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Published in: International Journal of Behavioral Medicine 1/2012

Open Access 01-03-2012

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

Authors: Maarten J. Fischer, Margreet Scharloo, Jannie Abbink, Alex van ’t Hul, Dirk van Ranst, Arjan Rudolphus, John Weinman, Klaus F. Rabe, Adrian A. Kaptein

Published in: International Journal of Behavioral Medicine | Issue 1/2012

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Abstract

Background

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.

Purpose

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.

Method

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.

Results

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.

Conclusion

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.
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Footnotes
1
This item was reverse scored.
 
Literature
1.
go back to reference Nici L, Donner C, Wouters E, Zuwallack R, Ambrosino N, Bourbeau J, et al. American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med. 2006;173:1390–413.PubMedCrossRef Nici L, Donner C, Wouters E, Zuwallack R, Ambrosino N, Bourbeau J, et al. American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. Am J Respir Crit Care Med. 2006;173:1390–413.PubMedCrossRef
2.
go back to reference Borak J, Chodosowska E, Matuszewski A, Zielinski J. Emotional status does not alter exercise tolerance in patients with chronic obstructive pulmonary disease. Eur Respir J. 1998;12:370–3.PubMed Borak J, Chodosowska E, Matuszewski A, Zielinski J. Emotional status does not alter exercise tolerance in patients with chronic obstructive pulmonary disease. Eur Respir J. 1998;12:370–3.PubMed
3.
go back to reference Trappenburg JC, Troosters T, Spruit MA, Vandebrouck N, Decramer M, Gosselink R. Psychosocial conditions do not affect short-term outcome of multidisciplinary rehabilitation in chronic obstructive pulmonary disease. Arch Phys Med Rehabil. 2005;86:1788–92.PubMedCrossRef Trappenburg JC, Troosters T, Spruit MA, Vandebrouck N, Decramer M, Gosselink R. Psychosocial conditions do not affect short-term outcome of multidisciplinary rehabilitation in chronic obstructive pulmonary disease. Arch Phys Med Rehabil. 2005;86:1788–92.PubMedCrossRef
4.
go back to reference Cully JA, Graham DP, Stanley MA, Ferguson CJ, Sharafkhaneh A, Souchek J, et al. Quality of life in patients with chronic obstructive pulmonary disease and comorbid anxiety or depression. Psychosomatics. 2006;47:312–9.PubMedCrossRef Cully JA, Graham DP, Stanley MA, Ferguson CJ, Sharafkhaneh A, Souchek J, et al. Quality of life in patients with chronic obstructive pulmonary disease and comorbid anxiety or depression. Psychosomatics. 2006;47:312–9.PubMedCrossRef
5.
go back to reference Giardino N, Curtis J, Andrei AC, Fan V, Benditt J, Lyubkin M, et al. Anxiety is associated with diminished exercise performance and quality of life in severe emphysema: a cross-sectional study. Respir Res. 2010;11:29. http://respiratory-research.com/content/11/1/29.PubMedCrossRef Giardino N, Curtis J, Andrei AC, Fan V, Benditt J, Lyubkin M, et al. Anxiety is associated with diminished exercise performance and quality of life in severe emphysema: a cross-sectional study. Respir Res. 2010;11:29. http://​respiratory-research.​com/​content/​11/​1/​29.​PubMedCrossRef
6.
go back to reference Fishbein M, Ajzen I. Belief, attitude, intention, and behavior: an introduction to theory and research. Reading, MA: Addison-Wesley; 1975. Fishbein M, Ajzen I. Belief, attitude, intention, and behavior: an introduction to theory and research. Reading, MA: Addison-Wesley; 1975.
