Assessing Lifestyle Goal Setting in Patients with COPD

Purpose: Healthy lifestyle changes can reduce symptoms and slow disease progression in patients with chronic obstructive pulmonary disease (COPD). To tailor strategies supporting long-term behavior change, this study investigated patients’ willingness to set lifestyle goals during personalized counseling. Goal focus and content, goal adjustments over time, reasons for unwillingness, barriers and facilitators, and differences between goal setters and non-goal setters were also examined. Patients and Methods: As part of an ongoing randomized controlled trial (NCT03807310), patients received monthly phone calls over 12 months, offering lifestyle counseling on diet and physical activity (PA) using motivational interviewing. Data were analyzed for a subset of patients who had completed the trial by 12 February 2025. Baseline trial data were used for patient characterization, and counseling notes were analyzed to assess willingness and factors affecting goal setting. Results: Data from 103 patients (61.2% male, mean age 68.3± 6.5 years, body mass index 26.3± 4.9 kg/m 2 , FEV1 56.6± 18.1% predicted), were analyzed. Overall, 71% were willing to set lifestyle goals, most often focused on PA. About one-quarter adjusted their goals during follow-up due to achievement or health complaints (PA) and previous unsuccessful attempts (diet). Patients unwilling to set goals mainly reported satisfaction with current habits or no perceived need for change. Experienced facilitators included accountability and favorable weather (PA) and visual reminders, social support, and seasonal influences (diet). Barriers were mainly health complaints (PA) and low motivation (diet). No differences were found between goal setters and non-goal setters in demographic, physiological, lifestyle or motivational characteristics. Conclusion: A majority of patients with COPD were willing to set lifestyle goals, particularly related to PA, but satisfaction with current behaviors and health-related barriers often limited engagement. These findings provide input for the design of future interventions to support sustainable lifestyle change in COPD care. Plain Language Summary: People with chronic obstructive pulmonary disease (COPD) often benefit from healthy lifestyle changes, such as being more active and improving their diet. These changes can reduce symptoms and help slow disease progression. However, patients may need support to make lifestyle changes by breaking them into manageable steps, or “goals”. This study looked at how willing patients with COPD were to set goals concerning changes in lifestyle when offered personalized counseling over the phone. Patients received monthly calls for 12 months, focusing on physical activity and diet, using supportive conversation techniques to encourage behavior change. Notes from these calls were analyzed to understand goal setting, reasons for reluctance, and factors that helped or hindered progress. Among 103 patients, about 7 out of 10 were willing to set goals, most often related to physical activity. Some patients adjusted their goals during the study due to achieving or struggling with initial goals, or because of health issues. Those who did not want to set goals usually felt satisfied with their current habits or saw no need to change. Factors that helped patients work on their goals included, for example, accountability (eg, a dog that needs walking) and social support, while barriers included health complaints and low motivation. These results show that most patients are willing to set goals, but satisfaction with current habits and health challenges can limit engagement. Understanding these factors can help healthcare providers improve programs to encourage sustainable lifestyle changes and improve quality of life for people with COPD. Keywords: chronic respiratory disease, physical activity, nutrition, behavior change, counseling