Implementing the intervention
nausea, dyspnea, PA behavior, chest pain, dizziness, bad emotions, TTM, COPD
COPD, DISEASE, BEND

Motivational interviewOn the first day of admission, the nurse introduced the ward environment and the purpose of the study to the patient and her family, obtained the patient’s consent and cooperation, and signed the informed consent form. The patient’s medical history, PA status and other information related to the disease were inquired. Subsequently, patients were provided with customized health education manuals, including the epidemiology, risk factors, disease symptoms and clinical manifestations of COPD. We assessed the stages of PA behavior change in COPD patients according to the Transtheoretical Model model (TTM). TTM stages include Precontemplation, Contemplation, Preparation, Action, Maintenance. TTM is a successful framework for guiding behavior change programs for several health behaviors. The type, duration, and intensity of the PA should be geared towards which stage the individual finds themselves in at the time. One-on-one motivational interview was used to assess the patients' current behavior change stage: in the pre-intention/intention stage, the health education of PA knowledge should be continued to be strengthened; in the preparation/action phase, nurses should help patients develop an action plan and provide information support.
Assess physical activityAt the study visit, we used the International Physical Activity Questionnaire (IPAQ) to assess the past and current PA history of patients, including the type, intensity, time and frequency of activity, and to understand the daily activity level of the patients; introduce the definition of PA and SB, the benefits of PA to health and the dangers of prolonged sedentary behavior to patients and their families, correct their incorrect perception, and establish a correct concept of disease. In addition, we should pay more attention to the psychological nursing of patients, understand the possible concerns of patients and their families in activities, strengthen psychological counseling for their bad emotions, and guide patients to master the skills to relieve psychological stress, such as listening to soothing music, reasonable exercise, mindfulness meditation practice, and planting green flowers.
Make a planAccording to the PA assessment results and lung function status at baseline, COPD patients were divided into a moderate- and vigorous-intensity group and a low-intensity group. Individual PA levels were classified according to criteria developed by the IPAQ group (see Exercise prescription.
Set a goal(I) Short-term goal: patients in the low-PA group might start with low-intensity PA (for example, walking at a leisurely pace, riding a bike on flat ground and lifting light weights) and gradually increase the intensity of exercise; patients in the moderate- to high-intensity PA group recommended performing moderate-intensity exercise (brisk walking) at least 5 days a week. (II) Long-term goal: All patients’ daily walking time increased, sedentary time decreased, dyspnea improved, and cardiopulmonary function and quality of life improved.
Implement exercise prescriptionIn the first week after discharge, exercise guidance was provided by the exercise rehabilitation therapist, and the patients in the moderate and vigorous PA groups received comprehensive training combined with aerobic exercise and resistance exercise. Patients in the low PA group only performed aerobic exercise; both groups performed warm-up and relaxation training for 5–10 min before and after exercise. Walking was recommended as the main training method of aerobic exercise. The workout session should last between 25 and 60 min with a frequency of 3–5 times every week. Resistance exercise is recommended to use an elastic band, mainly for the upper limbs, including three movements: standing front horizontal lift, arm bend lift in the standing position and chest push in the sitting position. Each movement lasts approximately 3 s, repeated 10–15 times as a set, for a total of 2 sets. The interval between the sessions was 2 min and 3 times a week.
Exercise monitoring and safety precautions(I) Explain the safety precautions related to the activities to the patients and their families in detail. Stretching and relaxation training can be performed before and after exercise. The duration was 5–10 min, and a slight stretching sensation was dominant. If the patient is over 75 years old and has poor physical fitness, it is best to be accompanied by a family member. (II) Identify the signs of termination of exercise: once a patient has chest pain, dyspnea (modified Borg dyspnea scale > 5 points), dizziness, nausea and vomiting, pallor, sweating, resting heart rate above 120 beats per minute, systolic blood pressure ≥ 180 mmHg and/or diastolic blood pressure > 100 mmHg (1 mmHg = 0.133 kPa), SpO
Regular follow-upAfter discharge, the patients were followed up by telephone or WeChat (that is a smartphone application) every week for 15–20 min for 12 weeks. The main contents of follow-up included asking the patient about the activity history of the past week, assessing whether the patient's exercise goal had been completed, reminding the patient to continue exercising, recording the results on the follow-up form, and giving feedback in a timely manner.