7.
8.
go back to reference Horne R. Treatment perceptions and self-regulation. In: Cameron LD, Leventhal H, editors. The self-regulation of health and illness behaviour. New York, NY: Routledge; 2003. p. 138–53. Horne R. Treatment perceptions and self-regulation. In: Cameron LD, Leventhal H, editors. The self-regulation of health and illness behaviour. New York, NY: Routledge; 2003. p. 138–53.
9.
go back to reference Leventhal H, Meyer D, Nerenz D. The common sense representation of illness danger. In: Rachman S, editor. Contributions to medical psychology, vol. 2. New York, NY: Pergamon; 1980. p. 7–30. Leventhal H, Meyer D, Nerenz D. The common sense representation of illness danger. In: Rachman S, editor. Contributions to medical psychology, vol. 2. New York, NY: Pergamon; 1980. p. 7–30.
10.
go back to reference Leventhal H, Nerenz D, Steele DJ. Illness representations and coping with health threats. In: Baum A, Taylor SE, Singer JE, editors. Handbook of psychology and health: social psychological aspects of health, vol. 4. Hillsdale, NJ: Lawrence Erlbaum Associates; 1984. p. 219–52. Leventhal H, Nerenz D, Steele DJ. Illness representations and coping with health threats. In: Baum A, Taylor SE, Singer JE, editors. Handbook of psychology and health: social psychological aspects of health, vol. 4. Hillsdale, NJ: Lawrence Erlbaum Associates; 1984. p. 219–52.
11.
go back to reference Horne R. Patients' beliefs about treatment: the hidden determinant of treatment outcome? J Psychosom Res. 1999;47:491–5.PubMedCrossRef Horne R. Patients' beliefs about treatment: the hidden determinant of treatment outcome? J Psychosom Res. 1999;47:491–5.PubMedCrossRef
12.
go back to reference Bucks RS, Hawkins K, Skinner TC, Horn S, Seddon P, Horne R. Adherence to treatment in adolescents with cystic fibrosis: the role of illness perceptions and treatment beliefs. J Pediatr Psychol. 2009;34:893–902.PubMedCrossRef Bucks RS, Hawkins K, Skinner TC, Horn S, Seddon P, Horne R. Adherence to treatment in adolescents with cystic fibrosis: the role of illness perceptions and treatment beliefs. J Pediatr Psychol. 2009;34:893–902.PubMedCrossRef
13.
go back to reference Cooper AF, Weinman J, Hankins M, Jackson G, Horne R. Assessing patients' beliefs about cardiac rehabilitation as a basis for predicting attendance after acute myocardial infarction. Heart. 2007;93:53–8.PubMedCrossRef Cooper AF, Weinman J, Hankins M, Jackson G, Horne R. Assessing patients' beliefs about cardiac rehabilitation as a basis for predicting attendance after acute myocardial infarction. Heart. 2007;93:53–8.PubMedCrossRef
14.
go back to reference Fischer MJ, Scharloo M, Abbink JJ, Thijs-Van Nies A, Rudolphus A, Snoei L, et al. Participation and drop-out in pulmonary rehabilitation: a qualitative analysis of the patient's perspective. Clin Rehabil. 2007;21:212–21.PubMedCrossRef Fischer MJ, Scharloo M, Abbink JJ, Thijs-Van Nies A, Rudolphus A, Snoei L, et al. Participation and drop-out in pulmonary rehabilitation: a qualitative analysis of the patient's perspective. Clin Rehabil. 2007;21:212–21.PubMedCrossRef
15.
go back to reference Haughney J, Price D, Kaplan A, Chrystyn H, Horne R, May N, et al. Achieving asthma control in practice: understanding the reasons for poor control. Respir Med. 2008;102:1681–93.PubMedCrossRef Haughney J, Price D, Kaplan A, Chrystyn H, Horne R, May N, et al. Achieving asthma control in practice: understanding the reasons for poor control. Respir Med. 2008;102:1681–93.PubMedCrossRef
16.
