Motivational regulations and lifestyle in muscle-wasted COPD patients undergoing pulmonary rehabilitation

Summary: Background & Aims: Low physical activity (PA) levels and a poor-quality diet are common in chronic obstructive pulmonary disease (COPD) patients eligible for pulmonary rehabilitation (PR). PR may improve short-term nutritional status and exercise capacity but generally not long-term lifestyle outcomes. We hypothesized that healthy lifestyle motivation is related to PA levels and dietary quality before PR and the responsiveness thereof after PR. Methods: Before and after standardized outpatient PR, 81 COPD patients with low muscle mass completed validated motivational regulation self-reports. Physical (in)activity was assessed before and after PR through 7-day accelerometry (GT3X Actigraph). Dietary quality was assessed using a validated cross-check dietary history before and after PR and quantified as the Mean Adequacy Ratio (MAR). Results: Patients' baseline motivational profile was unrelated to dietary quality or PA. Baseline integrated motivation and its change during PR significantly predicted MAR change during PR and its levels after PR. Baseline introjected motivation and its change during PR significantly predicted PA change during PR and its levels after PR. Conclusions: Specific motivational regulations predict dietary quality and PA improvements of patients with COPD admitted to PR. Therefore, targeting integrated and introjected motivation may be key to achieving lasting behavior change after PR. Registry site: Maastricht University Medical Centre+. Clinical trial identifier number: NCT01344135.