# Time to consider modifiable (especially motivational) determinants of physical activity among COPD patients?

## A commentary on Arbillaga-Etxarri et al. (2017)

Guillaume Chevance

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Guillaume Chevance. Time to consider modifiable (especially motivational) determinants of physical activity among COPD patients? A commentary on Arbillaga-Etxarri et al. (2017. 2017. hal-05042150

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Submitted on 22 Apr 2025

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Time to consider modifiable (especially motivational) determinants of physical activity among COPD patients? A commentary on Arbillaga-Etxarri et al. (2017)

* Guillaume Chevance, PhD student 1 Laboratory Espylon, Univ. Montpellier, Montpellier, France. 2 Les Cliniques du Souffle , Groupe 5 Santé, France

I read with interest the article published by Arbillaga-Etxarri et al.[1] titled
"Socioenvironmental correlates of physical activity in patients with chronic obstructive
pulmonary disease (COPD)". In the introduction section, the authors stated that the
current interventions (e.g., pharmacological treatment, rehabilitation, self-
management) aiming to change physical activity behavior in COPD patients lack
effectiveness, particularly in the long-term. The authors argue that this absence of
effectiveness could be due to a lack of knowledge of physical activity determinants in
this population. To address this issue, Arbillaga-Etxarri et al.[1] examined the socio-
ecological determinants of active behaviours in 400 COPD patients and found that,
after controlling potential confounders, having a dog and grandparenting were
positively associated with physical activity; effects sizes were small, β = .19 and very
small β = .08 for dog walking and grandparenting, respectively. The authors
concluded that these two socio-environmental characteristics should be considered
to promote physical activity both at the clinical level and in future research. This study
is important because there is a lack of knowledge regarding the determinants of
physical activity in this population.[2]

Nonetheless, there are some reservations regarding the clinical utility of physical
activity socio-environmental correlates to design physical activity programs.
Socioenvironmental correlates of physical activity are often largely beyond
participants' control and thus non-modifiable during an intervention for a clinician,
such as the 'walkability' of the environment. For example, in the current study, only 18
% of the sample had a dog and 12% of the participants reported walking it. The
authors explained that patients could have concerns about dogs such as difficulties
with controlling the animal, which could explain the lack of dog owners in the study. It
could also be hypothesized that patients have a dog because they are already active
and feel capable of owning a dog. Nevertheless, it could be difficult to use this
leverage during a physical activity counseling intervention.

Physical activity is a complex behavior that may depend from many different factors,
such as socio-environmental variables (e.g. age, family support), biological functions
(e.g. functional capacity), or environmental factors (e.g. climatic conditions;
'walkability' of the environment). Among these potential predictors of physical activity
there is an urgent need to identify factors that could be modifiable during an
intervention. In this regard, the concept of motivation is an important target.

Motivation could be operationalized through different theoretical constructs, which
have received different levels of empirical support regarding their associations with
physical activity behaviour depending on the context [3]. These constructs could be
clustered into (1) intentional processes (the development of objectives and intentions
to be active), (2) affective judgments (feelings about physical activity) (3) self-
perception of capability and opportunity (confidences in one's capacity to be active) (4) self-regulation processes ( strategies used to maintain motivation and dealing with barriers) and (5) automatic or unconscious processes (physical activity habits driven by feelings about physical activity). Methodologically, these processes are often measured through either self-reported questionnaires [4] or computerized reaction-time tests.[5] To date, research dealing with motivational processes toward physical activity for patients with chronic respiratory disease are scarce. Selzler et al [6] found that stronger physical activity-specific self-efficacy was positively associated with exercise attendance, as well as 6-minute walk test improvement during pulmonary rehabilitation. Chevance et al [7] highlighted that unconscious feelings (measuring with computerized test) about physical activity prospectively predict self-reported physical activity at 6 months after pulmonary rehabilitation. These preliminary results are important because identifying modifiable determinants of physical activity could help (i) to motivate patient to integrate a program, or identify patient at risk to failing physical activity after an intervention and (ii) to design more effective evidence-based interventions regarding physical activity in COPD patients. In conclusion, future studies should consider the motivational determinants of physical activity as well as interventions to specifically enhance motivation.

Acknowledgments: I sincerely thank Anne-Marie Selzler for their comments

## References

1. Arbillaga-Etxarri A, Gimeno-Santos E, Barberan-Garcia A, et al. Socio-environmental correlates of physical activity in patients with chronic obstructive pulmonary disease (COPD). Thorax, forthcoming. doi: 10.1136/thoraxjnl-2016-209209.

2. Gimeno-Santos E, Frei A, Steurer-Stey C, et al. Determinants and outcomes of physical activity in patients with COPD: a systematic review. Thorax, 2014;69: 731-39. doi: 10.1136/thoraxjnl-2013-204763.

3. Rhodes R. The Evolving Understanding of Physical Activity Behavior: A Multiprocess Action Control Approach. Advances in Motivation Science, 2017;4:171-205. doi: 10.1016/bs.adms.2016.11.001.

4. Rodgers W, Wilson P, Hall C, et al. Evidence for a Multidimensional Self-Efficacy for Exercise Scale. Res Q Exerc Sport, 2008;79:222-34. doi:10.1080/02701367.2008.10599485.

5. Chevance G, Heraud N, Guerrieri A, et al. Measuring implicit attitudes toward physical activity and sedentary behavior: Test-retest reliability of three scoring algorithms of the Implicit Association Test and Single Category-Implicit Association Test. Psychology of Sport and Exercise, 2017;31:70-8. doi: 10.1016/j.psychsport.2017.04.007.

6. Selzler A, Rodgers W, Berry T, et al. The importance of exercise self-efficacy for clinical outcomes in pulmonary rehabilitation. Rehabil Psychol, 2016;61:380-8. doi:
10.1037/rep0000106

7. Chevance G, Héraud N, Varray A, et al. Change in Explicit and Implicit Motivation toward Physical Activity and Sedentary Behavior in Pulmonary Rehabilitation and Associations with Postrehabilitation Behaviors. Rehabil Psychol, forthcoming. doi: 10.1037/rep0000137.

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Conflict of Interest:
None declared.