Codesign of balance training for people with chronic obstructive pulmonary disease (pwCOPD)

<bold>Introduction:</bold> Falls are a complex problem and common in pwCOPD due to poor balance. Codesign to develop complex interventions can improve engagement and effectiveness but is often omitted. <bold>Aim:</bold> To codesign balance training for pwCOPD. <bold>Methods:</bold> A sequential, codesign process was undertaken with experts by experience (EE) (pwCOPD and carers) and health and exercise professionals (HEP). Evidence were presented and reviewed in workshop/survey 1 (EE=10, HEP=22) resulting in a beta-prototype of the intervention. In workshop/survey 2 (EE=10, HEP=35) a refined alpha-prototype was produced. The COM-B and Theoretical Domains Framework (TDF) were applied to findings and to select active intervention ingredients (Behaviour Change Techniques [BCTs]. <bold>Results:</bold> Balance training should be offered to people at risk of falls, post pulmonary rehabilitation, as a fun activity in the community. Home-exercises should be incorporated into daily routines. Including proprioception and strength training, negotiating obstacles, back chaining and falls prevention was advised. EE emphasised the importance of peer-support, enjoyment, and time to socialise. Location, time of day and cost were potential barriers. HEP recommended goal-setting and incentives. Important outcomes included walking endurance, steadiness, quality of life, balance confidence and mental health, assessed as EE self-reflection or reported as statistics. TDF domains included: environmental context and resources and social influences. >18 BCTs were selected, most frequently credible source and social support. <bold>Conclusion:</bold> Codesigned balance training addresses key barriers to engagement which increases the likelihood that it is acceptable and feasible.