Intensity is in the eye of the beholder: a qualitative photovoice study of perceptions of physical activity intensity for people with chronic obstructive pulmonary disease

Background Physical activity (PA)-related health benefits are greatest for activity undertaken at higher intensities. However, individuals living with Chronic Obstructive Pulmonary Disease (COPD) often find engaging in higher-intensity PA challenging. Due to the lack of qualitative research on how those with COPD perceive PA intensity, this photovoice study explores how PA intensity is experienced in day-to-day living. Methods Semi-structured interviews, enhanced by photovoice, were conducted with individuals with COPD and other comorbidities to explore their perceptions of PA intensity in daily life. Participants captured images over 7 days to illustrate how their conditions impact their PA. The participant-generated images were used in the interviews. Reflexive inductive thematic analysis was used to generate themes. Results Thirteen interviews were conducted (54% female, aged 64 ± 6 years), generating two main themes. Theme 1 focused on how individuals employ strategies to manage the intensity of their PA: breaking down PA, pacing themselves or trying to do the activity all in one go. Theme 2 highlighted the reciprocal relationship between participants and their family/friends regarding PA intensity. Family/friends often ensure individuals do not “overdo it” while participants may influence the intensity of their family/friends activities, sometimes requiring family/friends to slow down or stop. Conclusion This study provides insights into the social complexities and strategies used to manage PA intensity in daily life, which can inform behavioural interventions to increase participation in higher-intensity PA among people with COPD. Trial registration The study was retrospectively registered on Clinical Trials.gov (Identifier: NCT06330623) on the 26th of March 2024.