People with chronic obstructive pulmonary disease and exercise behaviour: a scoping review using the CFIR framework.

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Learn more: PMC Disclaimer | PMC Copyright Notice BMC Pulm Med . 2026 Mar 9;26:177. doi: 10.1186/s12890-026-04204-3 Search in PMC Search in PubMed View in NLM Catalog Add to search People with chronic obstructive pulmonary disease and exercise behaviour: a scoping review using the CFIR framework Huan Tang Huan Tang 1 Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400040 People’s Republic of China Find articles by Huan Tang 1, # , Xiaoqing Luo Xiaoqing Luo 1 Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400040 People’s Republic of China Find articles by Xiaoqing Luo 1, # , Guihua Chen Guihua Chen 1 Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400040 People’s Republic of China 2 Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Yuzhong District, No. 74, Linjiang Road, Chongqing, 400010 China Find articles by Guihua Chen 1, 2, ✉ , Qian Wu Qian Wu 1 Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400040 People’s Republic of China 2 Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Yuzhong District, No. 74, Linjiang Road, Chongqing, 400010 China Find articles by Qian Wu 1, 2, ✉ , Huapeng Shen Huapeng Shen 1 Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400040 People’s Republic of China Find articles by Huapeng Shen 1 , Ming Zhen Ming Zhen 1 Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400040 People’s Republic of China Find articles by Ming Zhen 1 , Yiqun Liu Yiqun Liu 1 Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400040 People’s Republic of China Find articles by Yiqun Liu 1 Author information Article notes Copyright and License information 1 Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400040 People’s Republic of China 2 Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Yuzhong District, No. 74, Linjiang Road, Chongqing, 400010 China ✉ Corresponding author. # Contributed equally. Received 2025 Dec 6; Accepted 2026 Feb 20; Collection date 2026. © The Author(s) 2026 Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ . PMC Copyright notice PMCID: PMC13085465  PMID: 41803771 Abstract Background Lack of exercise constitutes an independent predictor of mortality in patients with chronic obstructive pulmonary disease (COPD). Despite a considerable number of intervention studies having been conducted to promote exercise behaviour among these patients, implementation outcomes remain poor, and little is known about the factors influencing intervention delivery. From an implementation science perspective, we analysed previous research on exercise behaviour in people with COPD, synthesising assessment indicators, evaluation tools, and the implementation-related facilitators and barriers affecting exercise behaviour. Methods The scope definition review framework by Arksey and O'Malley guided this review process, which was registered in PROSPERO. We searched five databases from their inception to 31 January 2025: CINAHL, PubMed, Embase, Cochrane, and Web of Science. Observational studies, qualitative research, and intervention studies concerning exercise behaviour in people with COPD were included. Measurement tools for exercise behaviour had to assess actual rather than hypothetical behaviour. Two authors independently screened literature, extracted study characteristics from included research, and conducted content analysis using the Comprehensive Intervention Framework for Research (CIFR) to organise and summarise facilitating and impeding factors, mapping these to the CIFR framework. Results A total of 133 articles published between 2005 and 2025 were included, involving 19 countries and 88,721 participants. These comprised cross-sectional studies ( n = 45), retrospective studies ( n = 18), prospective studies ( n = 14), randomized controlled trials ( n = 41), and qualitative studies ( n = 15).The most frequently used outcome measure for exercise behaviour across included studies was daily step count. Measurement tools encompassed both objective instruments such as accelerometers and pedometers, and subjective instruments including questionnaires. According to the CIFR framework, within the domain of fundamental characteristics of intervention programmes, facilitators for initiating and sustaining patient exercise behaviour primarily centred on integrating programmes into daily life (5/23), increasing the number of educational subjects (4/23), and enhancing enjoyment (4/23). Barriers mainly included insufficient motivation to act (3/5) and overly simplistic training plans (2/5). Within the external factors domain, facilitating factors primarily included the summer season (9/16) and higher economic status of the residential area (7/16), while impeding factors mainly involved the passage of time (6/23). In the internal factors domain, support from family members, peers, and medical/rehabilitation professionals served as facilitating factors, whereas overprotective family members (1/5) and significant household financial burdens (4/5) acted as impeding factors. Within the individual characteristics domain, patients' perceived benefits of exercise (9/65) emerged as a prominent facilitator, whereas poor exercise capacity (25/199), severe dyspnoea symptoms (26/199), heavy disease burden (17/199), advanced age (16/199), and depression (11/199) were distinctly prominent barriers; Within the implementation process domain, receiving positive feedback from professionals (6/23) and setting progressive, personalised short-term exercise goals (5/23) were prominent facilitators for intervention implementation, whereas acute exacerbations of COPD (9/15) constituted a significant barrier. Behavioural interventions employed techniques including motivational interviewing, real-time feedback, goal setting, educational programmes, and remote support. Each study combined at least two techniques, with goal setting being the most frequently employed behavioural technique. Conclusion Our research indicates that exercise behaviour levels among people with COPD are concerning, with initiation and maintenance influenced by multidimensional factors. Multi-technique combined behavioural interventions may benefit patients, yet clinical implementation studies remain scarce. Future efforts should focus on standardising assessment tools and conducting multicentre implementation randomised controlled trials to advance the long-term application of effective interventions. Trial registration PROSPERO CRD420251138371. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-026-04204-3. Keywords: Chronic obstructive pulmonary disease, Exercise behavior, Scoping review, The CFIR model, Facilitators, Barriers Background Chronic Obstructive Pulmonary Disease (COPD) is a common chronic airway disorder characterised by high mortality and disability rates [ 1 ]. Statistics indicate that its economic burden reaches US$384 million annually, ranking fifth globally among disease-related economic burdens [ 2 ]. Furthermore, due to persistent exposure to COPD risk factors and the impact of population ageing, the disease and economic burden of COPD are projected to continue increasing in the future [ 3 ]. Consequently, there is a pressing need to explore effective disease treatment and management strategies. Exercise training, as a vital non-pharmacological treatment for people with COPD, has been demonstrated by Level 1 evidence [ 1 ] to improve dyspnoea, enhance exercise tolerance, and promote favourable health outcomes. Conversely, physical inactivity has been identified as an independent predictor of all-cause mortality in people with COPD [ 4 ]. Compared to inactive individuals, people with COPD with higher levels of exercise behaviour exhibited a 34% reduction in the risk of readmission within 30 days post-discharge and a 47% decrease in the risk of mortality within 12 months post-discharge [ 5 ]. Nevertheless, despite growing public awareness of the importance of exercise rehabilitation, only approximately 23.0% of people with COPD achieve guideline-recommended exercise levels, and exercise adherence tends to decline over time, leading to a gradual diminishment of exercise’s therapeutic effects [ 6 ]. Consequently, we place particular emphasis on managing patients' exercise rehabilitation to enhance their exercise behaviour. According to Webster's Dictionary [ 7 ], exercise behaviour is defined as an individual’s purposeful, conscious use of various means to engage in exercise to maintain or improve health. This must be distinguished from general activity, as the latter encompasses numerous unconscious actions not directed towards health improvement, rendering it unsuitable for extracting effective exercise management recommendations. It also differs from functional activity, which fails to address behavioural modification. Hence, we employ the term “exercise behaviour” to describe conscious, purposeful engagement in exercise. Our study encompasses research on daily physical activities or various sports training programmes—such as endurance training and aerobic training—conducted for health purposes. We summarise existing measurement tools and evaluation indicators for exercise behaviour among people with COPD, analyse behavioural characteristics within a scientific implementation framework, and compile behavioural facilitators and barriers. This aims to provide a reference for developing effective exercise intervention strategies. Methods We conducted a scoping review of the literature concerning exercise behaviour in patients with chronic obstructive pulmonary disease (COPD). The scoping methodology supported the inclusion of both qualitative and quantitative studies, enabling us to capture the breadth, depth, and gaps in the literature regarding exercise behaviour, facilitators, and barriers in people with COPD, ultimately providing further information for future research. We employed the five-step approach outlined by Arksey and O’Malley [ 8 ]: (1) defining the research question; (2) identifying relevant studies; (3) selecting studies; (4) charting data; and (5) synthesising and summarising findings. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses – Scoping Reviews (PRISMA-ScR) guideline [ 8 ] was used to ensure satisfactory reporting of this study (see Additional file 1). This scoping review has been registered in the PROSPERO database [ https://www.crd.york.ac.uk/PROSPERO/view/CRD420251138371 ]. Stage one: identifying the research question This study aims to address the following specific research questions: 1. What are the assessment indicators and measurement tools for exercise behaviour in people with COPD? 2. What are the implementation barriers and facilitating factors for initiating and maintaining exercise behaviour in people with COPD? 3. What exercise behaviour interventions are commonly employed in existing research? At this stage, Arksey and O'Malley recommend defining any potentially ambiguous terms used in the review. Therefore, we define exercise behaviour as purposeful engagement in exercise, encompassing light, moderate, and vigorous intensity levels, with outcome measures necessarily including assessments of exercise behaviour levels. Qualifying exercise behaviour assessment tools must measure actual, observable exercise behaviour, such as exercise frequency and/or quality, rather than assumed behaviour. Tools that solely measure perceived importance of exercise or patients' self-reported willingness to exercise are excluded. Assessors using exercise behaviour assessment tools may be any individual, including nurses, family members/carers, or the patient themselves via self-assessment. Stage two: identifying relevant research To comprehensively identify published relevant studies, we employed a three-step search strategy. Initial searches were conducted in PubMed and CINAHL using the keywords: ‘chronic obstructive pulmonary diseases exercise/rehabilitation’, ‘pulmonary disease, chronic obstructive/chronic obstructive lung disease/chronic obstructive pulmonary diseases/COPD/COAD’, and ‘exercise/rehabilitation/physical activity/training’. Following the initial search, we analysed the retrieved article titles and abstracts for inclusion of the keywords, along with relevant MeSH headings and descriptive terms. Subsequently, a second search was conducted using a revised strategy across CINAHL, PubMed, Embase, Cochrane, and Web of Science, retrieving records from indexing to 31 January 2025. Thirdly, reference lists of all identified articles and papers were manually searched to identify additional relevant studies. The search strategy for each database was drafted by the first author. The detailed search strategy is provided in Additional file 2. Stage three: selecting research Publications were included if they constituted original research concerning the exercise behaviour levels of people with COPD encompassing both formal exercise training within pulmonary rehabilitation programmes and purposeful engagement in exercise, behavioural determinants, or promotion strategies; were written in English; and employed qualitative, quantitative, or mixed-methods approaches. Articles were excluded if they focused on non-quantifiable exercise, lacked detailed descriptions of exercise behaviour, or were unavailable in full text. The results of the retrieval strategy were exported into the EndNote reference management system. Following the removal of duplicates, two assessors (TH and LXQ) independently applied a three-step screening method. First, both researchers conducted a pilot assessment of ten studies against the inclusion criteria, maintaining consistent interpretation of inclusion and exclusion criteria. Second, articles were screened based on titles and abstracts to exclude those clearly irrelevant. Thirdly, full-text articles were reviewed for re-screening and final study determination. Any disagreements regarding study eligibility were resolved through discussion; where consensus could not be reached, a third experienced researcher (CGH) was consulted (Professor). Stage four: charting data The research team discussed and developed a data charting table to record the characteristics of included articles and key information relevant to the review question. This tool encompassed the following key details: first author, year of publication, country or region, study design, sample size, participants, study purpose, exercise behaviour assessment tools, barriers and facilitators associated with exercise behaviour, and behavioural intervention strategies. Data extraction was performed by two independent assessors using the data extraction tool. One researcher (TH) extracted the data, while another researcher (SHP) cross-checked the extracted data. As this was a scoping review, no assessment of the quality of study designs was undertaken. Stage five: organising, summarising and reporting findings We synthesised the data according to the recommendations of Bradbury-Jones et al. [ 9 ]. Both qualitative and quantitative findings were summarized using descriptive methods. Guided by the Consolidated Framework for Implementation Research (CFIR), the study integrated both barriers and facilitators to exercise behavior