go back to reference Horne R, Parham R, Driscoll R, Robinson A. Patients' attitudes to medicines and adherence to maintenance treatment in inflammatory bowel disease. Inflamm Bowel Dis. 2009;15:837–44.PubMedCrossRef Horne R, Parham R, Driscoll R, Robinson A. Patients' attitudes to medicines and adherence to maintenance treatment in inflammatory bowel disease. Inflamm Bowel Dis. 2009;15:837–44.PubMedCrossRef
17.
go back to reference Lane DA, Langman CM, Lip GYH, Nouwen A. Illness perceptions, affective response, and health-related quality of life in patients with atrial fibrillation. J Psychosom Res. 2009;66:203–10.PubMedCrossRef Lane DA, Langman CM, Lip GYH, Nouwen A. Illness perceptions, affective response, and health-related quality of life in patients with atrial fibrillation. J Psychosom Res. 2009;66:203–10.PubMedCrossRef
18.
go back to reference Menckeberg TT, Bouvy ML, Bracke M, Kaptein AA, Leufkens HG, Raaijmakers JAM, et al. Beliefs about medicines predict refill adherence to inhaled corticosteroids. J Psychosom Res. 2008;64:47–54.PubMedCrossRef Menckeberg TT, Bouvy ML, Bracke M, Kaptein AA, Leufkens HG, Raaijmakers JAM, et al. Beliefs about medicines predict refill adherence to inhaled corticosteroids. J Psychosom Res. 2008;64:47–54.PubMedCrossRef
19.
go back to reference Al-Obaidi S, Beattie P, Al-Zoabi B, Al-Wekeel S. The relationship of anticipated pain and fear avoidance beliefs to outcome in patients with chronic low back pain who are not receiving workers' compensation. Spine. 2005;30:1051–7.PubMedCrossRef Al-Obaidi S, Beattie P, Al-Zoabi B, Al-Wekeel S. The relationship of anticipated pain and fear avoidance beliefs to outcome in patients with chronic low back pain who are not receiving workers' compensation. Spine. 2005;30:1051–7.PubMedCrossRef
20.
go back to reference George SZ, Fritz JM, Childs JD. Investigation of elevated fear-avoidance beliefs for patients with low back pain: a secondary analysis involving patients enrolled in physical therapy clinical trials. J Orthop Sports Phys Ther. 2008;38:50–8.PubMed George SZ, Fritz JM, Childs JD. Investigation of elevated fear-avoidance beliefs for patients with low back pain: a secondary analysis involving patients enrolled in physical therapy clinical trials. J Orthop Sports Phys Ther. 2008;38:50–8.PubMed
21.
go back to reference Morlock RJ, Lafata JE, Nerenz D, Schiller M, Rosenblum M. Expectations, outcomes, and medical costs in patients with low back pain referred to physical therapy. Dis Man. 2002;5:185–8.CrossRef Morlock RJ, Lafata JE, Nerenz D, Schiller M, Rosenblum M. Expectations, outcomes, and medical costs in patients with low back pain referred to physical therapy. Dis Man. 2002;5:185–8.CrossRef
22.
go back to reference Ries AL, Bauldoff GS, Carlin BW, Casaburi R, Emery CF, Mahler DA, et al. Pulmonary rehabilitation: joint ACCP/AACVPR evidence-based clinical practice guidelines. Chest. 2007;131(5_suppl):4S–42S.PubMedCrossRef Ries AL, Bauldoff GS, Carlin BW, Casaburi R, Emery CF, Mahler DA, et al. Pulmonary rehabilitation: joint ACCP/AACVPR evidence-based clinical practice guidelines. Chest. 2007;131(5_suppl):4S–42S.PubMedCrossRef
23.
go back to reference Troosters T, Casaburi R, Gosselink R, Decramer M. Pulmonary rehabilitation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2005;172:19–38.PubMedCrossRef Troosters T, Casaburi R, Gosselink R, Decramer M. Pulmonary rehabilitation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2005;172:19–38.PubMedCrossRef
24.
go back to reference Ajzen I, Fishbein M. Attitude-behavior relations: a theoretical analysis and review of empirical research. Psychol Bull. 1977;84:888–918.CrossRef Ajzen I, Fishbein M. Attitude-behavior relations: a theoretical analysis and review of empirical research. Psychol Bull. 1977;84:888–918.CrossRef
