Facilitators and barriers to exercise adherence in patients with COPD: A qualitative study guided by the fear-avoidance model.

BackgroundExercise adherence is central to pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD), yet sustained adherence remains difficult. Fear of exertional symptoms, particularly dyspnoea, may promote exercise avoidance. This study explored perceived facilitators and barriers to exercise adherence using the fear-avoidance model.MethodsFace-to-face semi-structured interviews were conducted with 18 patients with COPD recruited from respiratory inpatient wards. Data were analysed using qualitative content analysis, with the fear-avoidance model used as a sensitising framework.ResultsTwo interrelated themes and five subthemes were developed. Threat appraisal transformed exertional symptoms into cues for fear-related avoidance when exercise was viewed as unsafe, symptoms were interpreted as deterioration, and inactivity was used as self-protection. Manageable experiences and social responses rebuilt safety and control through graded success, practical resources, and family and professional responses. Family influence was bidirectional: reassurance supported engagement, whereas alarmed symptom interpretations reinforced avoidance.ConclusionsExercise adherence appeared to be shaped not only by symptoms, but also by how symptoms were interpreted in relation to previous experiences and social context. Interventions should combine symptom reappraisal, individually graded exercise, and structured family and professional support.