among people with COPD.CFIR is one of the most widely applied implementation science frameworks for assessing determinants of real-world implementation scenarios, encompassing five sub-domains (Innovation, External, Internal, Individual, and Process) [ 10 ]. Grounded in behavioural theory [ 11 ], these sub-domains are well-suited to assist this review in identifying and exploring the diverse factors influencing the complex process of generating and sustaining patient exercise behaviour within clinical settings. Result Articles selection As illustrated in the PRISMA flow diagram (Fig. 1 ), a total of 15,800 citations were identified, with 4,879 duplicate citations removed. A total of 10,921 titles and abstracts were screened, resulting in the exclusion of 10,083 articles. A total of 838 articles underwent full-text eligibility review. Of these, 705 were excluded, leaving 133 studies. The most common reason for exclusion was that the outcome measures did not incorporate measurable exercise behaviour. Fig. 1. Open in a new tab Flow of trials through the review Characteristics of the included studies This review comprises 133 studies published between 2005 and 2025, originating from 19 countries. Due to limitations in the search period, statistical data for articles published in 2025 is incomplete.The article count charts were produced using Microsoft Excel (Figs. 2 and 3 ). The United States was the most frequently studied country ( n = 21, 15.8%), followed by Spain ( n = 16, 12.0%), the Netherlands ( n = 12, 9.0%), and the United Kingdom ( n = 11, 8.3%). Fifteen qualitative studies and 118 quantitative studies were identified. Quantitative study designs included: cross-sectional studies ( n = 45, 33.8%), retrospective studies ( n = 18, 13.5%), prospective studies ( n = 14, 10.5%), and clinical intervention studies ( n = 41, 30.8%). The included qualitative studies all employed semi-structured interviews to explore the themes.These studies collectively enrolled 88,721 participants, with sample sizes ranging from 8 to 531 in qualitative studies and 18 to 13,190 in quantitative studies. Participant ages spanned 50–89 years. Nine studies did not report gender, while 11 reported male predominance exceeding 90%. Detailed information on these documents is presented in Tables 1 and 2 . Fig. 2. Open in a new tab Annual publication volume trend chart Fig. 3. Open in a new tab National publication output Table 1. General characteristics of included scoping reviews ( n = 133) Characteristic Number of studies Percentage (%) Publication year 2019–2024 70 52.6 2018–2011 54 40.6 2010–2005 9 6.8 Total 133 100 Top 5 Active Countries with Count US 21 15.8 Spain 16 12 Netherlands 12 9 UK 11 8.3 Multicenter 10 7.2 Brazil 10 7.2 Total 80 60.2 Methodology Quantitative study 118 88.7 Qualitative study 15 11.3 Total 133 100 Study designs Cross-sectional study 45 33.8 Retrospective study 18 13.5 Prospective study 14 10.5 Qualitative study 15 11.4 RCT 41 30.8 Total 133 100 Open in a new tab Table 2. Basic characteristics of the included studies ( n = 133) Author (year) Study location Study design Sample size,gender (male/female) Age (`x ± s) Subject Tool/valuation indicators for exercise Result Pitta et.al [ 12 ] (2005) Brazil Cross-sectional survey studies 75,53/22 65.0 ± 6.0 Investigation and analysis of the behavioral characteristics of exercise in daily life of people with COPD accelerometer(DynaPort Activity Monitor; McRoberts BV) activity intensity、ewalking time people with COPD exercise less than healthy elderly individuals, spending 12% of their time (or twice their walking time) lying down and walking 25% slower than healthy elderly individuals (i.e., with lower exercise intensity) Walking time is positively correlated with 6WMD Donesky-Cuenco et.al [ 13 ] (2007) America Cross-sectional survey studies 103,46/57 66.47 ± 7.6 Investigation and analysis of people with COPD' compliance with home walking plans and types of exercise compliance exercise diary Adherence: Actual Completion/Planned Completion(Number of days of exercise) The frequency of exercise decreased from 3 days per week to 2.5 days after 12 months, but each time the walking time exceeded the prescribed 20 min; There is a positive correlation between 6WMD, healthy quality of life, and mental health level with exercise compliance Liu et.al [ 14 ] (2008) China A randomized controlled trial 48,24/24 72.1 ± 1.5 Evaluate the effectiveness of mobile based exercise plans in promoting active exercise in people with COPD Intervention: personalized walking goals, intensity + personalized music during walking + health education manual exercise frequencye、walking time The mobile based home intervention system provides an efficient home endurance exercise training program for patients with moderate to severe COPD, with good compliance and clinical outcomes Nguyen et.al [ 15 ] (2008) America A randomized controlled trial 39,20/19 69.5 ± 8.5 To evaluate the effectiveness of the Internet based self-management plan for dyspnea in promoting active exercise in patients with COPD Intervention: personalized customized exercise plan + self-monitoring of respiratory symptoms and exercise + personalized reinforcement and feedback of exercise and respiratory distress self-management strategies exercise frequencye、walking time 84% of participants reported being in a state of action or maintenance at 3 months; The intervention group showed a significant increase in exercise time compared to the control group;The exercise ability gradually decreased over time in the control group, while gradually increased in the intervention group Pitta et.al [ 16 ] (2008) Brazil Cross-sectional survey studies 40,21/19 68.0 ± 7.0 Investigating and analyzing whether the exercise behavior of people with COPD is influenced by lung function accelerometer(the SenseWear Armban Bodymedia, United States) daily step count、exercise time(time spent on moderate physical activity) MVV is significantly correlated with patients' levels of exercise behavior, while FEV1 is not correlated Hospes et.al [ 17 ] (2009) Holland A randomized controlled trial 35,21/14 62.1 ± 8.7 Evaluate the effectiveness of a 12 week pedometer based exercise counseling strategy in promoting daily exercise behavior in people with COPD Intervention: based on the principles of goal setting and implementation, motivational interview techniques are used as counseling techniques, and pedometers are worn to monitor and support participation motivation pedometer(Digiwalker SW-2000, Yamax; Tokyo, Japan) daily step count The 12 week pedometer based exercise counseling strategy is feasible and effectively enhances the daily physical activity, physical fitness, health-related quality of life, and intrinsic motivation of outpatient people with COPD who do not participate in rehabilitation programs Pitta et.al [ 18 ] (2009) Multicenter Cross-sectional survey studies 80,39/41 64.5 ± 7.5 Investigating and analyzing whether the exercise behavior of people with COPD is influenced by socioeconomic and racial factors accelerometer(DynaPort Activity Monitor, McRoberts BV, The Hague, The Netherlands) activity intensity、exercise time Socioeconomic and racial factors have no effect on the exercise behavior of stable people with COPD Berry et.al [ 19 ] (2010) America A randomized controlled trial 176,95/81 66.0 ± 10.0 Evaluate the effectiveness of the Behavioral Lifestyle Activity Plan (LAP) in promoting physical activity in people with COPD Intervention: Promote patients to engage in long-term daily activities at home and/or in the community through personal counseling meetings, phone calls, and other means Questionnaires(the Community Health Activities Model Program for Seniors, CHAMPS) Adherence(Actual Participation/Planned Participation) There was no statistically significant difference in the improvement of exercise behavior level and exercise function between the two groups But compared to baseline, the intervention group was effective in maintaining a moderate level of physical activity after 3 months Effing et.al [ 20 ] (2011) Holland A randomized controlled trial 153,34/37 63.4 ± 8.0,77/76 Assessing the impact of adding community-based exercise programs in self-management of people with COPD on changing their exercise behavior Preventive: Personalized exercise training schedule + regular health education to promote changes in exercise behavior pedometer(Yamax Digi-Walker SW-200, Tokyo, Japan), activity diary: Paper-based daily step count In the control group, there was a gradual decline in daily activity, with even higher differences between groups at 12 months Mador et.al [ 21 ] (2011) America A randomized controlled trial 32,24/8 69.2 ± 7.4 Assessing the effectiveness and predictive factors of improving exercise behavior levels in people with COPD immediately after short-term pulmonary rehabilitation Intervention: Individual and group education was provided on various topics, including correct inhaler and spacer techniques, symptom management and prevention, the importance of exercise for sustained health, respiratory techniques (pursed lips and diaphragm), etc accelerometer(RT3, Stay Healthy Inc,Monrovia,California) activity intensity、exercise time There was a significant improvement in exercise capacity and quality of life after the PR intervention, but this did not translate into a significant increase in activity levels Hogg et.al [ 22 ] (2012) Britain qualitative research 16,9/7 69.0 ± 10.5 What are the views and opinions of people with COPD on maintaining an active lifestyle after completing pulmonary rehabilitation management? – 5 themes promoting exercise behavior: 1) Perception of pulmonary rehabilitation value; 2) Exercise habits; 3) Professional support; 4) Social support; 5) Health condition Gestel et.al [ 23 ] (2012) Switzerland Cross-sectional survey studies 70,49/21 62.4 ± 7.4 Exploring predictive factors for daily physical activity in people with COPD accelerometer(SenseWear Pro™ armband; BodyMedia, Inc., Pittsburgh, PA, USA),Questionnaire(Zutphen Physical Activity Questionnaire,ZPAQ) daily step count、energy expenditure、exercise time、exercise frequency 6MWD and total energy expenditure TEE are promoting factors for exercise behavior Moy et.al [ 24 ] (2012) America Cross-sectional survey studies 127 71.4 ± 8.0 Investigation and analysis of daily walking and related influencing factors in people with COPD in the United States accelerometer(the StepWatch Activity Monitor SAM) (Orthocare Innovations, Seattle, WA, USA) daily step count Pulmonary function, motor function, and daily step count are positively correlated, while respiratory distress symptoms are negatively correlated Katajisto et.al [ 25 ] (2012) Sweden Cross-sectional survey studies 699,419/280 63.4 ± 7.0 Investigation and analysis of exercise activity levels and related influencing factors in people with COPD Self designed questionnaire exercise frequency、exercise time The level of exercise behavior is negatively correlated with subjective dyspnea and bronchial obstruction, and positively correlated with health-related quality of life and activity scores Regardless of the severity of COPD in patients, the biggest obstacle to exercise is the subjective feeling of difficulty breathing Borges et.al [ 26 ] (2012) Brazil Cross-sectional survey studies 20,14/6 68.6 ± 10.7 Investigation and analysis of physical activity in daily life of Brazilian people with COPD during and after aggravated hospitalization accelerometer(DynaPort Moviemonitor McRoberts, The Netherlands) walking time The walking time during hospitalization is positively correlated with 6MWD, quadriceps strength, and PaO2, and negatively correlated with BODE index prognosis The walking time at home for one month after discharge is positively correlated with FEV1 and 6MWD, and negatively correlated with BODE, previous hospitalization history, and respiratory distress scale Selzler et.al [ 27 ] (2012) Canada Prospective cohort study 814,404/410 67.6 ± 10.5 Exploring and analyzing predictive factors for the completion and success of pulmonary rehabilitation programs in people with COPD adherence (dropouts)、Completion Young, current smokers, and patients with lower health status have a higher rate of pulmonary rehabilitation withdrawal Soicher et.al [ 28 ] (2012) Canada Prospective cohort study 215,116/90 66.0 ± 8.0 Longitudinal analysis of endurance activity trajectory in people with COPD after completing pulmonary rehabilitation exercise Diary exercise time Higher disease severity and more severe breathing difficulties are obstacles to exercise behavior Pleguezuelos et.al [ 29 ] (2013) Spain A randomized controlled trial 71 70.3 ± 2.5 Improving physical activity in people with COPD through urban walking cycle Intervention: Moderate intensity plan, frequency of 3 times a week, lasting for 12 weeks; Jointly developed 32 urban pedestrian routes activity diary: Paper-based daily step count、exercise frequency Urban Cycling is a simple, inexpensive strategy that has been shown to help stimulate physical activity in our severe and very severe COPD patient population, increasing exercise capacity even 9 months after completing a rehabilitation program Andersson et.al [ 30 ] (2013) Sweden Cross-sectional survey studies 72,28/44 65.0 ± 7.0 Physical activity levels and their clinical relevance in people with COPD: a cross-sectional study accelerometer(The ActiReg activity monitor Premed AS, Oslo, Norway) energy expenditur Walking speed and muscle strength are positively correlated with the level of exercise behavior Nguyen et.al [ 31 ] (2013) America Cross-sectional survey studies 148,115/33 66.5 ± 8.8 Chronic obstructive pulmonary disease patients with higher levels of anxiety are more physically active accelerometer(Stepwatch 3 Activity Monitor,SAM) (OrthoCare Innovations LLC) daily step count The increase in anxiety is related to the elevation of PA levels. For every 1 point increase in HADS Anxiety score, there is a corresponding increase of 288 steps per day Only when anxiety is present in the model, higher levels of depressive symptoms are associated with lower levels of physical activity, indicating that the higher the level of anxiety, the greater the negative impact of depression on physical activity Altenburg et.al [ 32 ] (2013) Holland Cross-sectional survey studies 155,102/53 62 Functional and psychological variables both affect daily physical activity in patients with chronic obstructive pulmonary disease: a structural equation model pedometer(the Digiwalker SW-200 pedometer Yamax; Tokyo, Japan) daily step count Better functional ability is a promoting factor for exercise behavior, while psychological factors indirectly affect exercise behavior by influencing functional ability Tabak et.al [ 33 ] (2014) Holland A randomized controlled trial 24,12/12 63.4 ± 8.2 Assessing the effectiveness of remote medical plans for self-management of COPD exacerbations and promoting positive lifestyles Intervention: web-based exercise plan + real-time feedback uploaded by activity monitor + self-management (condition, exercise) + remote consultation accelerometer(Inertia Technology, Enschede, the Netherlands),Questionnaires(The Baecke Physical Activity Questionnaire),activity diary(online diary) activity intensity, BPAQ Telemedicine