‘The focus when you’re in the gym is on being well and getting well’ - experiences of patients undertaking pulmonary rehabilitation in private physiotherapy and exercise physiology practices

Pulmonary rehabilitation (PR) is a highly effective intervention for chronic respiratory disease, but many barriers are faced by people accessing traditional hospital-based PR. Alternative PR models have reduced some known barriers, but little qualitative evidence exists that explores the experiences of people undertaking PR in private practice. To explore the acceptability and experiences of people with chronic respiratory disease who undertook PR in private physiotherapy and exercise physiology practices. Participants with chronic respiratory disease who enrolled in a randomised controlled feasibility trial comparing 8-weeks of PR conducted in a private practice to usual care were purposively sampled to undertake semi-structured qualitative interviews. Interviews transcripts were analysed using inductive thematic analysis. Twenty-two participants were interviewed. Four major themes were identified. Care That Fits described how private practice environments normalised exercise through familiar gym-like settings, fostered belonging through smaller classes and community atmosphere, and provided practical accessibility compared to hospitals. The Therapeutic Alliance highlighted how clinician-participant relationships, characterised by rapport, alignment and appropriate progression, drove engagement. Shifting Capability captured internal transformations including reorientation from complacency to proactive health beliefs, reclaiming of identity from passive illness-focused to capable individuals, and strengthened confidence extending beyond exercise to other life activities. Ongoing Commitment reflected strong desire and ability to maintain exercise, with many continuing at their practice. Minor themes confirmed intervention acceptability, positive physical and psychological outcomes, and variable education experiences. Participants described the supportive, familiar and accessible environment of a private practice, along with the therapeutic relationship facilitated a shift in mindset and identity. In combination with the skills and knowledge gained from PR, participants completed the program with a strong desire and belief in sustaining exercise and a shift into proactive management of their health. Australian and New Zealand Clinical Trials Registry number ACTRN12622001501730. Registration date 1st December 2022.