Camp P1,2, Maiwald K3, Simms A4, Bendall C5
1University of British Columbia, Faculty of Medicine, Physical Therapy, Vancouver, Canada, 2University of British Columbia, Centre for Heart Lung Innovation, Vancouver, Canada, 3Interior Health Authority, Research, Kelowna, Canada, 4Interior Health Authority, Physiotherapy, Vernon, Canada, 5Interior Health Authority, Chronic Disease Management, Vernon, Canada
Background: Most pulmonary rehabilitation programs in Canada are located in urban centres and do not consider the realities of living with chronic lung disease in a remote or rural community. It is especially important to understand physical activity in this context in order to prescribe appropriate exercise and support ongoing physical activity behaviour.
Purpose: The purpose of this study is to understand the norms and values of physical activity undertaken by remote and rural residents living with chronic lung disease.
Methods: This presentation reports on the information gained via Photovoice methodology. All participants provided informed consent. Adults living with chronic lung disease in their own homes were recruited through pulmonary rehabilitation programs. Participants took photographs that represented their physical activity preferences, barriers, and facilitators, over a one week period, 6 months apart. They then participated in a one-to-one interview where they discussed their pictures with a trained interviewer. Interviews were transcribed verbatim and coded using an applied thematic content analysis approach. Codes were then used to construct themes related to having a chronic lung disease and being physically active in terms of 1) characteristics and values associated with being physically active; and 2) barriers and facilitators of being physically active.
Results: 24 individuals (50% female), mean (standard deviation [SD]) age = 73 (7) years with COPD (n=19), asthma (n=1) or COPD-asthma overlap (n=4) participated. Mean (SD) post-bronchodilator forced expiratory volume in the first second (FEV1) % predicted = 62% (21%) and mean FEV1/forced expiratory capacity = 0.51 (.13). 92% had completed pulmonary rehabilitation. Regarding characteristics & values of physical activity, three main themes were identified: 1) physical activity is part of maintaining a rural residence; 2) physical activities involve the whole body; and 3) social physical activity counteracts isolation. Themes on facilitators of physical activity included 1) pulmonary rehabilitation; and 2) setting personal challenges. Themes on barriers to physical activity were: 1) respiratory symptoms; 2) forest fire smoke in summer; and 3) inconsistency of community programming for exercise. Other than during pulmonary rehabilitation, most participants did not engage in structured exercise such as using a cycle ergometer, lifting weights, or using equipment at a local gym.
Conclusion(s): People with chronic lung disease who live in a rural community remain physically active in order to maintain their rural residence and property. Participants set personal challenges to remain active and adapted these depending on symptoms. Pulmonary rehabilitation provided an opportunity to socialize with others who share similar problems, as opposed to being specifically about exercise. Summer forest fire smoke was a primary barrier to being active in the summer.
Implications: Pulmonary rehabilitation programming must consider the realities of living with chronic lung disease in a rural community. Pulmonary rehabilitation should support progressive goal setting and the creation of personal, meaningful challenges for each participant. Exercise prescription should incorporate whole-body exercises that help maintain a rural lifestyle. Structured social engagement is key. Forest fire smoke is now a regular summer occurrence in many locations and strategies for remaining activity while being unable to go outside should be developed.
Keywords: Physical activity, chronic lung disease, remote and rural communities
Funding acknowledgements: University of British Columbia & the British Columbia Interior Health Authority
Purpose: The purpose of this study is to understand the norms and values of physical activity undertaken by remote and rural residents living with chronic lung disease.
Methods: This presentation reports on the information gained via Photovoice methodology. All participants provided informed consent. Adults living with chronic lung disease in their own homes were recruited through pulmonary rehabilitation programs. Participants took photographs that represented their physical activity preferences, barriers, and facilitators, over a one week period, 6 months apart. They then participated in a one-to-one interview where they discussed their pictures with a trained interviewer. Interviews were transcribed verbatim and coded using an applied thematic content analysis approach. Codes were then used to construct themes related to having a chronic lung disease and being physically active in terms of 1) characteristics and values associated with being physically active; and 2) barriers and facilitators of being physically active.
Results: 24 individuals (50% female), mean (standard deviation [SD]) age = 73 (7) years with COPD (n=19), asthma (n=1) or COPD-asthma overlap (n=4) participated. Mean (SD) post-bronchodilator forced expiratory volume in the first second (FEV1) % predicted = 62% (21%) and mean FEV1/forced expiratory capacity = 0.51 (.13). 92% had completed pulmonary rehabilitation. Regarding characteristics & values of physical activity, three main themes were identified: 1) physical activity is part of maintaining a rural residence; 2) physical activities involve the whole body; and 3) social physical activity counteracts isolation. Themes on facilitators of physical activity included 1) pulmonary rehabilitation; and 2) setting personal challenges. Themes on barriers to physical activity were: 1) respiratory symptoms; 2) forest fire smoke in summer; and 3) inconsistency of community programming for exercise. Other than during pulmonary rehabilitation, most participants did not engage in structured exercise such as using a cycle ergometer, lifting weights, or using equipment at a local gym.
Conclusion(s): People with chronic lung disease who live in a rural community remain physically active in order to maintain their rural residence and property. Participants set personal challenges to remain active and adapted these depending on symptoms. Pulmonary rehabilitation provided an opportunity to socialize with others who share similar problems, as opposed to being specifically about exercise. Summer forest fire smoke was a primary barrier to being active in the summer.
Implications: Pulmonary rehabilitation programming must consider the realities of living with chronic lung disease in a rural community. Pulmonary rehabilitation should support progressive goal setting and the creation of personal, meaningful challenges for each participant. Exercise prescription should incorporate whole-body exercises that help maintain a rural lifestyle. Structured social engagement is key. Forest fire smoke is now a regular summer occurrence in many locations and strategies for remaining activity while being unable to go outside should be developed.
Keywords: Physical activity, chronic lung disease, remote and rural communities
Funding acknowledgements: University of British Columbia & the British Columbia Interior Health Authority
Topic: Cardiorespiratory; Disability & rehabilitation
Ethics approval required: Yes
Institution: University of British Columbia
Ethics committee: St. Paul's Hospital Clinical Research Ethical Review Board
Ethics number: H16-01597
All authors, affiliations and abstracts have been published as submitted.