programs with decision support showed good satisfaction, but the use of exercise modules and activity coaches was very low Zwerink et.al [ 34 ] (2014) Holland A randomized controlled trial 153,77/76 63.6 ± 7.9 Evaluate the effectiveness of community-based exercise programs in improving self-management and exercise behavior in people with COPD Intervention:self management meetings (increasing patients' knowledge, facing the consequences of specific behaviors, and providing them with tools to deal with different components of the disease to change patients' disease behavior) + personalized exercise plans + self-management (condition, exercise) pedometer: (Yamax Digi-Walker SW-200; Tokyo, Japan) daily step count In contrast to self-management-only programs, community-based physical therapy exercise programs are effective in achieving behavioral change, and increases in daily physical activity can be maintained in the second year, but increases in exercise capacity cannot Cameron et.al [ 35 ] (2014) Australia A randomized controlled trial 84,43/41 65.8 ± 9.3 Evaluate the effectiveness of adding supervised exercise to chronic disease self-management plans to improve exercise behavior in people with COPD Intervention: Self management courses include weekly lectures, problem-solving, brainstorming, action planning, and interactive reporting activities Questionnaires(CHAMPS Activities Questionnaire for Older Adults) 、Stages of Change Short Form questionnaire exercise frequency、exercising time Adding just one supervised exercise session intervention seems to make little sense Guo et.al [ 36 ] (2014) China qualitative research 25,13/12 68.8 ± 7.7 Improving understanding and compliance with pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a qualitative survey of patient and healthcare professional perspectives – There are three main themes: 1) building confidence, ① learning to coexist with chronic obstructive pulmonary disease and limitations, ② regaining independence and initiative, ③ learning practical skills, ④ experiencing positive team dynamics—fun; 2) Perceive immediate and tangible results, ① acquire relevant knowledge, ② pay personal attention to the first few classes; 3) Ready and accessible, ① perceive needs and benefits, ② work in fear, ③ develop diverse entry points, ④ minimize access barriers to the greatest extent possible Stewart et.al [ 37 ] (2014) Holland qualitative research 22,14/8 63.5 ± 7.8 Maintaining an active lifestyle in people with COPD after pulmonary rehabilitation: a qualitative study on motivational factors – Self motivation (perceiving the benefits of exercise), perceptual ability (no physical limitations), and social support are promoting factors for people with COPD to maintain an active physical lifestyle Thorpe et.al [ 38 ] (2014) Australia qualitative research 28,22/6 71.9 Obstacles and contributing factors of physical activity in people with COPD after admission: a qualitative study – The identified main obstacles are health-related (comorbidities, symptoms of chronic obstructive pulmonary disease, and physical injuries or diseases), environment related (weather, transportation, and finance), and self related obstacles;The main advantageous factors of the report are access to healthcare professionals and equipment, social support, daily and extracurricular activities, personal goals and motivation, as well as the impact of physical activity and "feeling better" Barriga et.al [ 39 ] (2014) Britain Cross-sectional survey studies 55,100/0 67.2 ± 9.6 The main factors of physical activity in daily life pedometer(Geonaute Dista T300) daily step count The daily step count is negatively correlated with age, mMRC, depression, BODE index, and disease severity; There is a positive correlation between the 6-min walk test (6MWT), first second forced expiratory volume (FEV1), carbon monoxide diffusion capacity (DLCO), arterial oxygen saturation (SpO2), and body mass index (BMI) Miravitlles et.al [ 40 ] (2014) Spain Cross-sectional survey studies 4574,3833/741 67.1 ± 10.0 Factors associated with low-level physical activity in patients with chronic obstructive pulmonary disease Self designed questionnaire walking time After adjusting for age and symptom severity, poor health, COPD severity, and depression are the main factors contributing to short walking time in people with COPD Burtin et.al [ 41 ] (2015) Holland A randomized controlled trial 80,40/40 66.0 ± 7.0 Assessing the impact of individual activity counseling plans during pulmonary rehabilitation on physical activity levels in patients with moderate to severe COPD Intervention: exercise training consultation and health education based on motivational interviews accelerometer(McRoberts BV, The Hague, the Netherlands,the SenseWear Pro Armband) daily step count,activity intensity (METs),exercising time(walking time、time spent on moderate or above physical activity) Improvements in daily physical activity levels were minimal in both groups, and increased personal activity counseling did not enhance activity behaviors in our patient sample Kawagoshi et.al [ 42 ] (2015) Japan A randomized controlled trial 27,15/12 74.5 ± 8.5 Assessing the impact of low-intensity home lung rehabilitation on exercise behavior levels in people with COPD Intervention: use pedometers to provide supervision and feedback, and exercise training includes upper and lower limb exercises, etc accelerometer(Activity Monitoring and Evaluation System [A-MES™], Solid Brains, Kumamoto, Japan) walking time Low-intensity and home PR using pedometer feedback was effective in improving PA, and improvements in physiologic function were associated with increased walking time in patients with COPD Altenburg et.al [ 43 ] (2015) Holland A randomized controlled trial 155,78/77 62 Evaluate the impact of providing a physical exercise counseling program on the exercise behavior level of people with COPD Intervention: based on the principles of goal setting and implementation, and using motivational interview techniques to receive patient counseling pedometer(Digiwalker SW-2000, Yamax; Tokyo Japan) daily step count The PA counseling program was effective in increasing PA levels in patients with COPD at three months, and the trend toward increased physical activity levels persisted at 15 months, and patients who were sedentary at baseline continued to benefit at 15 months Mendoza et.al [ 44 ] (2015) Spain A randomized controlled trial 97,50/47 68.7 ± 8.5 Evaluate the effects of pedometer based and non pedometer based walking interventions on improving the exercise behavior level of people with COPD Intervention: pedometer feedback + walking plan guidance pedometer(PD724 Triaxial pedometer,Tanita,Tokyo, Japan) daily step count The recommended program alone had no effect on physical activity, while the pedometer-based program resulted in a significant increase in daily steps Hornikx et.al [ 45 ] (2015) Belgium A randomized controlled trial 30,17/13 67 ± 6.5 Evaluating the effect of physical exercise consultation combined with real-time feedback on improving the exercise behavior level of people with COPD with acute exacerbation after discharge Intervention: real-time feedback from pedometers + personalized phone exercise consultation (including short-term exercise goals) pedometer(The Fitbit Ultra®),accelerometer(Dynaport MoveMonitor) daily step count、activity intensity、exercising time(walking time) The level of motor behavior of the patients gradually increased after discharge, but there was no significant difference between the two groups Benzo et.al [ 46 ] (2015) America qualitative research 531,239/292 70.0 ± 10.0 Investigation and analysis of the reasons why people with COPD do not participate in rehabilitation management plans (free of charge) after hospitalization – The topics that did not participate included lack of interest (39%), feeling "too sick, physically weak or disabled" (24%), feeling "too busy or having too much to do" (11%), distance or need to travel (11%), commitment issues (7%), comorbidities (6%), and lack of social support (2%) Tödt et.al [ 47 ] (2015) Sweden Cross-sectional survey studies 101,49/52 67.9 ± 7.3 Investigation and analysis of the influencing factors of low exercise behavior level in people with COPD Questionnaire(the International Physical Activity Questionnaire-Short Form,IPAQ-SF)、IPAQ-S Severe fatigue, poor exercise ability, and high smoking volume are independent factors associated with low PA and obstacles to exercise behavior Alahmari et.al [ 48 ] (2015) Britain Prospective cohort study 73,51/22 71.1 ± 8.7 Longitudinal investigation on the effects of climate and air pollutants on the exercise behavior level of people with COPD pedometer(Yamax Digi-Walker SW-200) daily step count The warming of the weather is related to an increase in daily steps, with an increase of 43 steps per day for every 1° C increase in temperature; Meteorological factors (cold, rainy, and cloudy) and high levels of atmospheric pollutants are obstacles to the exercise behavior of people with COPD Vorrink et.al [ 49 ] (2016) Holland A randomized controlled trial 156,78/79 62.5 ± 8.5 Evaluating the effectiveness of mobile health interventions to improve or maintain exercise behavior in people with COPD after pulmonary rehabilitation Intervention: smartphone app + monitoring website provided by physical therapist + personalized exercise goals adjusted in real time accelerometer(SenseWear PRO or MF-SW mini armband; Body Media, Pittsburgh, USA) daily step count、Adherence(Actual Completion/Planned Completion) A mobile health intervention using a smartphone with the support of a primary care physical therapist did not improve or maintain physical activity in patients with COPD after pulmonary rehabilitation, with adherence in the intervention group being approximately 89 ± 18.5% Moy et.al [ 50 ] (2016) America A randomized controlled trial 238,154/84 66.8 ± 8.8 To evaluate the long-term effectiveness of Internet mediated pedometer based walking intervention (called "taking healthy steps") in improving the exercise behavior of patients with COPD Intervention: The website has four key components: setting personalized goals based on uploaded steps + iterative feedback allowing self-monitoring of steps + incentivizing content providing new educational tips every other day, providing new motivational information every week + and enhancing social support through online community forums pedometer: Omron HJ-720 ITC daily step count The difference in daily steps in the intervention group compared to the control group was greatest and statistically significant at month 4 and remained above baseline values for all months of the study, and the improvement in daily steps at 12 months was significant Cruz et.al [ 51 ] (2016) Portugal A randomized controlled trial 32,16/16 66.4 ± 8.2 Evaluate the effectiveness of physical activity (PA) centered behavioral interventions during or after pulmonary rehabilitation in improving exercise behavior levels in people with COPD Intervention: Based on Social Cognitive Theory (SCT), with self-efficacy, goal setting and performance feedback, and motivation as the core elements of behavior change, incorporating objective feedback from pedometers accelerometer(GT3X +,ActiGraph, Pensacola, Florida, USA) daily step count、exercise time(time spent on moderate physical activity) The addition of a PA-focused behavioral intervention to PR resulted in significant improvements in levels of motor behavior in the intervention group, which were maintained after follow-up support Hayata et.al [ 52 ] (2016) Japan Cross-sectional survey studies 98,92/6 71.4 ± 6.9 Investigation and analysis of the predictive effect of dyspnea on the level of exercise behavior in people with COPD accelerometer(the Actimarker Panasonic, Osaka, Japan) activity intensity、exercise time(time spent on moderate physical activity) mMRC is negatively correlated with levels of exercise behavior; MMRC ≥ 2 is the most balanced critical point for identifying patients with low motor behavior Iwakura et.al [ 53 ] (2016) Japan Cross-sectional survey studies 35 71.6 ± 6.9 Investigation and analysis of the relationship between balance function and exercise behavior level in elderly people with COPD accelerometer(Lifecorder™, Suzuken Co., Nagoya, Japan) daily step count、activity intensity(METs) 、exercise time(time spent on moderate physical activity) Age, 6MWD, mMRC are negatively correlated with patients' levels of exercise behavior Brown et.al [ 54 ] (2016) America Retrospective survey study 440,261/179 66.2 ± 9.0 Retrospective investigation and analysis of predictive factors for completing sports training Self designed questionnaire exercise frequency、activity intensity、exercise time FEV1, no depression, healthy quality of life, and exercise behavior are positively correlated;Smoking as the sole independent predictor of pulmonary rehabilitation dropout Hansen et.al [ 55 ] (2016) Denmark Retrospective survey study 40,188,19,296/20892 56.9 ± 14.6 Survey on trends in leisure time physical activity (PA), smoking, alcohol consumption, and body mass index (BMI) among people with and without COPD in Denmark from 2000 to 2010 Self designed questionnaire activity intensity、exercise frequency、exercise time Smoking, increasing age, elevated BMI, and increased alcohol consumption are negatively correlated with exercise behavior, while being married or cohabiting with a partner and education level are positively correlated Alahmari et.al [ 56 ] (2016) Britain Prospective cohort study 141,95/46 72.9 ± 8.1 Longitudinal investigation on whether the acute changes in exercise behavior during acute exacerbation of people with COPD are related to changes in exercise ability, quadriceps strength, systemic inflammatory markers, and fatigue level accelerometer(SenseWear (Bodymedia Inc., Pittsburgh, PA, USA) activity intensity、exercise time(time spent on moderate physical activity) The duration of exercise decreases with the prolongation of time; Frequent deterioration of depression is an obstacle to exercise behavior Tsai et.al [ 57 ] (2016) Multicenter Prospective cohort study 50,21/29 71.0 ± 10 Longitudinal study on changes in exercise behavior levels of people with COPD with acute exacerbation upon admission and discharge accelerometer(The SenseWearArmband SWA; BodyMedia, Pittsburgh, Pennsylvania, USA) daily step count、exercise time(time spent on moderate physical activity) Patients with higher COPD severity and lower motor function have lower levels of exercise behavior Nolan et.al [ 58 ] (2017) England A randomized controlled trial 152,110/42 68.0 ± 9.0 Evaluating the effectiveness of adding a pedometer to improve exercise behavior levels in people with COPD Intervention: personalized daily walking goal + exercise health coaching pedometer(Yamax Digi-walker CW700;Yamax, Bridgnorth, UK)、accelerometerSenseWear; Body Media Inc., Pittsburgh, PA),activity diary(Paper-based) daily step count、activity intensity (metabolic equivalent of tasks,METs) 、exercise time(time spent on moderate physical activity) Pedometer-guided step goals did not increase moderate-intensity physical activity levels in patients with COPD compared with those in an outpatient PR program Kosteli et.al [ 59 ] (2017) England qualitative research 26,15/11 50–89 