improve symptoms and physical activity levels following a programme of pulmonary rehabilitation (PR). The objective of the present study was to provide proof of concept that offering an intervention comprising cognitive behavioural therapy (CBT) alongside physical activity behavioural modification strategies (BPA) during PR is more effective in improving physical activity outcomes compared to PR and CBT alone. Methods 32 patients with COPD (mean±SD forced expiratory volume in 1 s 42±14% predicted) were assigned 1:1 to receive PR+CBT+BPA or PR+CBT. BPA comprised motivational interviews, step-count monitoring, feedback using a pedometer and goal setting. Assessments included accelerometer-derived steps per day, movement intensity, 6-min walk distance (6MWD) and Hospital Anxiety and Depression Scale (HADS) scores. Results The magnitude of improvement across physical activity outcomes was greater for the PR+CBT +BPA compared to the PR+CBT intervention (by 829 steps per day (p=0.029) and by 80±39 vector magnitude units (p=0.042), respectively). Compared to PR and CBT alone, the PR+CBT+BPA intervention induced greater clinically meaningful improvements in HADS anxiety scores (by −2 units, 95% CI −4–1 units) and 6MWD (by 33±20 m). Conclusions Providing anxious and/or depressed patients with COPD with a combined intervention of CBT and BPA during PR presents more favourable improvements in physical activity outcome measures compared to CBT alone during PR.

Publication metadata

Author(s): Armstrong M, Hume E, McNeillie L, Chambers F, Wakenshaw L, Burns G, Marshall KH, Vogiatzis I

Publication type: Article

Publication status: Published

Journal: ERJ Open Research

Year: 2023

Volume: 9

Issue: 5

Print publication date: 01/09/2023

Online publication date: 11/09/2023

Acceptance date: 14/06/2023

Date deposited: 03/10/2023

ISSN (electronic): 2312-0541

Publisher: European Respiratory Society

URL: https://doi.org/10.1183/23120541.00074-2023

DOI: 10.1183/23120541.00074-2023

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