25.
go back to reference Conner M, Sparks P. The theory of planned behaviour and health behaviours. In: Conner M, Norman P, editors. Predicting health behaviour. Buckingham: Open University Press; 1996. p. 121–62. Conner M, Sparks P. The theory of planned behaviour and health behaviours. In: Conner M, Norman P, editors. Predicting health behaviour. Buckingham: Open University Press; 1996. p. 121–62.
26.
go back to reference ZuWallack RL, Patel K, Reardon JZ, Clark III BA, Normandin EA. Predictors of improvement in the 12-minute walking distance following a six-week outpatient pulmonary rehabilitation program. Chest. 1991;99:805–8.CrossRef ZuWallack RL, Patel K, Reardon JZ, Clark III BA, Normandin EA. Predictors of improvement in the 12-minute walking distance following a six-week outpatient pulmonary rehabilitation program. Chest. 1991;99:805–8.CrossRef
27.
go back to reference Cote CG, Pinto-Plata V, Kasprzyk K, Dordelly LJ, Celli BR. The 6-min walk distance, peak oxygen uptake, and mortality in COPD. Chest. 2007;132:1778–85.PubMedCrossRef Cote CG, Pinto-Plata V, Kasprzyk K, Dordelly LJ, Celli BR. The 6-min walk distance, peak oxygen uptake, and mortality in COPD. Chest. 2007;132:1778–85.PubMedCrossRef
28.
go back to reference Palange P, Ward SA, Carlsen KH, Casaburi R, Gallagher CG, Gosselink R, et al. Recommendations on the use of exercise testing in clinical practice. Eur Respir J. 2007;29:185–209.PubMedCrossRef Palange P, Ward SA, Carlsen KH, Casaburi R, Gallagher CG, Gosselink R, et al. Recommendations on the use of exercise testing in clinical practice. Eur Respir J. 2007;29:185–209.PubMedCrossRef
29.
go back to reference Enright PL, McBurnie MA, Bittner V, Tracy RP, McNamara R, Arnold A, et al. The 6-minute walk test. Chest. 2003;123:387–98.PubMedCrossRef Enright PL, McBurnie MA, Bittner V, Tracy RP, McNamara R, Arnold A, et al. The 6-minute walk test. Chest. 2003;123:387–98.PubMedCrossRef
30.
go back to reference Troosters T, Gosselink R, Decramer M. Six minute walking distance in healthy elderly subjects. Eur Respir J. 1999;14:270–4.PubMedCrossRef Troosters T, Gosselink R, Decramer M. Six minute walking distance in healthy elderly subjects. Eur Respir J. 1999;14:270–4.PubMedCrossRef
31.
go back to reference Camarri B, Eastwood PR, Cecins NM, Thompson PJ, Jenkins S. Six minute walk distance in healthy subjects aged 55-75 years. Respir Med. 2006;100:658–65.PubMedCrossRef Camarri B, Eastwood PR, Cecins NM, Thompson PJ, Jenkins S. Six minute walk distance in healthy subjects aged 55-75 years. Respir Med. 2006;100:658–65.PubMedCrossRef
32.
go back to reference Huijsmans RJ, de Haan A, ten Hacken NNHT, Straver RVM, van't Hul AJ. The clinical utility of the GOLD classification of COPD disease severity in pulmonary rehabilitation. Respir Med. 2008;102:162–71.PubMedCrossRef Huijsmans RJ, de Haan A, ten Hacken NNHT, Straver RVM, van't Hul AJ. The clinical utility of the GOLD classification of COPD disease severity in pulmonary rehabilitation. Respir Med. 2008;102:162–71.PubMedCrossRef
33.
go back to reference Wijkstra PJ, ten Vergert EM, van der Mark TW, Postma DS, van Altena R, Kraan J, et al. Relation of lung function, maximal inspiratory pressure, dyspnoea, and quality of life with exercise capacity in patients with chronic obstructive pulmonary disease. Thorax. 1994;49:468–72.PubMedCrossRef Wijkstra PJ, ten Vergert EM, van der Mark TW, Postma DS, van Altena R, Kraan J, et al. Relation of lung function, maximal inspiratory pressure, dyspnoea, and quality of life with exercise capacity in patients with chronic obstructive pulmonary disease. Thorax. 1994;49:468–72.PubMedCrossRef