Exploring the promoting and hindering factors of exercise participation in primary healthcare for people with COPD – Two overall high-level themes related to PA: Theme 1 "Obstacles" (factors that prevent participation in PA): including two secondary themes; ① Personal obstacles: Four level 3 sub themes, including physical limitations, psychological distress, lack of motivation, and negative attitudes/perceptions related to PA Social barriers: consisting of two sub themes, namely overprotection of family members and lack of time; Theme 2 "Driving factors" (factors that encourage participation in PA): including 2 secondary themes; ① Personal driving factors: Five Level 3 sub themes: Self initiative, controlled motivation, attitude/perception, self-regulation, and achievement; ② Social support refers to social and environmental factors that individuals cannot control; Cho et.al [ 60 ] (2017) China Cross-sectional survey studies 135,129/6 72.4 ± 8.5 Investigation and analysis of the relationship between exercise and exercise behavior in people with COPD Questionnaire(The Leisure Time Exercise Questionnaire,LTEQ) exercise frequency、exercise time、energy expenditure Educational level and the frequency of acute exacerbations within 2 years are important predictive factors for high exercise behavior Ramon et.al [ 61 ] (2017) Spain Cross-sectional survey studies 5969,5145/824 67.5 ± 9.6 Investigation and analysis of the relationship between daily walking time and related clinical and functional characteristics in people with COPD Self designed questionnaire walking time Severe respiratory distress (mMRC) ≥ 3, hospitalization more than 3 times in the past 12 months, and CAT score > 4 are factors that hinder exercise behavior Arbillaga-Etxarri et.al [ 62 ] (2017) Spain Cross-sectional survey studies 410,349/61 69.0 ± 8.5 Investigation and analysis of the influence of social environment on exercise behavior of people with COPD accelerometer(Dynaport accelerometer McRoberts, The Hague, The Netherlands) daily step count、walking time 、time spent on moderate physical activity Walking dogs and being grandparents are both associated with higher levels of physical activity and intensity in people with COPD Mesquita et.al [ 63 ] (2017) Multicenter Cross-sectional survey studies 1001,650/351 67 Investigation and analysis of exercise behavior patterns and clusters in people with COPD accelerometer(The SenseWear Armband or SenseWear Mini Armband activity monitors) activity intensity、exercise time(time spent on moderate physical activity) Age (≥ 67 years old), gender (female), BMI (obesity), mMRC respiratory distress level (higher), home oxygen therapy (yes), and disease severity (1–4) are obstacles to exercise behavior Spina et.al [ 64 ] (2017) Multicenter Retrospective survey study 932,615/317 66.4 ± 8.3 Investigation and analysis of the impact of sleep quality and status on exercise behavior in people with COPD accelerometer) (the SenseWear Armband (SWA) or SenseWear Mini Armband activity monitors BodyMedia, Pittsburgh, Pennsylvania, USA) daily step count、exercise time Patients with better sleep indicators (i.e. non fragmented sleep, no difficulty falling asleep, longer sleep duration) spend significantly more time on moderate to vigorous physical activity Clarenbach et.al [ 65 ] (2017) Switzerland Prospective cohort study 177,119/58 64 Longitudinal study on predictive factors of exercise behavior in people with COPD accelerometer(SenseWear Pro; Bodymedia Inc., Pittsburgh, PA, USA) daily step count Over time, the level of exercise behavior in people with COPD significantly decreases—people with COPD lose about 500 steps per day per year; This is equivalent to an average annual decrease of 11%, and multiple factors indicate that decreased lung function (FEV1) is an independent hindering factor Furlanetto et.al [ 66 ] (2017) Multicenter Prospective cohort study 37,22/15 69.0 ± 6.5 Investigation and Analysis of the Effects of Different Climate Conditions on the Exercise Behavior of people with COPD accelerometer(SenseWear Pro, Body Media, Pittsburgh, United States of America) activity intensity、exercise time(time spent on moderate physical activity) Summer, high temperatures, longer sunshine duration, and shorter rainfall duration are favorable factors for high levels of exercise behavior O'Neil et.al [ 67 ] (2018) America A randomized controlled trial 49,24/25 64.4 ± 8.6 To evaluate the effectiveness of a clinician-involved behavioral facilitation intervention to improve exercise behavior in patients with COPD Intervention: Clinician-directed pedometer-driven walking program based on the Opportunity, Motivation, and Behavior (COM-B) model + pedometers, exercise diary Recording, feedback + communication and health education via telephone pedometer(Yamax Digiwalker CW700) 、accelerometer(Actigraph GT3X), Questionnaires(International Physical Activity Questionnaire, IPAQ), activity diary(Paper-based) daily step count、IPAQ、dropout(withdrawal from the exercise training program) The intervention increased the number of steps taken by patients, but patient adherence was suboptimal and the adherence results need to be treated with caution due to the limitations of the number included Arbillaga-Etxarri et.al [ 68 ] (2018) Spain A randomized controlled trial 407,205/202 69 To evaluate the long-term efficacy of behavioral and community-based exercise interventions (urban training) to increase physical activity in patients with COPD Interventions: pedometers, walking schedules, physical activity brochures, websites, phone text messages accelerometer (Dynaport; McRoberts BV, The Hague, The Netherlands),Questionnaires(Clinical-PROactive Physical Activity,C-PPAC) daily step count,C-PPAC The urban training intervention was more effective than usual care in increasing physical activity in people with COPD after 12 months, with few safety concerns. However, the intervention was not effective according to the results of the ITT analysis set, suggesting that it only improved physical activity in voluntary, compliant patients de Roos et.al [ 69 ] (2018) England A randomized controlled trial 52,26/26 70.0 ± 9.0 Evaluating the effectiveness of exercise training combined with a home walking program to improve exercise behavior in patients with COPD Intervention: physiotherapist-supervised exercise training + home walking instruction accelerometer(Actigraph),Questionnaires(the Physical Activity Scale for Elderly,PASE) daily step count,activity intensity (METs),PASE Combined exercise training and home walking program improves daily steps in patients with moderate COPD Benito et.al [ 70 ] (2018) Spain Cross-sectional survey studies 13,190,6239/6951 ≥ 65 Investigation and analysis of self-reported walking and related influencing factors among people with COPD in Spain Questionnaire(the International Physical Activity Questionnaire-Short Form,IPAQ-SF) IPAQ-S Male gender, advanced age (over 65), place of residence (in poorer areas), poorer sexual health, and mental illnesses (such as depression or anxiety) are independent predictors of low exercise behavior Lee et.al [ 71 ] (2018) Korea Cross-sectional survey studies 160,149/11 71.8 ± 4.5 Investigation and analysis of the related influencing factors of low exercise behavior level in elderly people with COPD Self designed questionnaire activity intensity、exercise time Severe dyspnea (mMRC score ≥ 2) and depression (HADS-D score ≥ 8) are independent factors associated with low levels of exercise behavior Kantorowski et.al [ 72 ] (2018) America Retrospective survey study 94,92/2 69.2 ± 8.4 Investigation and analysis of the determining factors and results of changes in exercise behavior levels in people with COPD pedometer(the Omron HJ-720ITC) daily step count Depression, reduced social support, oxygen intake, and seasonal factors (summer and autumn) are obstacles to exercise behavior Sievi et.al [ 73 ] (2018) Switzerland Retrospective survey study 202,133/69 64 Longitudinal investigation of changes in exercise behavior and exercise ability in people with COPD accelerometer(SenseWear Pro™; Bodymedia Inc., Pittsburgh, PA, USA) daily step count Reduced lung function is a hindrance to exercise behavior, with patients with higher baseline step counts experiencing a significantly greater decline over time Wootton et.al [ 74 ] (2019) multicenter A randomized controlled trial 86,42/23 69.0 ± 8.0 To evaluate the effect of adding continuous feedback to a walking program on exercise behavior in patients with COPD Intervention: pedometer monitoring of PA steps + biofeedback via pedometer and progressive goal setting accelerometer(SenseWear® Pro3 Armband,SWA) daily step count、activity intensity (METs)、exercise time(time spent on moderate physical activity) There were no between-group differences in motor behavior level variables, and continuous feedback was no more effective in improving PA than no feedback at all Lahham et.al [ 75 ] (2019) Australia A randomized controlled trial 45,23/22 68.0 ± 8.0 Investigation and analysis of the impact of center-based and home-based rehabilitation on patients' participation in exercise and physical activity Central group: supervised group exercise training + self-management education sessions; Family group: personalized exercise goals + family exercise diary + motivational health education by telephone accelerometer daily step count、exercise time(time spent on moderate physical activity) 、Adherence(Actual Completion/Planned Completion) Daily steps, MVPA exercise duration, and adherence were not statistically different between the two groups, and adherence to the exercise prescription at week 8 was similar in both groups regardless of setting and supervision; however, our analysis found that at week 110 of PR, participants in home and center-based rehabilitation maintained the recommended MVPA duration Cani et.al [ 76 ] (2019) Brazil Cross-sectional survey studies 59 67.9 ± 7.6 Investigation and analysis of the effect of home style oxygen therapy on the exercise behavior level of people with COPD accelerometer(DynaPort Activity Monitor,McRoberts, The Netherlands) daily step count、activity intensity、exercise time(time spent on moderate physical activity) Home oxygen therapy is an obstacle to the exercise behavior level of people with COPD Hoaas et.al [ 77 ] (2019) Multicenter Cross-sectional survey studies 168,96/72 65 Investigation and analysis of the effects of seasons, weather, and different countries and regions on the exercise behavior of people with COPD accelerometer: (SenseWear Armband, BodyMedia, Inc, Pittsburgh, PA. USA) daily step count、energy expenditure、exercise time(time spent on moderate physical activity) Summer is a promoting factor for sports behavior Orme et.al [ 6 ] (2019) Britain Cross-sectional survey studies 244,67/42 65.7 ± 7.1 Investigation and analysis of the current status of various physical behaviors in people with COPD within 24 h and their relationships with each other accelerometer(ActiGraph wGT3X-BT accelerometer (ActiGraph, LLC, Pensacola, FL, USA) activity intensity 、exercise time(time spent on moderate physical activity) Age, self-care limitations, and self-reported pain are obstacles to exercise behavior Geidl et.al [ 78 ] (2019) Germany Cross-sectional survey studies 326,220/106 58.0 ± 5.1 Investigation and analysis of the impact of iron deficiency on exercise behavior in people with COPD accelerometer(tri-axial Actigraph wGT3X-BT),activity diary: Paper-based daily step count、activity intensity、exercise time(time spent on moderate physical activity) The severity of the disease, exercise ability, lung function, and symptom burden are hindering factors for patients' exercise behavior Koolen et.al [ 79 ] (2019) Holland Retrospective survey study 662,364/298 63 Investigation and analysis of the distribution of exercise ability and behavior levels in people with COPD, as well as the characteristics and influencing factors between each condition pedometer(Digiwalker SW-200; Yamax Corporation, Tokyo, Japan),Questionnaire: Marshall Questionnaire daily step count、exercise frequency、exercise time Good physical function, social support, and exercise behavior are positively correlated; BMI、 The number of acute exacerbations, degree of lung function impairment, comorbidities, and symptom burden are negatively correlated with exercise behavior Paneroni et.al [ 80 ] (2019) Italy Retrospective survey study 200,154/46 68.7 ± 9.1 Investigation and analysis of the effects of oxygen therapy on the exercise behavior level of people with COPD accelerometer(the SenseWear Armband 2 Body Media Inc., Pittsburgh, PA, USA) daily step count、activity intensity、exercise time(time spent on moderate physical activity) The exercise behavior level of people with COPD receiving oxygen therapy is significantly lower than that of patients who do not require oxygen therapy; In patients who do not require oxygen therapy, daily step count is not related to 6MWD and oxygenation levels, while in patients receiving oxygen therapy, daily step count is strongly correlated with 6MWD Koreny et.al [ 81 ] (2019) Spain Retrospective survey study 202,170/32 68.8 ± 9.2 Retrospective investigation of predictive factors for people with COPD completing exercise training (aimed at behavior change intervention to improve exercise behavior levels) accelerometer(the Dynaport accelerometer McRoberts BV, The Hague, The Netherlands),Questionnaire(the Clinical-PROactive Physical Activity,C-PPAC) daily step count、activity intensity、exercise time(time spent on moderate physical activity) 、C-PPAC Active work (on-the-job), baseline high levels of exercise behavior, living with partners, and increased levels of exercise behavior after intervention are positively correlated, while living in more vulnerable communities is negatively correlated Boutou et.al [ 82 ] (2019) Multicenter Retrospective survey study 157,119/38 67.2 ± 7.8 Prospective investigation into the impact of weather (temperature, day length, rainfall) on changes in patients' exercise behavior accelerometer(the Dynaport MiniMod McRoberts BV, the Hague, the Netherlands and Actigraph GT3X Actigraph, Pensacola, FL, USA) daily step count、activity intensity(METs)、walking time The patient's level of exercise behavior decreases over time; The passage of time is the most important predictor of low exercise behavior; Daily rainfall is a hindrance to physical activity Kohlbrenner et.al [ 83 ] (2020) Switzerland A randomized controlled trial 74,37/37 66.0 ± 9.0 Evaluating the effectiveness of a pedometer-based, exercise counseling exercise intervention on maintaining long-term exercise in patients with severe COPD Interventions: short-term step goals + real-time pedometer upload feedback + motivational phone calls and communication pedometer(HJ-325-EB, Omron Healthcare Co., Kyoto, Japan) activity diary: Paper-based daily step count Steps increased by ≥ 15% in people with COPD three months post-intervention, but long-term follow-up results showed no significant increase in daily steps, suggesting a maintenance effect and showing that age is a facilitator of exercise behavior Fastenau et.al [ 84 ] (2020) Holland A randomized controlled trial 90,44/46 62.5 ± 9.9 Evaluating the effectiveness of setting exercise training in a primary care setting to improve exercise