Exploring exercise experiences in people living with chronic obstructive pulmonary disease (COPD): A photo-elicitation study

Introduction: Pulmonary rehabilitation (PR) is crucial in managing chronic obstructive pulmonary disease (COPD) per international guidelines. In Malaysia, individuals with COPD may find exercise a challenge as they often contend with other comorbidities, have poor family and financial support. Thus, our study aimed to explore exercise experiences in people living with COPD and their caregivers using visual documentation. Methods: Using qualitative methodology, we purposefully recruited adults aged ≥18 years diagnosed with COPD and were on pulmonary rehabilitation prescription, alongside their caregivers. Participants were tasked with capturing their home exercise routines through photography, used in joint interviews with their primary caregivers, employing a technique called family photo-elicitation interviews. Conducted in participants' preferred language, interviews using a semi-structured guide were audio-recorded, transcribed verbatim, and analysed using the Health Belief Model framework. Results: Eighteen participants were interviewed, including nine men and nine women. All were reported to have additional co-morbidities. Most participants and caregivers lacked an understanding of COPD and the role of exercise in improving quality of life. Contextual barriers, such as the absence of a local COPD term, contributed to this misunderstanding. While most attempted home exercise, they experienced symptoms of exacerbations and perceived it as a barrier. Other barriers included complications of other health conditions such as heart failure. Lack of self-efficacy and caregiver support were evident, with only two participants acknowledging exercise benefits. Discussion & Conclusion: People living with COPD encounter multiple challenges in managing their illness. Leveraging untapped caregiver support is crucial for sustaining exercise routines. Future pulmonary rehabilitation care models in resource-limited settings should prioritise guided personalised approaches and family empowerment for effectiveness.