Evaluation of the Implementation of a Home-Based Exercise Training Program for People With COPD: A Mixed-Methods...

Area of Science:

• Pulmonary Rehabilitation
• Exercise Physiology
• Health Services Research

Background:

• Home-based exercise programs are crucial for managing chronic obstructive pulmonary disease (COPD).
• The HOMEX program was previously developed and tested for its effectiveness over one year.
• Long-term sustainability requires understanding implementation from user perspectives.

Purpose of the Study:

• To evaluate the implementation of the HOMEX program from the viewpoints of patients with COPD, coaches, and stakeholders.
• To optimize the HOMEX program for long-term sustainability and continued use.

Main Methods:

• A mixed-methods approach combining qualitative and quantitative data.
• Assessment of implementation outcomes: dose, reach, fidelity, and adherence using coach notes and patient diaries.
• Evaluation of acceptability and appropriateness through surveys and semistructured interviews.

Main Results:

• High fidelity in program delivery (99%) and good adherence (70% completed, 79% trained for ≥10 months).
• Patients, coaches, and stakeholders reported very high acceptability, valuing the home-based nature.
• Key motivators for patients included perceived strength improvement, coach supervision, and routine integration; a need for peer interaction was identified.

Conclusions:

• The HOMEX program demonstrates high acceptability and adherence among patients with COPD.
• Program optimization based on user feedback, including revised exercise materials and new exercises, enhances its potential for long-term sustainability.
• The findings support the adaptation of HOMEX for broader clinical and community settings for COPD management.