behavior in patients with COPD Intervention: goal-oriented, guideline-based development of four primary behavioral goals: improvement in exercise capacity, muscle strength, daily physical activity, and respiratory skills accelerometer: (Dynaport MiniMod; McRoberts BV),Questionnaires (self-reported daily physical activity-brief physical activity assessment tool) daily step count、exercise time(walking time、time spent on moderate or above physical activity) The difference in the number of daily steps taken by the patients between the end of the intervention and 6 months of follow-up was not significant, but there was a decline in the control group, suggesting that there was no increase in the level of exercise behavior, but the decline was delayed Bentley et.al [ 85 ] (2020) England A randomized controlled trial 30,13/17 67 Evaluating the effectiveness of a Behavior Change Theory (BCT)-based exercise intervention with smartphones and activity monitors to promote exercise in people with COPD pedometer(Fitbit Charge 2 (wrist-worn), a Fitbit One (hip-worn),Questionnaires(CHAMPSd questionnaire) daily step count、Adherence(Actual Completion/Planned Completion)、CHAMPSd There was no statistically significant difference in step change between the two groups, but participants who completed the study were generally positive about the technique and found it easy to use Park et.al [ 86 ] (2020) Korea A randomized controlled trial 42,20/22 67.8 ± 10.5 Evaluating the impact of a smartphone App-based self-management intervention on self-management bhavior in people with COPD Interventions: interventions based on Social Cognitive Theory and Self-Efficacy Theory: health education + personalized exercise training program + pedometer real-time feedback and recording + motivation and encouragement accelerometer(wGT-3X-BT, ActiGraph, Shalimar, FL) daily step count、activity intensity、exercise time(time spent on moderate physical activity) Significant differences between groups were found in patients' total activity counts and in the percentage of time spent in moderate to vigorous physical activity over a 6-month period, and a self-management program using a smartphone app promotes behavioral change in patients with COPD Meshe et.al [ 87 ] (2020) England qualitative research 12,5/7 74.33 Exploring the obstacles and promoting factors perceived by people with COPD in participating in community sports exercise – The theme of obstacles and promoting factors for participating in community sports programs: Promoting factors include accessibility, perceived benefits of participation, structured and convenient program components, retirement, social support, summer, and a sense of security, totaling 7; Obstacle factors include poor physical health, family burden (taking care of physically uncomfortable partners and grandchildren), and transportation difficulties Ichinose et.al [ 88 ] (2020) Japan Cross-sectional survey studies 417,358/59 73.6 ± 7.5 A cross-sectional survey of exercise behavior levels and related influencing factors in people with COPD accelerometer: (model HJA-750C, Omron Healthcare Co., Ltd., Kyoto, Japan) daily step count、activity intensity、exercise time(time spent on moderate physical activity) Advanced age, stage III and IV GOLD, mMRC respiratory distress score, unemployment, and levels of moderate to high-intensity exercise behavior are correlated; MMRC respiratory distress score ≥ 2 and lack of employment are significantly correlated with step count Castillo et.al [ 89 ] (2020) Spain Cross-sectional survey studies 601,287/314 52.8 ± 14.1 A cross-sectional study on the impact of comorbidities in people with COPD on their exercise behavior Questionnaire(the International Physical Activity Questionnaire-Short Form, IPAQ-SF) IPAQ-S Low exercise behavior is associated with a higher risk of comorbidities, especially urinary incontinence, chronic constipation, cataracts, and chronic anxiety Matkovic et.al [ 90 ] (2020) Spain Cross-sectional survey studies 111,76/35 67.7 ± 7.8 A cross-sectional study on the predictive role of physical performance or muscle function/mass in people with COPD and their low levels of exercise behavior accelerometer(SAM,USA) daily step count、exercise time 6MWD can predict low levels of exercise behavior, and there is no significant correlation between other physical manifestations such as fat free mass and grip strength and exercise behavior Hirata et.al [ 91 ] (2020) Brazil Cross-sectional survey studies 55,28/27 67 A cross-sectional study on the effect of sleep quantity quality on exercise behavior levels in people with COPD accelerometer(SenseWear® Pro2 Armband, BodyMedia, Pittsburgh, USA) exercise time(time spent on moderate physical activity) Long sleep duration (> 9 h/night) is an independent predictor of low levels of exercise behavior; Having more sleep (difficulty falling asleep) is a hindrance to exercise behavior—the amount of sleep is not the quality of sleep. Spending more time on sleep will reduce exercise time, thus having a reverse effect Cheng et.al [ 92 ] (2020) Australia Cross-sectional survey studies 69,33/36 74.0 ± 9.0 A cross-sectional study on the impact of sedentary behavior on exercise behavior in people with COPD accelerometer(the activPAL3 activity monitor, PAL Technologies Ltd., Glasgow, UK), activity diary: Paper-based exercise time(time spent on moderate physical activity) Sedentary sitting is a barrier to exercise behavior in people with COPD Sanchez et.al [ 93 ] (2020) Spain Prospective observational studies 137,120/17 66.9 ± 8.3 Investigating the predictive factors for people with COPD transitioning to low exercise behavior Questionnaire(the Minnesota Leisure Time Physical Activity Questionnaire,VREM) exercise frequency、activity intensity、energy expenditure、exercise time Older age, current smoking, depression, frequent deterioration, difficulty breathing, and weak grip are hindering factors for exercise behavior Albarrati et.al [ 94 ] (2020) Britain Retrospective survey study 128,65/63 66.0 ± 7.5 Investigation on the level of exercise behavior and related influencing factors in COOPD patients accelerometer(SenseWear™ BodyMedia, Inc. Pittsburgh, PA) daily step count、exercise time(time spent on moderate physical activity) The low level of exercise behavior in people with COPD is associated with worsening and frequent exacerbation of respiratory distress, and is not related to age, lung function, gender, or peripheral muscle mass intensity Geidl et.al [ 95 ] (2021) Germany A randomized controlled trial 327,167/160 58.02 ± 5.43 Evaluating the impact of adding a pedometer to a pulmonary rehabilitation program on long-term improvement of exercise behavior in patients with COPD Intervention: Behavior Change Technology (BCT)-based development of intervention: development of individualized exercise behavior goals and plans + feedback and monitoring (self-monitoring using pedometers with parallel diary entries, educational feedback from physical therapist) accelerometer(ActiGraph,Pensacola, Florida, wGT3X-BT) daily step count、exercising time(time spent on moderate physical activity) Improvement in the level of motor behavior was not significant in the intervention group compared to the control group, but both groups showed a significant increase from the previous Armstrong et.al [ 96 ] (2021) America A randomized controlled trial 60,31/29 72.0 ± 9.0 Evaluating the impact of a rehabilitation intervention based on behavior modification to improve motor behavior in patients with COPD Intervention: progressive, individualized aerobic and resistance training + individualized behavior change plan based on motivational interviewing, including step goals + health education, feedback, and motivation from researchers accelerometer(Actigraph wGT3X, Actigraph LLC, Pensacola, FL, USA),C-PPAC questionnaire,activity diary(paper-based) daily step count、C-PPAC、Adherence: Actual Completion/Planned Completion(exercise goal) daily steps and quality of life were significantly improved in the intervention group compared to the control group, especially in advanced people with COPD with low baseline levels of motor behavior, and the addition of behavioral modification interventions had a positive impact on promoting motor behavior Wang et.al [ 97 ] (2021) China A randomized controlled trial 68,35/33 63.9 ± 6.8 Evaluating the impact of a self-management program supported by a mobile health-based smartphone App on exercise behavior in people with COPD Interventions: educational knowledge board + visual aids board, synchronized with physical therapist for disease management + motivational board, including peer support chat room and expert support portal Questionnaires: Self-designed exercise frequency、exercise time exercise frequency increased significantly in the intervention group compared to the control group, and exercise time increased significantly within the group but not significantly compared to the control group, effectively improving health-related quality of life and self-management behaviors in people with COPD Robinson et.al [ 98 ] (2021) America A randomized controlled trial 153,75/78 69.8 ± 7.2 Evaluating the effectiveness of a web-based exercise behavior self-management intervention on improving patient exercise adherence Interventions: objective walking assessment and feedback + personalized step goals + educational tips and motivational messages + online community pedometer(Fitbit Zip pedometer (fitbit, San Francisco, CA, USA) daily step count、Adherence: Changes in weekly step goals Web-based self-management interventions resulted in significant improvements in daily step counts compared with controls and achieved the smallest clinically important difference in daily step counts for COPD, but no difference in motor function improvement effects Ko et.al [ 99 ] (2021) China A randomized controlled trial 136,68/68 75.0 ± 6.5 Assessing whether short-term exercise training and telephone reminders can improve home exercise behavior after acute exacerbations in COPD ptients Intervention: outpatient training supervised by physiotherapist + bi-weekly phone calls for reminders and encouragement accelerometer(Actigraph, Pensacola, FL, USA) daily step count、activity intensity(metabolic equivalent of tasks (MET)) 、exercise time(time spent on moderate physical activity) The program reduced the frequency of acute exacerbations of AECOPD and increased time to readmission, but did not improve physical activity and exercise tolerance at 12 months, although time spent exercising at more than moderate intensity was significantly increased compared with the control group Simmich et.al [ 100 ] (2021) Australia A randomized controlled trial 18,9/9 67.5 ± 6.5 Evaluating the effectiveness of using a video game co-designed with patients to improve patient motor behavior Interventions: activity monitor with real-time feedback on steps, heart rate + video games (including upper and lower extremity exercises) + patient communication platforms pedometer(Fitbit Inc) daily step count、exercising time(time spent on moderate physical activity) 、Adherence: Actual Completion/Planned Completion(Video Game Training Programs) The use of the game intervention was positively associated with changes in daily steps, but the intervention did not prevent the reduction in the number of steps taken by the patients, but the number of steps was reduced by 2% after the intervention in the test group compared to 12.5% in the control group Mihaltan et.al [ 101 ] (2021) Multicenter Cross-sectional survey studies 406,339/67 65.9 ± 8.5 Investigation on the level of exercise behavior and related influencing factors in stable people with COPD Questionnaire(the Exercise Vital Sign, EVS)、 (Yale Physical Activity Survey, YPAS) exercise time、energy expenditure、EVS、YPAS Influencing factors: Dyspnea, symptom burden (morning, daytime, and nighttime respiratory distress symptoms), severity of the disease, and frequency of exacerbations are obstacles to exercise behavior Schneider et.al [ 102 ] (2021) Brazil Cross-sectional survey studies 176,96/80 67.0 ± 7.9 A cross-sectional study on the relationship between body composition and exercise behavior in patients with moderate to severe COPD accelerometer(SenseWear® Armband BodyMedia, USA) daily step counts、activity intensity、exercise time(time spent on moderate physical activity) Influencing factors: Poor exercise ability, muscle strength and lung function, muscle atrophy and obesity are obstacles to high levels of exercise behavior Sritharan et.al [ 103 ] (2021) Denmark Cross-sectional survey studies 493,169/324 68.0 ± 8.3 A cross-sectional study on the obstructive factors of exercise behavior in people with COPD Self designed questionnaire Active at an intensity higher than the conversation limit for 20–30 min (sentences interrupted due to difficulty breathing) Low motivation, comorbidities, and fear of breathing difficulties are obstacles to exercise behavior Minakata et.al [ 104 ] (2021) Japan Cross-sectional survey studies 227,213/14 73.1 ± 6.7 A cross-sectional study on predictive factors of exercise behavior in people with COPD accelerometer(Active Style Pro HJA-750C, Omron Healthcare, Kyoto, Japan), activity diary(Paper-based) daily step count、activity intensity、exercise time(time spent on moderate physical activity) Physical function, dyspnea symptoms, anxiety, and lung function are predictive factors for exercise behavior, while age and BNP are related factors Mendoza et.al [ 105 ] (2021) Spain Cross-sectional survey studies 734,448/286 69.6 ± 8.7 A cross-sectional survey of exercise behavior levels and related factors in people with COPD in Latin America Questionnaire(the International Physical Activity Questionnaire-Short Form, IPAQ-SF) exercise frequency、exercise time、energy expenditure Older age, higher levels of respiratory distress, higher CAT scores, female gender, and higher frequency of exacerbation are obstacles to the level of exercise behavior Aguilaniu et.al [ 106 ] (2021) France Cross-sectional survey studies 1409,914/495 66.1 ± 9.1 Retrospective analysis of predictive factors for low exercise behavior levels in people with COPD Self designed questionnaire exercise time、activity intensity Reduced lung function, quality of life (CAT), COPD related disability tools (Direct) A higher mMRC score is a predictive factor for low levels of exercise behavior Pimenta et.al [ 107 ] (2021) Portugal Cross-sectional survey studies 92,76/16 67.4 ± 8.1 Cross sectional survey on promoting factors of exercise behavior in people with COPD accelerometer: Actigraph GT3X + (Actigraph Pensacola, Pensacola, FL, USA) daily step count、exercise time(time spent on moderate physical activity) There is no significant correlation between the intrinsic motivation and physical activity factors (such as difficulty breathing) of patients' exercise and their level of exercise behavior Carl et.al [ 108 ] (2021) Germany Retrospective survey study 350,240/110 58.2 ± 5.6 Exploring predictive factors of exercise behavior in people with COPD based on the Comprehensive Physical Activity Related Health Competence (PAHCO) model accelerometer(triaxial ActiGraph Pensacola, Florida wGT3X-BT) daily step count The three abilities of motor function, control, and self-regulation are predictive factors for exercise behavior