Study Demonstrates Benefits of Community Participation in Patients With COPD

Community participation by individuals with chronic obstructive pulmonary disease (COPD) resulted in better lung function, improved exercise capacity, and less breathlessness, according to a recent study.

Community participation among individuals with chronic obstructive pulmonary disease (COPD) resulted in better lung function, improved exercise capacity, and less breathlessness, according to a recent study.

The study authors, from the Centre of Research Excellence in Rural and Remote Primary Health Care at Monash University in Australia, cited the World Health Organization’s definition of community participation as “involvement in life situations that provide interaction with friends, relatives, or members of a community,” and noted that it should be emphasized in disability rehabilitation efforts.

Because little is known about community participation in patients with COPD, the researchers set out to determine whether there is an association between community participation and activity-related outcome variables commonly collected among these patients during pulmonary rehabilitation assessment, they wrote in COPD: Journal of Chronic Obstructive Pulmonary Disease.

Their findings are important because individuals with COPD tend to have reduced engagement in social activities, which is associated with an increased risk of both hospitalization and mortality, the authors wrote.

Additionally, greater formal community participation is related to better quality of life and fewer symptoms of depression in the elderly and is protective against the development and progression of chronic disease, the investigators noted.

“The prevalence of depression in COPD is high,” they wrote. “The association between depression and social restriction may be attributed to the inability to perform daily activities due to a decline in functional status associated with disease progression.”

The researchers enrolled 99 individuals older than 40 years with COPD and assessed community participation (measured by the Community Participation Indicator [CPI] and European Social Survey [ESS] for formal and informal community participation), daily physical activity levels with an activity monitor, exercise capacity with a 6-minute walk test, and breathlessness.

They also examined self-efficacy utilizing the Pulmonary Rehabilitation Adapted Index of Self-Efficacy and anxiety and depression with the Hospital Anxiety and Depression Scale.

Higher levels of community participation were associated with older age and greater levels of physical activity (total, light, and moderate to vigorous) (all rs = 0.30; P < .05). Older age and more moderate to vigorous physical activity independently predicted greater community participation measured by CPI, the investigators found.

“Interestingly, both the community participation indicator and formal community participation were positively associated with age, in contrast to our expectations that younger adults could be more community-engaged than older,” they wrote.

The participants studied were relatively young, with a mean age younger than 70 years. “It is unclear if these relatively younger participants had family and caring commitments that impacted on their capacity for social participation,” the researchers wrote.

Higher levels of depression symptoms were associated with less formal and informal community participation as measured by the ESS (rs = –0.25).

More formal community participation according to the ESS was weakly (rs = 0.2-0.3) associated with older age; better lung function, exercise capacity, and self-efficacy; and less breathlessness.

“Self-efficacy, exercise capacity, and age independently predicted formal community participation in individuals with COPD. Strategies to optimize self-efficacy and improve exercise capacity may be useful to enhance community participation in people with COPD,” the authors wrote.

However, the relationships between community participation and ESS were weak, so the results “should be interpreted with caution and confirmed in future studies,” the authors noted.


Malaguti C, Holland AE, McDonald CF, et al. Community participation by people with chronic obstructive pulmonary disease. COPD. 2021;18(5):533-540. doi:10.1080/15412555.2021.1966761