{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T02:43:12Z","timestamp":1769049792766,"version":"3.49.0"},"reference-count":30,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,1,7]],"date-time":"2022-01-07T00:00:00Z","timestamp":1641513600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100008530","name":"European Regional Development Fund","doi-asserted-by":"publisher","award":["POCI-01-0145-FEDER-028806"],"award-info":[{"award-number":["POCI-01-0145-FEDER-028806"]}],"id":[{"id":"10.13039\/501100008530","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Portugal Inova\u00e7\u00e3o Social","award":["POISE-03-4639-FSE-000597"],"award-info":[{"award-number":["POISE-03-4639-FSE-000597"]}]},{"DOI":"10.13039\/501100001871","name":"Funda\u00e7\u00e3o para a Ci\u00eancia e Tecnologia","doi-asserted-by":"publisher","award":["PTDC\/SAU-SER\/28806\/2017"],"award-info":[{"award-number":["PTDC\/SAU-SER\/28806\/2017"]}],"id":[{"id":"10.13039\/501100001871","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001871","name":"Funda\u00e7\u00e3o para a Ci\u00eancia e Tecnologia","doi-asserted-by":"publisher","award":["UIDB\/04501\/2020"],"award-info":[{"award-number":["UIDB\/04501\/2020"]}],"id":[{"id":"10.13039\/501100001871","id-type":"DOI","asserted-by":"publisher"}]},{"name":"LabEx DRIIHM International Observatory Hommes-Millieux","award":["N.A"],"award-info":[{"award-number":["N.A"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Healthcare"],"abstract":"<jats:p>Pulmonary rehabilitation (PR) is an effective intervention for people with chronic respiratory diseases (CRD); however, its effects fade after 6\u201312 months. Community-based strategies might be valuable to sustain PR benefits, but this has been little explored. People with CRD, informal carers, and healthcare professionals (HCPs) were recruited from pulmonology appointments of two local hospitals, two primary care centres, and one community institutional practice and through snowballing technique. Focus groups were conducted using a semi-structured guide. Data were thematically analysed. Twenty-nine people with CRD (24% female, median 69 years), 5 informal carers (100% female, median 69 years), and 16 HCPs (75% female, median 36 years) were included. Three themes were identified: \u201cMaintaining an independent and active lifestyle\u201d which revealed common strategies adopted by people with \u201cintrinsic motivation and professional and peer support\u201d as key elements to maintain benefits, and that \u201caccess to information and partnerships with city councils\u2019 physical activities\u201d were necessary future steps to sustain active lifestyles. This study suggests that motivation, and professional and peer support are key elements to maintaining the benefits of PR in people with CRD, and that different physical activity options (independent or group activities) considering peoples\u2019 preferences, should be available through partnerships with the community, namely city councils.<\/jats:p>","DOI":"10.3390\/healthcare10010119","type":"journal-article","created":{"date-parts":[[2022,1,9]],"date-time":"2022-01-09T20:29:26Z","timestamp":1641760166000},"page":"119","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Long-Term Maintenance Strategies after Pulmonary Rehabilitation: Perspectives of People with Chronic Respiratory Diseases, Informal Carers, and Healthcare Professionals"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5984-4844","authenticated-orcid":false,"given":"Sara","family":"Souto-Miranda","sequence":"first","affiliation":[{"name":"Lab3R\u2014Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal"},{"name":"iBiMED\u2014Institute of Biomedicine, School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal"}]},{"given":"Cl\u00e1udia","family":"Dias","sequence":"additional","affiliation":[{"name":"Home Care Department, Linde Healthcare, 1200-217 Lisbon, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1151-8791","authenticated-orcid":false,"given":"Cristina","family":"J\u00e1come","sequence":"additional","affiliation":[{"name":"Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal"},{"name":"Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal"}]},{"given":"Elsa","family":"Melo","sequence":"additional","affiliation":[{"name":"iBiMED\u2014Institute of Biomedicine, School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4980-6200","authenticated-orcid":false,"given":"Alda","family":"Marques","sequence":"additional","affiliation":[{"name":"Lab3R\u2014Respiratory Research and Rehabilitation Laboratory, School of Health Sciences (ESSUA), University of Aveiro, 3810-193 Aveiro, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2022,1,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1016\/S2213-2600(20)30105-3","article-title":"Prevalence and attributable health burden of chronic respiratory diseases, 1990\u20132017: A systematic analysis for the Global Burden of Disease Study 2017","volume":"8","author":"Soriano","year":"2020","journal-title":"Lancet Respir. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e13","DOI":"10.1164\/rccm.201309-1634ST","article-title":"An Official American Thoracic Society\/European Respiratory Society Statement: Key Concepts and Advances in Pulmonary Rehabilitation","volume":"188","author":"Spruit","year":"2013","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_3","first-page":"CD003793","article-title":"Pulmonary rehabilitation for chronic obstructive pulmonary disease","volume":"2","author":"McCarthy","year":"2015","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_4","first-page":"CD006322","article-title":"Pulmonary rehabilitation for interstitial lung disease","volume":"2","author":"Dowman","year":"2021","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1177\/0269215518779122","article-title":"Short- and long-term effects of pulmonary rehabilitation for idiopathic pulmonary fibrosis: A systematic review and meta-analysis","volume":"32","author":"Cheng","year":"2018","journal-title":"Clin. Rehabil."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1177\/1479972315619574","article-title":"Walk2Bactive: A randomised controlled trial of a physical activity-focused behavioural intervention beyond pulmonary rehabilitation in chronic obstructive pulmonary disease","volume":"13","author":"Cruz","year":"2015","journal-title":"Chronic Respir. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1164\/rccm.201510-1966ST","article-title":"An Official American Thoracic Society\/European Respiratory Society Policy Statement: Enhancing Implementation, Use, and Delivery of Pulmonary Rehabilitation","volume":"192","author":"Rochester","year":"2015","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1111\/resp.13518","article-title":"Maintaining the benefits following pulmonary rehabilitation: Achievable or not?","volume":"24","author":"Spencer","year":"2019","journal-title":"Respirology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1038\/s41533-018-0085-7","article-title":"Facilitators and barriers to physical activity following pulmonary rehabilitation in COPD: A systematic review of qualitative studies","volume":"28","author":"Robinson","year":"2018","journal-title":"NPJ Prim. Care Respir. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1111\/hsc.12929","article-title":"Participants\u2019 experiences of the benefits, barriers and facilitators of attending a community-based exercise programme for people with chronic obstructive pulmonary disease","volume":"28","author":"Meshe","year":"2020","journal-title":"Health Soc. Care Community"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups","volume":"19","author":"Tong","year":"2007","journal-title":"Int. J. Qual. Health Care"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1097\/ACM.0000000000000388","article-title":"Standards for reporting qualitative research: A synthesis of recommendations","volume":"89","author":"Harris","year":"2014","journal-title":"Acad. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1080\/13814788.2017.1375091","article-title":"Series: Practical guidance to qualitative research. Part 3: Sampling, data collection and analysis","volume":"24","author":"Moser","year":"2018","journal-title":"Eur. J. Gen. Pract."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1093\/geront\/gnu177","article-title":"Informal Caregiving and Its Impact on Health: A Reappraisal from Population-Based Studies","volume":"55","author":"Roth","year":"2015","journal-title":"Gerontologist"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1080\/2159676X.2019.1704846","article-title":"To saturate or not to saturate? Questioning data saturation as a useful concept for thematic analysis and sample-size rationales","volume":"13","author":"Braun","year":"2021","journal-title":"Qual. Res. Sport Exerc. Health"},{"key":"ref_16","unstructured":"Braun, V., and Clarke, V. (2013). Successful Qualitative Research: A Practical Guide for Beginners, Sage."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1177\/1525822X16639015","article-title":"How Many Focus Groups Are Enough? Building an Evidence Base for Nonprobability Sample Sizes","volume":"29","author":"Guest","year":"2016","journal-title":"Field Methods"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual. Res. Psychol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1802","DOI":"10.1177\/1049732316654870","article-title":"Member Checking: A Tool to Enhance Trustworthiness or Merely a Nod to Validation?","volume":"26","author":"Birt","year":"2016","journal-title":"Qual. Health Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/1609406917733847","article-title":"Thematic Analysis: Striving to Meet the Trustworthiness Criteria","volume":"16","author":"Nowell","year":"2017","journal-title":"Int. J. Qual. Methods"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1164\/rccm.201505-0929CI","article-title":"Pulmonary Rehabilitation and Physical Activity in Patients with Chronic Obstructive Pulmonary Disease","volume":"192","author":"Spruit","year":"2015","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1164\/rccm.201609-1925ED","article-title":"Maintaining the Benefits of Pulmonary Rehabilitation. The Holy Grail","volume":"195","author":"Rochester","year":"2017","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"257","DOI":"10.2147\/COPD.S150650","article-title":"Efficacy of supervised maintenance exercise following pulmonary rehabilitation on health care use: A systematic review and meta-analysis","volume":"13","author":"Jenkins","year":"2018","journal-title":"Int. J. Chronic Obstr. Pulm. Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e12530","DOI":"10.1111\/ijn.12530","article-title":"Self-determined motivation and exercise behaviour in COPD patients","volume":"23","author":"Cho","year":"2017","journal-title":"Int. J. Nurs. Pract."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1183\/13993003.01744-2015","article-title":"Interventions to modify physical activity in patients with COPD: A systematic review","volume":"48","author":"Mantoani","year":"2016","journal-title":"Eur. Respir. J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1800063","DOI":"10.1183\/13993003.00063-2018","article-title":"Long-term efficacy and effectiveness of a behavioural and community-based exercise intervention (Urban Training) to increase physical activity in patients with COPD: A randomised controlled trial","volume":"52","author":"Balcells","year":"2018","journal-title":"Eur. Respir. J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"106353","DOI":"10.1016\/j.rmed.2021.106353","article-title":"Behavioural modification interventions alongside pulmonary rehabilitation improve COPD patients\u2019 experiences of physical activity","volume":"180","author":"Armstrong","year":"2021","journal-title":"Respir. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/S1836-9553(12)70110-8","article-title":"People with COPD perceive ongoing, structured and socially supportive exercise opportunities to be important for maintaining an active lifestyle following pulmonary rehabilitation: A qualitative study","volume":"58","author":"Hogg","year":"2012","journal-title":"J. Physiother."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1164\/rccm.201603-0602OC","article-title":"Benefits of Long-Term Pulmonary Rehabilitation Maintenance Program in Patients with Severe Chronic Obstructive Pulmonary Disease. Three-Year Follow-up","volume":"195","author":"Cejudo","year":"2017","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_30","first-page":"1","article-title":"A qualitative study of patient and carer experiences with home respiratory therapies: Long-term oxygen therapy and home mechanical ventilation","volume":"7","author":"Caneiras","year":"2021","journal-title":"Pulmonology"}],"container-title":["Healthcare"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9032\/10\/1\/119\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T13:27:05Z","timestamp":1760362025000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9032\/10\/1\/119"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,7]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,1]]}},"alternative-id":["healthcare10010119"],"URL":"https:\/\/doi.org\/10.3390\/healthcare10010119","relation":{},"ISSN":["2227-9032"],"issn-type":[{"value":"2227-9032","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,7]]}}}