in people with COPD, and motor function has the strongest significance AI Chikhanie et.al [ 109 ] (2021) France Retrospective survey study 190,89/101 66 Retrospective analysis of response trajectories of people with COPD participating in pulmonary rehabilitation programs Questionnaire(physical activity questionnaire) exercise frequency、exercise time、energy expenditure Home oxygen users, severe respiratory distress, and advanced age are obstacles to exercise behavior Brito et.al [ 110 ] (2021) Brazil Retrospective survey study 43,21/22 65 Retrospective analysis of the relationship between energy expenditure and high levels of exercise behavior in people with COPD accelerometer(the Sensewear® Armband (SAB)(BodyMedia, USA and the Dynaport® Activity Monitor,DAM McRoberts BV, The Hague, the Netherlands) exercise frequency、activity intensity、exercise time(time spent on moderate physical activity) High energy consumption is an important predictor of high exercise behavior, with an increase of 1000 cal per minute in energy consumption and an 18 fold increase in opportunities for high exercise behavior Koreny et.al [ 111 ] (2021) Spain Prospective observational studies 291,237/54 68.0 ± 8.0 Prospective investigation of the development pattern of exercise behavior in people with COPD and identification of decisive factors affecting exercise behavior development accelerometer(the Dynaport MoveMonitor McRoberts BV, The Hague, The Netherlands), Questionnaire(the Clinical-PROactive Physical Activity,C-PPAC) daily step count、activity intensity、exercise time(time spent on moderate physical activity) 59% of patients were non exercisers at baseline, and their level of exercise behavior gradually decreased thereafter; Lower education levels, lower social support (living alone, not taking care of grandchildren), and higher depression scores are associated with low levels of exercise behavior, while lower exercise ability and higher mMRC respiratory distress scores are independent influencing factors for low levels of exercise behavior Dragnich et.al [ 112 ] (2021) Holland Prospective observational studies 35,33/2 66.5 ± 8.5 Prospective survey on the influencing factors of changes in exercise behavior levels in people with COPD accelerometer(Omron HJ-720ITC pedometer Omron Healthcare, Inc; Bannockburn, Illinois), Questionnaire(the PASE questionnaire) daily step count、exercise frequency、exercise time Living with others (supported by social support) is a promoting factor for high levels of behavior, while advanced age and white people are hindering factors Benzo et.al [ 113 ] (2022) multicenter A randomized controlled trial 375,187/188 68.0 ± 9.5 To evaluate the role of motivational interview-based health coaching and tele-exercise supervision in improving self-health management in patients with COPD Intervention: activity monitor with real-time monitoring and feedback + step-by-step motor training program with video-guided exercises + weekly health education based on motivational interviewing and positive thinking intervention pedometer(Actigraph GT3X, Pensacola FL) daily step count daily walk count, self-management, and sleep improved in the intervention group; compliance with daily step reporting was 76% Chen et.al [ 114 ] (2022) China A randomized controlled trial 45,21/24 72.7 ± 9.65 To evaluate the effectiveness of a pedometer-based walking program to improve home exercise behavior in patients with COPD Intervention: wearing a pedometer + personalized walking goals updated weekly pedometer daily step count Significant improvements in lung function, daily steps, dyspnea scale, and quality of life at the end of the study, and an increase in daily steps was associated with greater improvements in dyspnea scale and symptom-related quality of life questionnaire scores, but no significant improvement in exercise capacity Cerdan-de-las-Heras et.al [ 115 ] (2022) Denmark A randomized controlled trial 54,27/27 69.9 ± 8.8 To evaluate the effectiveness of tele-exercise rehabilitation in improving exercise behavior in people with COPD Intervention: mobile software, including personalized exercise plan + heart rate detector with real-time upload and feedback + video communication and chat with physical therapy + motivational messages accelerometer(ActiGraph Monitor wGT38X-BT) 7-day pedometry、activity intensity(total vector magnitude counts per minute, VMCPM) 、Actual Completion or Participation/Planned Completion or Participation(exercise plan) There was no difference in quality of life, function in life activities, 7-day step count between the VAPA tele-rehabilitation group and traditional hospital rehabilitation, and the compliance was 82%, indicating that tele-rehabilitation is not inferior to traditional hospital rehabilitation in terms of sustained exercise capacity, patients' exercise tolerance, compliance, and satisfaction, and that there are no safety concerns Skibdal et.al [ 116 ] (2022) Denmark qualitative research 84,31/53 70.4 ± 9.0 Based on the theoretical domain framework (TDF), investigate the promoting and hindering factors of people with COPD participating in remote rehabilitation exercises (obtaining exercise plans, exercise knowledge guidance, and communication through video calls, phone calls, or text messages) from the perspective of people with COPD – Lack of motivation and COPD symptoms are the main reasons why patients refuse to participate; The qualitative research results show that there are four main themes regarding patients' attitudes towards exercise rehabilitation training: 1) convenience and flexibility of participation, 2) belief in abilities, 3) willingness to participate in PTR, and 4) thoughts and preferences towards PTR content Turner et.al [ 117 ] (2022) Canada qualitative research 12 70.3 Interview people with COPD in remote and rural areas using environmental photo method to investigate their exercise status and attitudes towards exercise in these areas – There are three main themes: 1) Pulmonary symptoms pose challenges to maintaining exercise behavior; 2) Maintaining activity is a valuable part of participants' lives; 3) The unique environment hinders the participation of participants in activities Kaptain et.al [ 118 ] (2022) Denmark qualitative research 8,4/4 73.5 Exploring how people with COPD experience and manage home exercise rehabilitation – There are three categories of themes: 1) The consequences of symptoms of chronic obstructive pulmonary disease (COPD causing breathing difficulties and fatigue that restrict movement); 2) Activity adjustment (adjusting elements such as motivation to maintain activity as much as possible); 3) Society and Environment Stevens et.al [ 119 ] (2022) Canada Cross-sectional survey studies 418,145/273 58.0 ± 8.0 Investigating the impact of environmental factors on exercise behavior in people with COPD Questionnaire(The International Physical Activity Questionnaire, IPAQ) IPAQ Influencing factors: The higher the self-rated health level, the lower the level of air pollution, and the higher the income and education level, the higher the level of exercise behavior Chen et.al [ 120 ] (2022) America Cross-sectional survey studies 274,92/182 57.3 ± 12.6 Investigating the relationship between health-related factors and exercise behavior levels in people with COPD Self designed questionnaire exercise frequency Influencing factors: Younger age, higher education level, less functional limitations, lower negative impact scores, and higher positive impact scores result in higher levels of exercise behavior; Health attitude and health assessment are predictive factors for high levels of exercise behavior Da Silva et.al [ 121 ] (2022) Brazil Cross-sectional survey studies 76,44/32 67.0 ± 8.0 A cross-sectional study on the daily exercise behavior of people with COPD and its correlation with healthy quality of life accelerometer(activPAL3TM, PAL Technologies Ltd., Glasgow, United Kingdom) daily step count、activity intensity、walking time、time spent on moderate physical activity Influencing factors: Age, motor function, and respiratory distress symptoms are obstacles to high levels of exercise behavior in people with COPD De Bontridder et.al [ 122 ] (2022) Belgium Cross-sectional survey studies 102,62/40 67.1 ± 7.8 A cross-sectional study on the impact of COPD symptoms on patients' exercise behavior levels Questionnaire(the Exercise Vital Sign, EVS)、 (Yale Physical Activity Surve, YPAS) exercise frequency、exercise time、energy expenditure Influencing factors: Respiratory symptoms are obstacles to the level of exercise behavior Bamonti et.al [ 123 ] (2022) America Retrospective survey study 253 70.0 ± 8.0 Exploring predictive factors for people with COPD' non participation, compliance, and completion of exercise rehabilitation training (consisting of supervised exercise and behavior change education, personalized and progressive fish hole program) Adherence: PR uptake (never starters),dropouts and completion Comparison between never starting and completing PR: the lower the cancer, pain, 6MWD, and mMRC respiratory distress scores, the lower the completion rate; Comparison between the two groups of quitting midway and completing PR: those with previous smoking history, higher mMRC scores, and poorer psychological status have a higher rate of quitting midway Aguilar et.al [ 124 ] (2022) Spain Retrospective survey study 70,50/20 69.6 Retrospective analysis of the influencing factors of poor exercise rehabilitation compliance in people with COPD after completing pulmonary rehabilitation trials (including aerobic training, skeletal muscle endurance, respiratory physical therapy, and education) Adherence: Actual Participation/Planned Participation Increased difficulty breathing, frequent acute exacerbations of COPD, and advanced age are obstacles to exercise behavior Wan et.al [ 125 ] (2022) America Retrospective survey study 98,94/4 69.8 ± 7.9 Retrospective analysis of the impact of body composition of people with COPD (who participated in an Internet mediated exercise behavior promotion intervention test) on the level of exercise behavior pedometer(Fitbit Zip (Fitbit, Inc.),Questionnaire(the CHAMPS Physical Activity Questionnaire) daily step count、exercise frequency、energy expenditure、exercise time(time spent on moderate physical activity) 、CHAMPS Obesity is a hindrance to the level of exercise behavior, while good exercise function is a promoting factor Spielmanns et.al [ 126 ] (2023) Germany A randomized controlled trial 67,34/33 64.0 ± 8.0 To evaluate the effectiveness of a smartphone app for maintaining exercise behavior in people with COPD after rehabilitation Intervention: personalized full-body workout + activity tracker to record feedback in real time + weekly updates on personalized activity goals + push reminders for the program + workout video learning package pedometer(POLAR A370 watch) Adherence: Actual Completion or Participation/Planned Completion or Participation(exercise plan) The comprehensive plan using the Kaia application significantly increased the daily step count of the intervention group, exceeding the minimum clinically significant difference, which helped maintain PA and improve symptoms in people with COPD at 6 months Valeiro et.al [ 127 ] (2023) Spain A randomized controlled trial 46,22/24 66.0 ± 10.0 Motivational Interviewing-Based Promotion of Exercise Exercise in Hospitalized people with COPD Interventions: motivational interviewing to facilitate a shift in the patient's decision-making balance to positive + pedometer and short-term personalized exercise goals + weekly phone calls for feedback, supervision and motivation accelerometer(Dynaport accelerometer) daily step count,exercising time(time spent on moderate or above physical activity) personalized physical activity programs based on motivational interviewing and pedometers increase patients' daily steps Midthun et.al [ 128 ] (2023) America qualitative research 15,9/6 70.6 Determine the influencing factors related to healthy exercise behavior in people with COPD based on COM-B model Focusing on three aspects that affect behavior change: abilities [C]—physical and psychological abilities, opportunities [O]—physical and social aspects of opportunities (such as sports facilities, family members, and psychological support from coaches), and motivation [M]—a common motivation is the desire to improve physical health and daily physical activity Papp et.al [ 129 ] (2023) Sweden qualitative research 15 63 Semi structured interviews with female people with COPD regarding their views and suggestions on physical activity and exercise The overall theme of the interview results is "I hope to successfully participate in sports activities and exercise"; Three categories, each containing 2 or 3 subcategories: 1) Strategies to overcome insecurity: Subcategories include ① "Accept challenges and change behavior", described as fear and insecurity about physical activity and exercise, including fear of making mistakes or getting injured. Patients also mentioned wanting to practice correctly, but also wanting repeated instructions and feedback. ② Perceived social support and meeting others "is a powerful motivating factor for patients to participate in physical exercise, as they hope to receive support from family members, instructors, and other participants; 2) The subcategories of facilitating and hindering living conditions include: ① "suppressed by their role": as a female social role, daily life focuses on taking care of family members; ② Environment and prerequisites ": including work and being a parent with children, interference from weather, climate, transportation, and exercising at home, and mentioning that children and pets can promote physical activity, with children being both obstacles and facilitators; ③ Developing the habit of physical activity and/or exercise ", patients believe that sports and exercise should be a part of their daily routine, with a certain degree of regularity and enjoyment; 3) Intrinsic motivation and self focus: Subcategories include ① "feeling hope and faith", which includes believing in one's own exercise ability and capacity, including maintaining exercise behavior; ② Pay attention to yourself, choose sports activities or exercise types that you enjoy, or do beneficial things for yourself while exercising, avoiding distractions from other things; ③ 'Experience and insights' include the subjects' physical activity and exercise history prior to intervention Marklund et.al [ 130 ] (2023) Sweden qualitative research 13,6/7 49–84 Exploring the attitudes and views of people with COPD towards using network-based remote rehabilitation (electronic learning packages with images, written information, videos, and pedometers) to improve their exercise behavior levels The theme is perceived control over society and the environment, including 1) welcoming or diswelcoming actions: ① feeling happy about sports activities (PA), ② Feeling happy about using electronic health tools, ③ lacking sufficient motivation for action; 2) Having or lacking resources: ① Properly managing the situation, ② hoping to obtain external support to create ability, ③ determining as having no behavioral capacity; 3) Lowering the threshold: Utilizing the environment or background as a means of participating in PA