Levels of activity go up and down, my lungs do not stay the same all the time … you can’t just say this regimen is going to work, because in three weeks three hours, your breathing could be completely different. The routine and peer support of structured exercise sessions were helpful for motivating participants to overcome some of the barriers to activity imposed by chronic ill health. There’s a time in the week when you’re going to be there so it doesn’t matter what you feel like, you’re going to do it … You’re

gonna go there, so you’ve got motivation. Our findings suggest that people with COPD perceive peer and professional exercise-focused support to be important for maintaining an active lifestyle after pulmonary rehabilitation. This complements previous qualitative studies where a need for ongoing but less comprehensive Epigenetics inhibitor rehabilitation has been articulated GSK126 nmr (Toms and Harrison 2002, Wilson et al 2007). The importance of routine and social reinforcement within the exercise setting is also supported by previous research in general populations (Dishman et al 1985). While our study was in progress, Lewis and Cramp (2010) published their qualitative

exploration of facilitators and barriers to exercise maintenance amongst six pulmonary rehabilitation graduates, identifying comparable themes of peer and professional encouragement, health status and environment. Adding to these

findings, our study sampled a larger group and aimed to explore more deeply the rationale underpinning identified factors. Confidence featured within several themes in the current study. Participants identified pulmonary rehabilitation as instrumental in enhancing physical activity participation by improving confidence to manage breathlessness and reducing fear of activity, reflecting the findings of Williams and colleagues (2010). Potential difficulties with continued PDK4 activity were believed to be surmountable given access to structured exercise with social integration among peers and skilled staff. Our data suggest this desire for exercise opportunities after pulmonary rehabilitation is related to the confidence of individuals with COPD to continue with behaviours adopted during pulmonary rehabilitation. Although ‘confidence’ is a nonspecific term referring to strength of belief, it is an important component within the construct of perceived self-efficacy – the belief in one’s ability to succeed in a specific situation (Bandura 1997). Low self-efficacy for coping with exertional breathlessness develops commonly in COPD (Wigal et al 1991). Our findings, and those of Williams and colleagues (2010), suggest pulmonary rehabilitation participation can redress this negative influence on physical activity.