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

Matthew Armstrong; Emily Hume; Laura McNeillie; Francesca Chambers; Lynsey Wakenshaw; Graham Burns; Karen Heslop Marshall; Ioannis Vogiatzis

doi:10.1183/23120541.00074-2023

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

ERJ Open Res. 2023 Sep 11;9(5):00074-2023. doi: 10.1183/23120541.00074-2023. eCollection 2023 Sep.

Authors

Matthew Armstrong^{1

2}, Emily Hume², Laura McNeillie³, Francesca Chambers³, Lynsey Wakenshaw³, Graham Burns³, Karen Heslop Marshall³, Ioannis Vogiatzis²

Affiliations

¹ Department of Rehabilitation and Sport Sciences, Faculty of Health and Social Sciences, Bournemouth University, Poole, UK.
² Department of Sport, Exercise and Rehabilitation, School of Health and Life Sciences, Northumbria University, Newcastle, UK.
³ Chest Clinic, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK.

Abstract

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.