Chapter 7 136 behavioral patterns (being more adherent) to make regular exercise decrease depressive symptoms. Conclusion Overall, it can be concluded that TPB on its own does not have sufficient power to explain exercise adherence during pulmonary rehabilitation and that other more relevant determinants as MRC-score and education (largest b’s), should receive more attention. This extended TPB model is a more promising theory for understanding exercise adherence during PR in patients with COPD. Findings of this study suggest that healthcare providers should obtain information about their patients’ attitudes, PBC, depressive symptoms, alliance, MRC-score, and education level. To improve exercise adherence scores and health outcomes in patients, psychosocial interventions must take place simultaneously with the biomedical treatment to improve treatment results [30]. Potential interventions for improving attitude are teach-back, MI and CBT; for improving PBC these are also teach-back, MI and CBT; for decreasing perceived dyspnea teach-back can be used specifically applied to the BTF model; for decreasing depressive symptoms CBT might be used as well as exercise itself; and finally, both exercise intention and exercise adherence can be directly influenced by optimal alliance. If a healthcare provider does not consider themselves skilled enough or confident enough in performing psychosocial interventions, it is important to refer the patient to another healthcare provider for this purpose. References 1. Rich, A., K. Brandes, B. Mullan, and M.S. Hagger, Theory of planned behaviour and adherence in chronic illness: a meta-analysis. Journal of Behavioural Medicine, 2015. 38: p. 673-688. 2. Ajzen, I., The theory of planned behavior. Organizational Behavior and Human Decision Processes, 1991. 50: p. 179-211. 3. Dishman, R.K. and J.F. Sallis, Determinants and interventions for physical activity and exercise, in Physical activity, fitness, and health. 1994, Human Kinetics: Champaign, IL. p. 214-238. 4. Ambady, N., J. Koo, R. Rosenthal, and C.H. Winograd, Physical therapistis’ nonverbal communication predicts geriatric patients’ health outcomes. Psychology and Aging, 2002. 17: p. 443-452. 5. Hall, A.M., P.H. Ferreira, C.G. Maher, J. Latimer, and M.L. Ferreira, The influence of the therapist-patient relationship on treatment outcome in physical rehabilitation: a systematic review. Physical Therapy 2010. 90(8), 1099-1110 DOI: 10.2522/ptj.20090245.
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