34.
go back to reference Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007;176:532–55.PubMedCrossRef Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2007;176:532–55.PubMedCrossRef
35.
go back to reference Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.PubMedCrossRef Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.PubMedCrossRef
36.
go back to reference Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (updated 2008). 2008. Available from: www.goldcopd.com Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (updated 2008). 2008. Available from: www.​goldcopd.​com
37.
go back to reference Rabe KF, Beghe B, Luppi F, Fabbri LM. Update in chronic obstructive pulmonary disease 2006. Am J Respir Crit Care Med. 2007;175:1222–32. Rabe KF, Beghe B, Luppi F, Fabbri LM. Update in chronic obstructive pulmonary disease 2006. Am J Respir Crit Care Med. 2007;175:1222–32.
38.
go back to reference Borg GAV. Psychophysical bases of physical exertion. Med Sci Sports Exerc. 1982;14:377–81.PubMed Borg GAV. Psychophysical bases of physical exertion. Med Sci Sports Exerc. 1982;14:377–81.PubMed
39.
go back to reference Troosters T, Gosselink R, Decramer M. Exercise training in COPD: how to distinguish responders from nonresponders. J Cardiopulm Rehabil. 2001;21:10–7.PubMedCrossRef Troosters T, Gosselink R, Decramer M. Exercise training in COPD: how to distinguish responders from nonresponders. J Cardiopulm Rehabil. 2001;21:10–7.PubMedCrossRef
40.
go back to reference Puhan MA, Mador MJ, Held U, Goldstein R, Guyatt GH, Schunemann HJ. Interpretation of treatment changes in 6-minute walk distance in patients with COPD. Eur Respir J. 2008;32:637–43.PubMedCrossRef Puhan MA, Mador MJ, Held U, Goldstein R, Guyatt GH, Schunemann HJ. Interpretation of treatment changes in 6-minute walk distance in patients with COPD. Eur Respir J. 2008;32:637–43.PubMedCrossRef
41.
go back to reference Frazier PA, Tix AP, Barron KE. Testing moderator and mediator effects in counseling psychology research. J Counsel Psychol. 2004;51:115–34.CrossRef Frazier PA, Tix AP, Barron KE. Testing moderator and mediator effects in counseling psychology research. J Counsel Psychol. 2004;51:115–34.CrossRef
42.
go back to reference Fischer MJ, Scharloo M, Abbink JJ, van't Hul AJ, van Ranst D, Rudolphus A, et al. Drop-out and attendance in pulmonary rehabilitation: the role of clinical and psychosocial variables. Respir Med. 2009;103:1564–71.PubMedCrossRef Fischer MJ, Scharloo M, Abbink JJ, van't Hul AJ, van Ranst D, Rudolphus A, et al. Drop-out and attendance in pulmonary rehabilitation: the role of clinical and psychosocial variables. Respir Med. 2009;103:1564–71.PubMedCrossRef
43.
go back to reference Velloso M, Jardim JR. Study of energy expenditure during activities of daily living using and not using body position recommended by energy conservation techniques in patients with COPD. Chest. 2006;130:126–32.PubMedCrossRef Velloso M, Jardim JR. Study of energy expenditure during activities of daily living using and not using body position recommended by energy conservation techniques in patients with COPD. Chest. 2006;130:126–32.PubMedCrossRef
44.
go back to reference Moss-Morris R, Weinman J, Petrie KJ, Horne R, Cameron LD, Buick D. The revised Illness Perception Questionnaire (IPQ-R). Psychol Health. 2002;17:1–16.CrossRef Moss-Morris R, Weinman J, Petrie KJ, Horne R, Cameron LD, Buick D. The revised Illness Perception Questionnaire (IPQ-R). Psychol Health. 2002;17:1–16.CrossRef
45.
