Exercise Adherence in Chronic Obstructive Pulmonary Disease: Review of Current Evidence from the Netherlands

Main Article Content

Ellen Ricke, PhD


Chronic obstructive pulmonary disease is one highly prevalent chronic disease that demands increasing care; it is already the third leading cause of death worldwide. There is accumulating evidence that in patients with chronic obstructive pulmonary disease pulmonary rehabilitation is effective in improving the prognostic risk factor profile and in delaying mortality. In order to benefit from pulmonary rehabilitation, exercise adherence plays a crucial role. The present review discusses the current evidence on exercise adherence in chronic obstructive pulmonary disease and provides practical tips for assessing and adopting strategies to improve adherence in the Dutch context.

Studies from the Netherlands identify varying rates of exercise adherence depending on the complexity of the disease, such as comorbidities, and its treatment. Multiple factors determine exercise adherence in chronic obstructive pulmonary disease. In the Netherlands, factors such as perceived behavioral control, self-efficacy, exercise history, motivation, education, physical health, comorbidities, depressive symptoms and fatigue determine exercise adherence.

The Dutch version of the Rehabilitation Adherence Measure for Athletic training and a prediction model, the Predicting Adherence in paTients with CHronic diseases tool, can be used to identify poor adherence. Improving exercise adherence requires a multifaceted approach with strategies targeting healthcare providers, patients and healthcare systems. In the Dutch context, raising awareness of the patient’s context, emphasizing the importance of the patient-therapist relationship, providing clearer information, and enhancing social support within the patient’s environment are essential for improving exercise adherence and chronic obstructive pulmonary disease control.

Article Details

How to Cite
RICKE, Ellen. Exercise Adherence in Chronic Obstructive Pulmonary Disease: Review of Current Evidence from the Netherlands. Medical Research Archives, [S.l.], v. 12, n. 2, feb. 2024. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/5116>. Date accessed: 22 july 2024. doi: https://doi.org/10.18103/mra.v12i2.5116.
Research Articles


1. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. Dec 15 2012;380(9859):2095-128. doi:10.1016/s0140-6736(12)61728-0
2. Stolz D, Mkorombindo T, Schumann DM, et al. Towards the elimination of chronic obstructive pulmonary disease: a Lancet Commission. The Lancet. 2022;400(10356):921-972. doi:10.1016/S0140-6736(22)01273-9
3. FIRS. The global impact of respiratory disease. 2021. https://www.firsnet.org/images/publications/FIRS_Master_09202021.pdf
4. GOLD. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. 2023. https://goldcopd.org/2023-gold-report-2/
5. Vzinfo.nl. COPD. Accessed November 22, 2023. https://www.vzinfo.nl/copd
6. RIVM. Maatschappelijke kosten voor astma, COPD en respiratoire allergie. [Social costs of asthma, COPD and respiratory allergy]. 2012. https://www.rivm.nl/bibliotheek/rapporten/260544001.pdf
7. Spruit MA, Singh SJ, Garvey C, et al. An Official American Thoracic Society/European Respiratory Society Statement: Key Concepts and Advances in Pulmonary Rehabilitation. Am J Respir Crit Care Med. 2013;188(8):e13-e64. doi:10.1164/rccm.201309-1634ST
8. Griffiths R, Jones A, Davies H, Mitra R. An observation of the predictors of patient adherence and performance in a multidisciplinary regional cardiac rehabilitation programme. Conference Abstract. Heart. 2020;106(SUPPL 2):A35-A36. doi:10.1136/heartjnl-2020-BCS.42
9. Winkelmann J, Williams GA, Rijken M, Polin K, Maier CB. Chronic conditions and multimorbidity: skill-mix innovations for enhanced quality and coordination of care. In: Maier CB, Kroezen M, Wismar M, Busse R, eds. Skill-mix Innovation, Effectiveness and Implementation: Improving Primary and Chronic Care. Cambridge University Press; 2022:152-220. European Observatory on Health Systems and Policies.
10. Zeilstra A, den Ouden A, Vermeulen W. Middellangetermijn- verkenning zorg 2022-2025. [Medium-Term Care Exploration 2022-2025]. Accessed November 22, 2023. https://www.cpb.nl/sites/default/files/omnidownload/CPB-Middellangetermijnverkenning-zorg-2022-2025-nov2019.pdf
11. Holman H, Lorig K. Patient self-management: a key to effectiveness and efficiency in care of chronic disease. Public Health Rep. May-Jun 2004;119(3):239-43. doi:10.1016/j.phr.2004.04.002
12. Bakker JH. Therapietrouw; van ervaren belang naar gedeeld belang. 2016. [Therapy adherence; from perceived importance to shared importance. 2016]. Accessed December 30, 2023. https://zoek.officielebekendmakingen.nl/blg-671330.pdf
13. Allegrante JP, Wells MT, Peterson JC. Interventions to support behavioral self-management of chronic diseases. Annu Rev Public Health. 2019;40:127-146. doi:10.1146/annurev-publhealth-040218-044008
14. WHO. WHO Guideline on Self-Care Interventions for Health and Well-Being. WHO Guideline on Self-Care Interventions for Health and Well-Being. World Health Organization; 2021.
15. Sabaté E. Adherence to long-term therapies. Evidence for action World Health Organization; 2003.
16. Wiecek E, Tonin FS, Torres-Robles A, Benrimoj SI, Fernandez-Llimos F, Garcia-Cardenas V. Temporal effectiveness of interventions to improve medication adherence: a network meta-analysis. PLoS One. 2019;14(3). doi:10.1371.journal.pone.0213432
17. Meichenbaum D, Turk D. Facilitating treatment adherence. Plenum; 1987.
18. Clark H, Bassett S, Siegert R. Validation of a comprehensive measure of clinic-based adherence for physiotherapy patients. Physiotherapy. 2018;104(1):136-141. doi: 10.1016/j.physio.2017.07.003
19. Ricke E, Dijkstra A, Bakker EW. Prognostic factors of adherence to home-based exercise therapy in patients with chronic diseases: A systematic review and meta-analysis. Front Sports Act Living. 2023;5:1035023. doi:10.3389/fspor.2023.1035023
20. Ricke E, Dijkstra A. Determinants of Exercise Adherence in a Prospective Cohort Study of Patients with Chronic Obstructive Pulmonary Disease: An Application of the Theory of Planned Behavior and the Concept of Alliance. Medical Research Archives. 2023;11(8). doi: https://doi.org/10.18103/mra.v11i8.4346
21. Stone AA, Shiffman S, Schwartz JE, Broderick JE, Hufford MR. Patient compliance with paper and electronic diaries. Control Clin Trials. Apr 2003;24(2):182-99. doi:10.1016/s0197-2456(02)00320-3
22. Yuen HK, Wang E, Holthaus K, et al. Self-reported versus objectively assessed exercise adherence. Am J Occup Ther. Jul-Aug 2013;67(4):484-9. doi:10.5014/ajot.2013.007575
23. Yang CC, Hsu YL. A review of accelerometry-based wearable motion detectors for physical activity monitoring. Sensors (Basel). 2010;10(8):7772-88. doi:10.3390/s100807772
24. Brewer BW, van Raalte JL, Peptitpas AJ, et al. Preliminary psychometric evaluation of a measure of adherence to clinic-based sport injury rehabilitation. Physical Therapy in Sport. 2000;1:68-74.
25. Granquist M, Gill D, Appaneal R. Development of a Measure of Rehabilitation Adherence for Athletic Training. Journal of Sport Rehabilitation. 2010;19(3):249-267.
26. Ricke E, Bakker E. Measuring Adherence in Clinic-Based Physiotherapy; A Study of the Inter-Rater Reliability of A Dutch Measurement. International Journal of Physiotherapy and Rehabilitation. 2019;5(1)
27. Ricke E, Lindeboom R, Dijkstra A, Bakker EW. Measuring Adherence to Pulmonary Rehabilitation: A Prospective Validation Study of the Dutch Version of the Rehabilitation Adherence Measure for Athletic Training (RAdMAT-NL). Patient Prefer Adherence. 2023;17:1977-1987. doi:10.2147/ppa.S423207
28. American College of Medicine. ACSM's Guidelines for Exercise Testing and Prescription. Lippincott Williams & Wilki; 2021.
29. Ricke E, Bakker E. Development and validation of a multivariable exercise adherence prediction model for patients with COPD: a prospective cohort study. Int J Chron Obstruct Pulmon Dis. 2023;18:385-398. doi:10.2147/COPD.S401023
30. Hall AM, Ferreira PH, Maher CG, Latimer J, Ferreira ML. The influence of the therapist-patient relationship on treatment outcome in physical rehabilitation: a systematic review. Physical Therapy 2010;90(8):1099-1110. doi:10.2522/ptj.20090245
31. Gordon C, Beresin EV. The doctor-patient relationship. In: Stern TA, Fava M, Wilens TE, et al., eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 2nd ed. Elsevier Health Sciences; 2016:1-7.
32. Chipidza FE, Wallwork RS, Stern TA. Impact of the Doctor-Patient Relationship. Prim Care Companion CNS Disord. 2015;17(5). doi:10.4088/PCC.15f01840 PMC4732308,
33. Bassett S. Measuring Patient Adherence to Physiotherapy. Journal of Novel Physiotherapies. 2012;2(7). doi:10.4172/2165-7025.1000e124