Concerns About Exercise Are Related to Walk Test Results in Pulmonary Rehabilitation for Patients with COPD

Although international guidelines on pulmonary rehabilitation acknowledge that psychological factors contribute to exercise
intolerance in patients with chronic obstructive pulmonary disease (COPD), the few empirical studies investigating this association
have found inconsistent results.

The purpose of this study is to investigate whether negative affect and beliefs about exercise of patients with COPD would
be related to baseline 6-min walk (6-MW) test results in a pulmonary rehabilitation setting, after correction for physical
variables (sex, age, height, weight, and lung function). A second aim was to examine whether patients’ beliefs are associated
with treatment outcomes, as measured by an improvement in 6-MW distance.

A 12-week pulmonary rehabilitation program was completed by 166 patients. Beliefs (perceived necessity and concerns) about
exercise and negative affect were assessed by a questionnaire. Clinical data were obtained from medical records.

Baseline 6-MW distance was positively related to younger age, male gender, better pulmonary function, and having fewer concerns
about exercise. After rehabilitation, patients had increased their walk distance by 12% (32 m), on average. Baseline physiological
and psychological variables were unrelated to patients’ response to treatment (increase in walk distance). However, subgroup
analysis showed that for patients with mild to moderate airflow obstruction, concerns about exercise were negatively related
to response to treatment.

We conclude that patients’ beliefs about the negative consequences of exercise are associated with baseline 6-MW test performance
and response to treatment for patients with mild to moderate COPD. We recommend that patients’ concerns about exercise are
discussed and, if necessary, corrected during the intake phase.