Walking football for people with chronic breathlessness: A mixed-methods proof of concept study

IntroductionPulmonary rehabilitation (PR) provides substantial benefits, but these are rarely sustained. Walking football (WF), with its slower pace and widespread availability, may offer an exercise-maintenance option. This proof-of-concept study aimed to understand the potential of WF as an exercise-maintenance intervention following PR.MethodsA mixed-methods, prospective observational design was used. Patients completing PR at two NHS trusts were invited to attend weekly 2-hour WF sessions for 6 weeks. Feasibility outcomes included recruitment, adherence, and safety. An ethnographic approach observed participant experiences and engagement. Health outcomes were assessed at baseline and post-intervention, and the intensity of a single WF session was analysed.Results160 individuals were approached; 36 expressed interest and 6 enrolled (5 male; mean age 71 years). Travel difficulties were the most common reason for declining. Five participants attended at least 4 sessions, and all continued WF after the study. One minor, unrelated adverse event occurred. Qualitative analysis of 18-hours of observations and 6 interviews generated 6 themes. The most notable finding highlighted the importance of WF sessions being exclusive to people with breathlessness. At least 3 participants achieved the minimal clinically important difference in functional exercise capacity, strength, health-related quality of life, and symptom burden. During a single session, group mean heart rate reached 66% of estimated HRmax, with a mean distance of 3.23 km covered.ConclusionsWF appears to be a promising, engaging, and potentially sustainable exercise-maintenance option following PR, though travel barriers limited uptake. Future interventions should prioritise accessible locations and consider transport support.