Correia et.al [ 4 ] (2023) Brazil Cross-sectional survey studies 28,14/14 68.0 ± 8.0 Can the results of a cross-sectional survey of exercise function tests in people with COPD predict their level of exercise behavior accelerometer(the DynaPort Move Monitor, DMM—McRoberts BV, the Netherlands) daily step count、activity intensity、walking time The correlation between motor function and motor behavior level Wang et.al [ 131 ] (2023) China Cross-sectional survey studies 223,186/37 72.4 ± 8.9 A cross-sectional study on the impact of exercise fear related to respiratory distress in people with COPD on their exercise behavior Questionnaire(The International Physical Activity Questionnaire, short-form, IPAQ-S) IPAQ-S Gender, marital status, disease duration, degree of respiratory distress (mMRC), respiratory distress related motor phobia, and level of exercise behavior are correlated; Movement perception has a positive direct impact on behavior, while respiratory distress related movement phobia has an indirect impact on behavior through movement perception Nakahara et.al [ 132 ] (2023) Japan Cross-sectional survey studies 406,309/97 70.2 ± 9.6 A cross-sectional survey was conducted to identify the factors contributing to low behavioral levels in people with COPD, and a neural network prediction model was established accelerometer(Omron) activity intensity Influencing factors: gender, number of cigarettes per day, age, Whole Body Phase Angle, respiratory distress symptoms, FEV1 of lung function,% RV/TLC、 Smoking years and BNP values Oostrik et.al [ 133 ] (2023) Canada Cross-sectional survey studies 1558,852/662 66.7 ± 9.8 A cross-sectional study on the relationship between symptom burden and exercise behavior in people with COPD Questionnaires(the Community Health Activities Model Program for Seniors, CHAMPS) exercise frequency、exercise time、energy expenditure Influencing factors: symptom burden score measured by CAT FEV1、 Winter, autumn, and past exercise habits Polo et.al [ 133 ] (2023) America Retrospective survey study 209,85/124 66.4 ± 10.7 Retrospective analysis of network remote exercise rehabilitation effect based on RE-AIM theory Adherence(Actual Completion/Planned Completion) This study added qualitative research to identify obstacles that affect patients' acceptance and compliance with PR, including: the patient's attending physician not introducing or recommending exercise training; The patient is aware of the potential benefits of exercise, but feels that their condition is severe and they are unable to exercise Bamonti et.al [ 134 ] (2023) America Retrospective survey study 212 69.0 ± 8.0 Retrospective evaluation of the correlation between depressive symptoms and changes in daily exercise steps in people with COPD before intervention accelerometer daily step count The high depression symptom score is associated with a decrease in the daily step count of patients Robinson et.al [ 135 ] (2023) America Retrospective survey study 239 66.7 ± 8.8 Assessing the impact of rural/urban disparities on web-based exercise self-management interventions pedometer(the Omron HJ-720 ITC) daily step count、Adherence(Actual Completion or Participation/Planned Completion) The intervention group (urban group) showed significant improvement in steps and participation compared to the control group Esteban et.al [ 136 , 137 ] (2023) Australia Prospective observational studies 68,38/30 69.2 ± 9.0 Longitudinal evaluation of exercise behavior levels during and after hospitalization in people with COPD with acute exacerbation accelerometer(wActiSleep-BT GT3X model Actigraph, Pensacola, FL, USA) daily step count、activity intensity、exercise time(walking time、time spent on moderate physical activity) The higher the level of exercise behavior during hospitalization, the more significant the improvement in behavior level after discharge; Patients who have been hospitalized for more than 5 days have lower levels of exercise behavior after discharge Stenlund et.al [ 138 ] (2024) Sweden A randomized controlled trial 146,77/69 69.5 ± 6.7 To evaluate the effectiveness of a web-based self-management support strategy for promoting physical activity levels in patients with COPD Intervention: web-based self-management support remotely + pedometer + weekly goal orientation + video, picture coaching pedometer daily step count Compared with conventional nursing combined with pedometers, the use of network-based self-management support and pedometers increases the objectively measured PA levels of people with COPD at 3 months Bamonti et.al [ 139 ] (2024) Brazil qualitative research 21,11/10 67 Using semi-structured interviews with people with COPD to explore the impact of emotional distress among American veterans on their participation in physical activity Five themes have been identified: knowledge about COPD and its management; Self cognition of people with COPD towards life; Knowledge and experience of depression and anxiety; Opinions on PA and the impact of COVID-19 Martins et.al [ 140 ] (2024) America qualitative research 29,26/3 67.7 ± 6.5 Exploring the psychological factors of people with COPD' participation in physical activity through semi-structured interviews COPD symptoms and physical limitations associated with COPD can affect their emotional distress experiences, which both promote and inhibit physical activity participation Breyer et.al [ 141 ] (2010) Australia A randomized controlled trial 60,30/30 60.3 ± 8.4 Evaluate the effectiveness of Nordic walking in improving daily physical activity in people with COPD Intervention: group outdoor walking + walking guidance accelerometer(DynaPort Activity Monitor; McRoberts BV; Den Haag, the Netherlands), activity diary(Paper-based) activity intensity、walking time Nordic walking is a feasible, simple, and effective physical training method in chronic obstructive pulmonary disease. In addition, Nordic walking has been shown to have a positive impact on the daily physical activity patterns of patients with chronic obstructive pulmonary disease in both short-term and long-term observations Open in a new tab Exercise behaviour assessment indicators and measurement tools Indicators of exercise behavior assessment The 118 quantitative studies included employed observable, measurable, and practical indicators to assess exercise behaviour, including step count, exercise duration, exercise frequency, exercise intensity, energy expenditure, and adherence. Daily step count was the most frequently used assessment metric. Exercise intensity and energy expenditure serve as indicators of exercise quality, with people with COPD typically recommended to engage in moderate-to-vigorous intensity exercise. Exercise adherence aids in measuring the feasibility and scalability of exercise programmes or protocols. Based on these practical indicators, exercise behaviour levels can be defined according to recommended thresholds from relevant guidelines. However, considerable heterogeneity exists in threshold classification across studies due to differences in the types of guidelines referenced and the target populations. One study [ 121 ] defined high-level exercise behaviour (i.e., active status) as 7000–8000 or more steps per day, derived from standardised classifications of exercise in people with COPD. Thirteen studies [ 6 , 40 , 62 , 70 , 71 , 75 , 77 , 81 , 104 , 105 , 110 , 119 , 122 ] defined " defined “active” as ≥ 150 min per week of moderate-to-vigorous intensity exercise OR ≥ 60 min per week of vigorous intensity exercise, derived from the US Physical Activity Guidelines for Adults and Younger Adults. Details are presented in Table 3 . Table 3. Breakdown of physical activity promotion strategies First author Motivational interviewing Goal setting Pedometer Remote support Education session Total behaviour change strategies Spielmanns √ √ √ √ 4 Valeiro √ √ √ √ 4 Benzo √ √ √ √ 4 Chen √ √ √ √ 4 Cerdan-de-las-Heras √ √ √ √ 4 Geidl √ √ √ 3 Armstrong √ √ √ 3 Wang.L √ √ 2 Robinson √ √ √ √ 4 Ko,F W √ √ 2 Simmich √ √ 2 Kohlbrenner √ √ √ 3 Fastenau √ √ 2 Bentley √ √ √ √ 4 Park √ √ √ √ 4 Wootton √ √ √ 3 Lahham √ √ √ √ √ 5 O'Neil √ √ √ √ 4 Arbillaga-Etxarri √ √ √ √ 4 de Roos √ √ 2 Nolan √ √ √ 3 Vorrink √ √ √ 3 Moy √ √ √ √ 4 Cruz √ √ √ 3 Burtin √ √ 2 kawagoshi √ √ 2 Altenburg √ √ √ 3 Mendoza √ √ √ 3 Hornikx √ √ √ 3 Tabak √ √ √ √ 4 Zwerink √ √ 2 Cameron √ √ √ 3 Pleguezuelos √ √ √ 3 Effing √ √ 2 Mador √ √ 2 Breyer √ √ 2 Berry √ √ √ 3 Hospes √ √ √ √ √ 5 Liu √ √ √ 3 Nguyen √ √ √ √ 4 Open in a new tab Measurement tools Among the studies included, exercise behaviour measurement tools comprised 43 types (26 objective and 17 subjective), with specific characteristics detailed in Fig. 4 . The former primarily referred to accelerometers and pedometers, while the latter mainly encompassed questionnaires and paper-based or exercise diaries. All exercise monitors employed in the studies underwent performance validation. Among these, the SenseWear Armband (SWA), Dynaport McRoberts BV, and ActiGraph wGT3X-BT represent widely used accelerometers (Activity Monitors), while the Digiwalker SW-2000, Omron HJ-720 ITC, and Fitbit Zip are prevalent pedometers. Pedometers offer relatively limited monitoring capabilities, typically measuring only step count, but they are more cost-effective than accelerometers, presenting a certain price advantage in clinical practice. The survey questionnaires employed assess patients' exercise behaviour levels through responses to items such as exercise type, frequency, and duration. However, these responses often carry a degree of subjectivity, as they require patients or their families to recall recent exercise patterns. The International Physical Activity Questionnaire, short-form (IPAQ-S), CHAMPS questionnaire, and C-PPAC questionnaire are widely applied, validated, and established survey instruments. Additionally, a significant proportion of studies develop their own questionnaire items, such as assessing exercise duration, frequency, and whether guideline recommendations are met. Fig. 4. Open in a new tab Exercise behaviour measurement tools for people with COPD Facilitators and barriers of exercise behavior Among the 92 studies excluding clinical intervention research (comprising 15 qualitative studies and 118 quantitative studies), we identified 44 barriers and 38 facilitators based on CFIR domains, categorised into five groups: intervention characteristics, external characteristics of implementation, internal characteristics, individual characteristics, and implementation processes. The intrinsic meanings of these categories and the number of mapped literature sources are detailed in Fig. 5 . Fig. 5. Open in a new tab Barriers and facilitators to exercise behaviour in people with COPD Category 1: Fundamental Characteristics of Intervention Programmes The first dimension of the CFIR primarily addresses the characteristics of intervention programmes developed for specific implementation settings, such as clinical treatments or educational initiatives. We identified seven enabling factors for intervention programmes, predominantly centred on the integration of programmes into daily routines (5/23). Conversely, expanding the target audience (4/23) emerged as a significant barrier. Category 2: External Factors External factors refer to economic, political, and social environmental elements influencing exercise behaviour or the implementation of exercise interventions. We identified two external facilitating factors and eight external hindering factors. Facilitators included favourable and warm weather (primarily during summer, 9/16) and higher socioeconomic status of residence (7/16). Hindrances were predominantly concentrated around the passage of time (6/23). These are summarised as three external factors beyond individual control: time, weather, and socioeconomic status. A higher socioeconomic status often signifies more comprehensive healthcare reimbursement systems, cleaner and more spacious exercise rehabilitation environments, more affluent rehabilitation equipment, and more convenient transport. These may well constitute the fundamental external conditions enabling people with COPD to both engage in and persist with exercise. Category 3: Internal Factors Internal factors refer to contextual elements within the organisation that influence exercise rehabilitation behaviour or the implementation of exercise interventions, such as organisational culture, structure, and networks. Internal facilitators encompass broad social support, including assistance from family members, peers, and healthcare or rehabilitation professionals. However, overprotection from family members (1/5) and significant financial burdens (4/5) may impede patients' exercise adherence. Category 4: Individual Characteristics The fourth dimension of the CFIR refers to the individual characteristics of the intervention or implementation process. Our review identified 16 facilitators and 29 barriers related to individual characteristics. Regarding facilitators, patients' perception of exercise benefits (9/65) emerged as a prominent enabler. Conversely, among barriers, poor exercise capacity (25/199), more severe dyspnoea symptoms (26/199), heavier disease burden (17/199), advanced age (16/199), and depression (11/199) were identified as significant impeding factors. Category 5: Implementation Process The final dimension of the CFIR concerns the process of implementing the intervention. We identified seven facilitators and four barriers. Prominent facilitators included patients receiving positive feedback from professionals (6/23) and progressive, personalised short-term exercise goals (5/23), whilst COPD exacerbations (9/15) emerged as a significant barrier. Interventions for promoting exercise behavior Forty randomised controlled trials (RCTs) promoting exercise behaviour in people with COPD were included. The intervention studies employed five behavioural change techniques: 1) motivational interviewing, 2) real-time feedback, 3) goal setting, 4) educational programmes, and 5) remote support. Each study combined at least two techniques, with goal setting being the most frequently used behavioural technique ( n = 34), followed by remote support ( n = 29), educational programmes ( n = 26), activity monitor/pedometer feedback ( n = 25), and motivational interviewing ( n = 12) (see Table 3 ). Intervention duration ranged from 8 weeks to 12 months: ≤ 8 weeks ( n = 11), 9 weeks to 6 months ( n = 19), and > 6 months ( n = 10). The longest intervention lasted 12 months, with follow-up periods spanning 8 to 24 months. The most frequently measured exercise behaviour variable in included RCTs was daily step count ( n = 31). Regarding intervention efficacy, among studies using daily step count as the exercise behaviour outcome, 20 reported a significant increase in daily step count among people with COPD compared to the control group. Although 11 others reported no significant difference in step count, they demonstrated an increase or maintenance relative to baseline within the group, suggesting a delay in the decline associated with time. Discussion Exercise behaviour refers to physical activities of varying intensities—light, moderate, and vigorous—but differs from mere physical activity in being more planned, organised, and purposeful, focusing