Supplement prediction model 135 influenced by interpretations from a variety of sources combined. That is, with every episode individuals have thoughts, emotions, feelings, and sensations related to exercise. Each exercise episode adds new information to existing information that include previous exercise experiences, media messages, healthcare providers recommendations, and society. Using the aggregate of this information, patients may alter goals and change their behaviors [27]. For patients, an intervention based on this theoretical model may offer advantages over interventions based on TPB. TPB assumes general interpretations (attitude about exercise) whereas selfregulation assumes the process of establishing these general interpretations (episode-specific interpretations). Because episode-specific interpretations are immediate, they can be changed more readily than general interpretations, making episode-specific interpretations a prime target for intervention. Patients general attitude about exercise (e.g., exercise is good for your health), and episode-specific interpretations (thinking more dyspnea during exercise is harmful) influence exercise adherence. Where general attitude influences exercise via intention, episode-specific interpretations have a direct influence on exercise adherence [27]. Further, patients exercise (episode-specific) experiences influence their (general) attitudes and beliefs about exercise. So, by giving patients positive experiences with exercise, this might contribute to patient's attitude and PBC and directly to exercise adherence. As an intervention guided by the self-regulation of exercise maintenance model, Cognitive Behavioral Therapy (CBT) strategies can be used to identify and change behavior [27]. Within CBT patient and healthcare provider work collaboratively to 1. identify maladaptive thoughts, beliefs and impact of current symptoms or feelings on exercise adherence; 2. develop skills to identify, monitor and counteract problematic cognitions related to the specific symptom; and 3. build a repertoire of coping skills appropriate to the target thoughts, beliefs, and behaviors to become adherent [28]. Since pulmonary rehabilitation (PR) is often offered in group form, there may be added value in offering CBT to the group as well. Three goals can be set here: 1. encourage patients to establish realistic exercise goals that incorporate their personal situation (positive PBC); 2. demonstrate techniques in the group that would help patients reach their goals (positive PBC); and 3. use the group as a way to highlight the common struggle of remaining active [27]. Literature shows that CBT consistently improved self-reported exercise behavior [27]. For CBT, too, there is only a chance of success if the patient-therapist relationship (alliance) is good. Further, CBT has been effectively used to treat depression, so when patients have a high score on depressive symptoms CBT might be used to influence the depressive symptoms [29]. Also, exercise itself has the ability to decrease depressive symptoms. Then CBT might be used by helping patients to understand their current ways of thinking and behaving, and by equipping them with the tools to change their maladaptive cognitive (more positive attitude and PBC), and
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