People with chronic obstructive pulmonary disease and exercise behaviour: a scoping review using the CFIR framework

Lack of exercise constitutes an independent predictor of mortality in patients with chronic obstructive pulmonary disease (COPD). Despite a considerable number of intervention studies having been conducted to promote exercise behaviour among these patients, implementation outcomes remain poor, and little is known about the factors influencing intervention delivery. From an implementation science perspective, we analysed previous research on exercise behaviour in people with COPD, synthesising assessment indicators, evaluation tools, and the implementation-related facilitators and barriers affecting exercise behaviour. The scope definition review framework by Arksey and O'Malley guided this review process, which was registered in PROSPERO. We searched five databases from their inception to 31 January 2025: CINAHL, PubMed, Embase, Cochrane, and Web of Science. Observational studies, qualitative research, and intervention studies concerning exercise behaviour in people with COPD were included. Measurement tools for exercise behaviour had to assess actual rather than hypothetical behaviour. Two authors independently screened literature, extracted study characteristics from included research, and conducted content analysis using the Comprehensive Intervention Framework for Research (CIFR) to organise and summarise facilitating and impeding factors, mapping these to the CIFR framework. A total of 133 articles published between 2005 and 2025 were included, involving 19 countries and 88,721 participants. These comprised cross-sectional studies (n = 45), retrospective studies (n = 18), prospective studies (n = 14), randomized controlled trials (n = 41), and qualitative studies (n = 15).The most frequently used outcome measure for exercise behaviour across included studies was daily step count. Measurement tools encompassed both objective instruments such as accelerometers and pedometers, and subjective instruments including questionnaires. According to the CIFR framework, within the domain of fundamental characteristics of intervention programmes, facilitators for initiating and sustaining patient exercise behaviour primarily centred on integrating programmes into daily life (5/23), increasing the number of educational subjects (4/23), and enhancing enjoyment (4/23). Barriers mainly included insufficient motivation to act (3/5) and overly simplistic training plans (2/5). Within the external factors domain, facilitating factors primarily included the summer season (9/16) and higher economic status of the residential area (7/16), while impeding factors mainly involved the passage of time (6/23). In the internal factors domain, support from family members, peers, and medical/rehabilitation professionals served as facilitating factors, whereas overprotective family members (1/5) and significant household financial burdens (4/5) acted as impeding factors. Within the individual characteristics domain, patients' perceived benefits of exercise (9/65) emerged as a prominent facilitator, whereas poor exercise capacity (25/199), severe dyspnoea symptoms (26/199), heavy disease burden (17/199), advanced age (16/199), and depression (11/199) were distinctly prominent barriers; Within the implementation process domain, receiving positive feedback from professionals (6/23) and setting progressive, personalised short-term exercise goals (5/23) were prominent facilitators for intervention implementation, whereas acute exacerbations of COPD (9/15) constituted a significant barrier. Behavioural interventions employed techniques including motivational interviewing, real-time feedback, goal setting, educational programmes, and remote support. Each study combined at least two techniques, with goal setting being the most frequently employed behavioural technique. Our research indicates that exercise behaviour levels among people with COPD are concerning, with initiation and maintenance influenced by multidimensional factors. Multi-technique combined behavioural interventions may benefit patients, yet clinical implementation studies remain scarce. Future efforts should focus on standardising assessment tools and conducting multicentre implementation randomised controlled trials to advance the long-term application of effective interventions. PROSPERO CRD420251138371.