on the exercise itself rather than daily living. Therefore, this scoping review examines exercise behaviour to systematically review how studies to date have measured and assessed exercise behaviour in people with COPD, mapping facilitators, barriers, and intervention strategies. The principal findings of our scoping review are as follows: 1) Exercise behaviour levels among people with COPD are low, commonly measured using objective tools such as activity monitors or pedometers, alongside subjective instruments like the IPAQ-S or CHAMPS questionnaire; the most prevalent assessment metric is daily step count; 2) Behavioural change is complex and influenced by multiple factors encompassing individual characteristics, intervention programme features, and the internal and external environments in which interventions are delivered; 3) Intervention studies employed two or more strategies, with goal setting being the most frequently utilised approach. It is undeniable that the exercise behaviour assessment indicators and measurement tools identified in our research partially overlap with those used for evaluating and measuring physical activity. Activity monitors, pedometers, and questionnaires such as the IPAQ-S are frequently employed to capture physical activity. This presents no contradiction, as we have already emphasised the similarity between the two in terms of exercise types. Our focus lies on exercise behaviour itself, hence the inclusion of both qualitative and quantitative studies centred on exercise. This approach allows our research to concentrate more sharply on behavioural aspects. Step count stands as the most prevalent metric for exercise behaviour assessment, largely owing to walking being the predominant form of exercise among people with COPD and the metric's objective measurability. In certain included randomised controlled. trials [ 96 , 113 , 115 , 126 ], intervention adherence was a commonly used outcome measure. However, the precise definition of adherence remains unclear; some studies referred to the ratio of participants who actually completed the intervention programme to those who were scheduled to complete it [ 96 , 113 ]. Other studies [ 67 , 123 ] employed the dropout rate from the rehabilitation programme. It is evident that our research once again demonstrates the lack of standardised measurement tools across studies. This stems from the inherent strengths and limitations of different measurement instruments. Activity monitors and pedometers can yield objective behavioural metrics, yet typically require continuous measurement over 7 or 14 days, recording total daily step counts/energy expenditure around the clock [ 66 , 113 , 115 ]. Some studies additionally require diaries to identify periods of non-wear [ 78 , 92 , 104 ] and abnormal events affecting activity levels, such as holidays or extreme temperatures. Consequently, these tools are time-consuming and costly, being more frequently employed in randomised controlled trials or small exploratory studies. Moreover, as real-time feedback tools, they facilitate patient self-monitoring and motivation. However, this motivational effect may inflate measured activity levels beyond actual behaviour [ 83 , 96 , 97 ]. Questionnaire-based measurement tools, being simple, low-cost, and easy to administer, are more widely employed in large-scale cross-sectional and longitudinal studies. However, questionnaire-based tools are inherently subjective due to the risk of recall bias among participants [ 88 , 133 ]. Furthermore, when scales are administered by physicians, results may be overestimated (physicians classified 54.4% as active vs. 23.9% by patients) [ 101 ]. To mitigate the respective shortcomings of subjective and objective measurement tools, research [ 107 ] suggests combining both approaches to assess people with COPD' behaviour. However, further investigation is required to determine how to reconcile the data discrepancies between these two methodologies. Exercise behaviour is characterised by its planned, organised and purposeful nature, aligning with the implementation essence of intervention measures. Therefore, to advance the translation of intervention measures into clinical practice, we summarised the factors influencing patient exercise behaviour according to an implementation framework. The CFIR theory [ 10 ] facilitates the identification and refinement of influencing factors, guiding targeted adjustments and enhancements to intervention measures. Based on CFIR theory, our study identified 82 factors categorised into five domains: intervention characteristics, outer setting, inner setting, individuals domain, and implementation process domain. Regarding intervention characteristics, exercise programmes should prioritise daily integration, including the everyday nature of exercise intensity and rhythm. Due to pulmonary function limitations, conventional-intensity exercise may exacerbate dyspnoea in people with COPD [ 118 ]. Consequently, the recommended exercise modality for such patients is typically regular activity [ 1 ], encompassing both formal exercise and daily routines such as housework and leisure pursuits. Interventions structured around daily rhythms can fulfil basic daily needs while providing exercise benefits, thereby better aligning with patient preferences [ 59 ]. Furthermore, educational outreach should extend to clinicians, patients' families, and community workers. Exercise programmes endorsed and encouraged by the attending physician typically yield higher patient motivation and adherence, with the converse also holding true [ 67 , 128 , 142 ]. However, some clinicians currently withhold exercise approval due to concerns about adverse events during activity, resulting in such patients often being in poorer health and more debilitated [ 87 ]. This may represent a critical educational gap concerning the relative benefits of exercise therapy, as most trials report no serious adverse events associated with exercise interventions [ 113 , 115 , 126 ]. Conversely, muscle atrophy and joint stiffness resulting from prolonged lack of appropriate exercise are inevitable consequences for patients. In terms of external setting characteristics, the passage of time, autumn and winter seasons, and lower socioeconomic status represent significant barriers to exercise behaviour among people with COPD [ 26 , 32 , 38 , 77 , 117 ]. Research indicates that daily step counts among people with COPD decrease progressively at an average annual rate of 451.0 steps, while compared to autumn and winter, a 1 °C temperature increase correlates with a 43-step rise in daily step counts, revealing pronounced seasonal movement pattern preferences [ 73 ]. This underscores the need for healthcare professionals to enhance collaboration with multiple stakeholder groups to mitigate adverse effects arising from time constraints, seasonal variations, and equipment shortages. In terms of inner setting characteristics, support from family members, peers and professionals constitutes a significant facilitator for exercise among people with COPD [ 37 , 59 , 111 , 129 , 130 ]. This support enhances patients' confidence and motivation for exercise while ensuring their safety. Within the individual domain, people with COPD' perception of exercise benefits—such as improved dyspnoea and reduced COPD exacerbations—can influence their decision-making towards initiating or maintaining exercise programmes [ 36 , 37 , 87 , 118 , 131 ]. Dyspnoea symptoms and disease burden constitute patient-related disease factors. Typically, patients limit physical exercise to avoid dyspnoea or disease exacerbation [ 46 , 59 , 93 , 111 , 113 , 116 , 118 ], thereby triggering a vicious cycle of worsening condition and reduced exercise. Furthermore, our research indicates that oxygen therapy constitutes one of the impeding factors. people with COPD receiving oxygen therapy exhibit fewer daily steps and reduced walking time compared to control groups [ 63 , 72 , 79 , 80 ], with oxygen therapy duration emerging as the strongest predictor of low exercise behaviour levels [ 76 ]. Evidently, increased oxygen therapy does not elevate exercise behaviour levels in people with COPD. This may relate to oxygen therapy increasing sedentary time and contributing to social isolation. Concurrently, anxiety demonstrated a weak positive association. Multiple studies [ 40 , 71 , 104 ] indicate anxiety correlates with low exercise behaviour in people with COPD, though this inhibitory effect disappears after adjusting for age and symptom severity. Nguyen et al. [ 31 ] found each one-point increase in HADS-A anxiety score corresponded to 288 additional daily steps in people with COPD; however, it remains unclear whether this elevated exercise behaviour represents a behavioural manifestation of anxiety or a coping mechanism. Within the final characteristic category—implementation—dynamic goal adjustment by intervention practitioners and timely feedback enhance adherence and facilitate programme execution. However, patients inevitably experience recurrent acute exacerbations of COPD, disrupting intervention continuity. Consequently, studies [ 27 , 118 ] incorporated management of dyspnoea symptoms and medication use to reduce acute episode frequency. As we did not conduct a meta-analysis, we cannot demonstrate the efficacy of behavioural interventions. However, our study: mapped behavioural intervention strategies for exercise in people with COPD, providing reference information for interventions. The vast majority of studies employed two or more behavioural techniques, including motivational interviewing, real-time feedback, goal setting, educational programmes, and remote support. The most frequently employed behavioural technique was goal setting, with intervention durations predominantly ranging from 9 weeks to 6 months. Personalised, dynamically updated goal-setting strategies facilitated by real-time feedback via remote technologies demonstrated significant behavioural improvements [ 115 , 127 ]. However, such behavioural intervention strategies rely heavily on patient compliance, including consistent wear of remote devices and a degree of technological proficiency. Concurrently, increased healthcare resources and manpower may be required. Consequently, subsequent research must address these barriers while further strengthening behavioural facilitators to ensure the effective implementation of behavioural intervention strategies. Advantages and limitations The PRISMA guidelines informed the reporting of this scoping review, employing a structured and transparent approach to conduct comprehensive database searches. Guided by an implementation framework, a broad range of study types were included to complement and strengthen findings, identifying assessment measures and tools for exercise behaviour in people with COPD, barriers and facilitators, and intervention strategies. However, several limitations of this study must be acknowledged. Firstly, given the nature of a scoping review, we did not analyse the reporting quality of included studies. Nevertheless, reliability was enhanced as two reviewers independently assessed all full-text reports against inclusion criteria, with only consistent findings being incorporated. Secondly, the inclusion of only English-language publications may have resulted in the omission of potentially relevant documents. Finally, the absence of quantitative comparisons in the analysis of behavioural intervention strategy effectiveness precludes clear identification of the significant role of behavioural improvement and the heterogeneity present between integrated intervention strategies. Future research exploring the efficacy of behavioural interventions could further investigate the optimal effectiveness of combined behavioural interventions. Conclusion Our systematic review examined studies on exercise behaviour among patients with chronic obstructive pulmonary disease (COPD). We found that patients' exercise behaviour levels were generally low, influenced by multiple barriers and facilitators, exhibiting complexity, while behavioural measurement tools demonstrated heterogeneity. Regarding behavioural improvement, comprehensive intervention strategies combining multiple behavioural interventions are commonly employed, yet studies on their clinical implementation are scarce. Future efforts should standardise clinical evaluation indicators and tools for exercise behaviour, clarify key factors influencing intervention implementation using the CFIR framework, and promote the clinical translation and long-term application of effective intervention strategies. Supplementary Information. Additional file 1. (123KB, pdf) Additional file 2. (104.7KB, pdf) Acknowledgements We thank the authors of the primary studies for providing their data. Contributions to the literature Implementing scientific strategy is a crucial aspect of promoting the dissemination and implementation of exercise rehabilitation management measures/programmes for people with COPD. Comprehensive literature reviews describing evaluation indicators, assessment tools, and barriers and facilitators for implementing behavioural interventions targeting exercise behaviour in people with COPD are limited. The implementation of exercise behaviour interventions for people with COPD is facilitated or hindered by the following factors: external factors、internal factors、individual characteristics and implementation process factors. Most existing behavioural intervention studies employ two or more behavioural techniques. Future research should consider implementing clearer strategies, adopting consistent behavioural indicators, and comprehensively examining both implementation barriers and facilitating factors. Authors’ contributions TH and LXQ conceived the research idea; TH, LXQ and CGH jointly designed the research protocol; TH and LYQ developed and tested the retrieval strategy; SHP and ZM executed the retrieval strategy; LXQ and LYQ reviewed all retrieved literature, screened studies meeting inclusion criteria, and extracted and analysed relevant content; TH and LXQ drafted the ‘Background’ section; TH and WQ drafted the ‘Methods’ section; TH and SHP authored the ‘Results’ chapter; TH, WQ and LYQ jointly authored the “Discussion” and ‘Conclusions’ chapters; all authors reviewed and approved the final manuscript; all authors acknowledge responsibility for their respective contributions and commit to ensuring that any issues concerning the accuracy or completeness of any part of the research (including non-directly involved sections) will be appropriately investigated, resolved, and documented within the literature. Funding This work was supported by Development Center for Medical Science & Technology, National Health Commission of the People's Republic of China (WKZX2023HK0102) and the Chongqing medical scientific research project (Joint project of Chongqing Health Commission and Science and Technology Bureau) (2025ZDXM010). The funder of this study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. Data availability Not applicable. Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Footnotes Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 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