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Abstract: Self-efficacy, defined as behaviour specific confidence, is a consistent correlate of physical activity and other health behaviours. In people with Chronic Obstructive Pulmonary Disease (COPD), self-efficacy has been found to be related to key clinical-health outcomes and is deemed an important contributor to disease self-management. The purpose of this dissertation was to (i) contribute to the understanding of how pulmonary rehabilitation (PR) and vicarious experiences (i.e., observing someone) impact self-efficacy types among patients with COPD, and (ii) examine the relationships of several different types of self-efficacy (i.e., task self-efficacy for exercise, coping self-efficacy for exercise, scheduling self-efficacy for exercise, coping self-efficacy for breathlessness, and walking self-efficacy) to clinical-health and behavioural outcomes: functional exercise capacity, health status, and physical activity. In study 1 (Chapter 2), self-efficacy increased as much or more with PR in COPD patients recently hospitalized for an acute exacerbation of COPD (AECOPD) compared to COPD patients without a recent AECOPD (stable COPD). Among the AECOPD patients, PR delivered within one month or between three and four months after an AECOPD did not impact the amount of improvement in self-efficacy observed. Study 1 also found that among both AECOPD and stable patients self-efficacy for walking was a superior predictor of all clinical-health and behavioural outcomes than self-efficacy for managing breathlessness. Additionally, the association between self-efficacy and physical activity was stronger among stable COPD patients compared to AECOPD patients at both pre- and post-PR. In Chapter 3, a two-part pilot study examined salient exercise-model characteristics to COPD patients and examined patient experiences with cardiopulmonary exercise tests (CPET). The results of this study informed the creation of the intervention evaluated in study 3 (Chapter 4), which examined the effects of coping and mastery model interventions on self-efficacy for walking and exercise (i.e., task self-efficacy for exercise, coping self-efficacy for exercise, scheduling self-efficacy for exercise, coping self-efficacy for breathlessness) in patients with COPD within the context of a CPET. Both the coping and mastery intervention conditions were found to enhance all types of self-efficacy, with the coping condition more strongly enhancing coping self-efficacy for exercise than the mastery condition. Coping self-efficacy for exercise was also the type of self-efficacy that was most strongly related to physical activity in patients with COPD the week following contact. The findings of this dissertation support the delivery of PR in both AECOPD and stable COPD patients and suggest that AECOPD and stable COPD patients may have different salient challenges/needs in PR which should be addressed accordingly. This dissertation highlights the role of self-efficacy within PR environments and provides insight into intervention content that may improve clinical-health and behavioural outcomes among people with COPD.

Abstract: Background: Exercise cognitions and beliefs are key associates of exercise behaviour. Self-talk is an intrapersonal communication system that may be a useful technique for studying exercise-related beliefs in pulmonary rehabilitation (PR) patients. The purpose of this research was to determine the relationships for self-talk, social-cognition, and clinical indicators in PR. Method: The following measures were assessed in 78 PR patients during the first two weeks of PR: the 6-minute walk test, St. George’s Respiratory Questionnaire, Exercise Self-talk Questionnaire, Self-talk Function Scale, and Social-Cognitive Questionnaire. Results: Moderate correlations were found for self-talk, cognition, and clinical indicator relationships that varied by gender. Self-efficacy, perceived severity, perceived difficulty, and personal physical evaluation self-talk had the strongest relationships to cognitions, and clinical indicators. Conclusions: Self-talk is related to social-cognitive constructs, health status, lung function, and functional exercise capacity in PR patients. Gender differences may be due to functional ability differences or gendered socialization experiences.