go back to reference Roelofs J, Sluiter JK, Frings-Dresen MHW, Goossens M, Thibault P, Boersma K, et al. Fear of movement and (re)injury in chronic musculoskeletal pain: evidence for an invariant two-factor model of the Tampa scale for kinesiophobia across pain diagnoses and Dutch, Swedish, and Canadian samples. Pain. 2007;13:181–90.CrossRef Roelofs J, Sluiter JK, Frings-Dresen MHW, Goossens M, Thibault P, Boersma K, et al. Fear of movement and (re)injury in chronic musculoskeletal pain: evidence for an invariant two-factor model of the Tampa scale for kinesiophobia across pain diagnoses and Dutch, Swedish, and Canadian samples. Pain. 2007;13:181–90.CrossRef
46.
go back to reference Blais MA, Otto MW, Zucker BG, McNally RJ, Schmidt NB, Fava M, et al. The anxiety sensitivity index: item analysis and suggestions for refinement. J Pers Assess. 2001;77:272–94.PubMedCrossRef Blais MA, Otto MW, Zucker BG, McNally RJ, Schmidt NB, Fava M, et al. The anxiety sensitivity index: item analysis and suggestions for refinement. J Pers Assess. 2001;77:272–94.PubMedCrossRef
47.
go back to reference Ferreira GM, Feuerman M, Spiegler PM. Results of an 8-week, outpatient pulmonary rehabilitation program on patients with and without chronic obstructive pulmonary disease. J Cardiopulm Rehabil. 2006;26:54–60.PubMedCrossRef Ferreira GM, Feuerman M, Spiegler PM. Results of an 8-week, outpatient pulmonary rehabilitation program on patients with and without chronic obstructive pulmonary disease. J Cardiopulm Rehabil. 2006;26:54–60.PubMedCrossRef
48.
go back to reference Garrod R, Marshall J, Barley E, Jones PW. Predictors of success and failure in pulmonary rehabilitation. Eur Respir J. 2006;27:788–94.PubMedCrossRef Garrod R, Marshall J, Barley E, Jones PW. Predictors of success and failure in pulmonary rehabilitation. Eur Respir J. 2006;27:788–94.PubMedCrossRef
49.
go back to reference Atkins CJ, Kaplan RM, Timms RM, Reinsch S, Lofback K. Behavioral exercise programs in the management of chronic obstructive pulmonary disease. J Consult Clin Psychol. 1984;52:591–603.PubMedCrossRef Atkins CJ, Kaplan RM, Timms RM, Reinsch S, Lofback K. Behavioral exercise programs in the management of chronic obstructive pulmonary disease. J Consult Clin Psychol. 1984;52:591–603.PubMedCrossRef
50.
go back to reference Blanchard CM, Courneya KS, Rodgers WM, Fraser SN, Murray TC, Daub B, et al. Is the theory of planned behavior a useful framework for understanding exercise adherence during phase II cardiac rehabilitation? J Cardiopulm Rehabil. 2003;23:29–39.PubMedCrossRef Blanchard CM, Courneya KS, Rodgers WM, Fraser SN, Murray TC, Daub B, et al. Is the theory of planned behavior a useful framework for understanding exercise adherence during phase II cardiac rehabilitation? J Cardiopulm Rehabil. 2003;23:29–39.PubMedCrossRef
51.
go back to reference Scherer YK, Schmieder LE. The effect of a pulmonary rehabilitation program on self-efficacy, perception of dyspnea, and physical endurance. Heart Lung. 1997;26:15–22.PubMedCrossRef Scherer YK, Schmieder LE. The effect of a pulmonary rehabilitation program on self-efficacy, perception of dyspnea, and physical endurance. Heart Lung. 1997;26:15–22.PubMedCrossRef
Metadata
Title
Concerns About Exercise Are Related to Walk Test Results in Pulmonary Rehabilitation for Patients with COPD
Authors
Maarten J. Fischer
Margreet Scharloo
Jannie Abbink
Alex van ’t Hul
Dirk van Ranst
Arjan Rudolphus
John Weinman
Klaus F. Rabe
Adrian A. Kaptein
Publication date
01-03-2012
Publisher
Springer US
Published in
International Journal of Behavioral Medicine / Issue 1/2012
Print ISSN: 1070-5503
Electronic ISSN: 1532-7558
DOI
https://doi.org/10.1007/s12529-010-9130-9

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