Abstract
Introduction: People with chronic breathlessness have limited opportunities to maintain exercise following pulmonary rehabilitation. Walking football, with its growing popularity and reduced pace, was identified as the potential basis for an exercise-maintenance intervention.Aim: To develop a walking football intervention tailored for people with chronic breathlessness.
Methods: Two phases of development were implemented: (1) initial and (2) applied development. Phase one (March 2021 – July 2023) began with three narrative reviews of the literature regarding chronic breathlessness, walking football, and intervention development frameworks. A mixed-methods systematic review (August 2021 – July 2023) with meta-aggregation and meta-analysis followed to determine the impact of sport for people with chronic breathlessness. The intervention was developed via patient/public involvement and engagement with key-stakeholders (healthcare professionals, walking football players and coaches, and the Walking Football Association), and feedback from a public involvement group comprising of 12 people with chronic breathlessness who took part in four walking football “taster sessions”.
Phase two (January 2023 – December 2023) consisted of three primary research studies. The first involved the application of the walking football intervention within a mixed-methods “proof of concept” study (January 2023 – August 2023); six participants were recruited following completion of their respective pulmonary rehabilitation programmes. Recruitment rates, adverse events, adherence, pre-post health outcomes (functional exercise capacity, lower limb strength, balance/balance confidence, quality of life, symptom burden, anxiety, depression), physiological demand, and interview data was collected. For the second study (July – August 2023), the public involvement group from phase one were interviewed to understand why they chose to help develop the walking football intervention and their preferred approaches to public involvement in research. For the final study (September 2023 – December 2023), focus groups with six stakeholders and 15 potential service users were conducted to understand potential barriers concerning the long-term acceptability and sustainability of the intervention. All qualitative data was analysed via template-thematic analysis and quantitative data was reported descriptively.
Results: The three narrative reviews, systematic review, and comprehensive public involvement activities supported the rationale that suitable exercise-maintenance options are needed following pulmonary rehabilitation, and that sport (including walking football) can provide the basis for such an intervention if it is tailored to the specific needs of the population. Behavioural theory suggested techniques such as demonstration of the behaviour, habit formation, and self-identification as a role model would promote uptake and adherence. Through the public involvement process, walking football was made exclusive to people with chronic breathlessness and tailored to promote social-inclusivity.
Recruitment to the proof-of-concept study was challenging, the primary reason being a combination of: the distance to the sports hall being perceived as too far away, being unable / uncomfortable travelling on public transport to cater for such distances, and dedicated transport (such as taxis) not being provided (recorded in 81% of pulmonary rehabilitation sessions visited); however, adherence was high for those who managed to participate, with 83% of participants attending at least four of the six sessions initially offered. One adverse event was witnessed but this was unrelated to the intervention. All pre-post health measures recorded were maintained or improved. Mean heart rate was recorded at 66% of estimated max across a single football session. Through interviews participants maintained that exclusivity was fundamental to the success of walking football, and that the emphasis on creating an enjoyable intervention promoted long-term sustainability. The public involvement group described a heightened sense of purpose though their engagement in research and they relished the opportunity to help others. Stakeholder and service user focus groups acknowledged an immediate need for more supporting staff to assist with coaching sessions, however, finding such staff could prove difficult given how uniquely tailored the intervention has become.
Conclusions: Walking football can provide the basis for an exercise-maintenance intervention if it is tailored to the needs of people with chronic breathlessness. Such requirements include: exclusivity to people with breathlessness-symptoms, reduced physicality and competitiveness in favour of inclusivity and enjoyability, and initial assistance with traveling to the community venue. Future research should prioritise improving the transition from pulmonary rehabilitation to exercise-maintenance programmes, and whether providing dedicated private transport to bolster recruitment could be made economically viable.
| Date of Award | 26 Aug 2025 |
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| Original language | English |
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| Supervisor | Samantha Harrison (Supervisor), Kirsti Loughran (Supervisor) & Denis Martin (Supervisor) |