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

Abstract

Introduction: Patients with COPD who exhibit elevated levels of anxiety and/or depression are typically less able to improve symptoms and physical activity (PA) levels following a programme of pulmonary rehabilitation (PR). Objective: To provide proof of concept that offering an intervention comprising cognitive behavioural therapy (CBT) alongside PA behavioural modification strategies (BPA) during PR is more effective in improving PA outcomes compared to PR and CBT alone. Methods: Thirty-two patients with COPD (mean±SD: FEV1: 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/day, movement intensity, 6MWD and HADS scores. Results: The magnitude of improvement across PA outcomes was greater for the PR+CBT+BPA compared to the PR+CBT intervention (by 828 steps/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 to 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 PA outcome measures compared to CBT alone during PR.