Another identified facilitator was high self-efficacy for physical activity. Self-efficacy is someone’s belief in his/her capability to successfully execute a specific type of behaviour, in this case physical

activity (Bandura 1997). High self-efficacy was found to be more present in people with mild to moderate COPD than in those with AC220 mw severe or very severe COPD, and more in males than in females. It is known that self-efficacy is a strong and consistent predictor of exercise adherence and that it is essential for the process of behavioural change (McAuley and Blissmer 2000, Schutzer and Graves 2004, Sherwood and Jeffery 2000). Furthermore, two studies in people with COPD showed that physical activity was positively associated with self-efficacy (Belza et al 2001, Steele et al 2000). This emphasises the importance of enjoyment of physical activity and self-efficacy for physical activity for adherence to a physically active lifestyle. Another perceived influence on physical activity was the weather, with 75% of participants reporting poor weather as a barrier to being physically active. Mostly, Ibrutinib nmr participants reported disease-related complaints caused by different weather types, such as more dyspnoea with high humidity in the air. This is consistent with studies in general adult populations but also COPD populations, showing that weather affects exercise

adherence and physical activity levels (O’Shea et al 2007, Sewell et al 2010, Tucker and Gilliland 2007). A second barrier was health problems. Health as a barrier was mainly due to COPD-related complaints like dyspnoea, but also other comorbidities such as joint problems were reported to affect physical activity. others Health as a barrier was more frequently reported in people with severe or very severe COPD. Health was also the most frequently reported reason to be physically active. Despite health-related limitations many participants also understood the benefits of regular physical

activity for their health. These results are in line with those found in an elderly population (Costello et al 2011). A third barrier was financial constraints – reported by almost a third of participants. The category of financial constraints included not being able to pay and not being willing to pay for physical activity. In general elderly populations, financial constraints are not among the most frequently reported reasons to be sedentary (Costello et al 2011, Reichert et al 2007, Schutzer and Graves 2004). However, in our COPD population it appears to be an important factor. The last barrier was shame. The reasons to feel ashamed, limiting these participants in physical activity, were use of a walking aid and sometimes an oxygen cylinder or having to exercise with healthy people.