Social support is linked to higher levels of physical activity and increased participation in pulmonary rehabilitation in adults with chronic obstructive pulmonary disease (COPD), according to data published online, ahead of print in the Annals of the American Thoracic Society.

Zijing Chen, PhD, from the School of Nursing at the University of Washington in Seattle, and colleagues conducted a longitudinal study using data from the CASCADE study, which focused on depression and functioning in COPD, to determine the association between functional and structural social support and self-care behaviors in patients with COPD.

The study included 282 participants with GOLD Stage II to Stage IV COPD. The researchers measured physical activity with a validated accelerometer at baseline, 1 year, and 2 years. They assessed self-care behaviors, including pulmonary rehabilitation attendance, smoking status, receiving an influenza or pneumococcal vaccine, and medication adherence.

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The investigators also analyzed structural social support indicators, including living status, having a partner, number of close friends and relatives, and the presence of a family caregiver. They used the Medical Outcomes Social Support Survey (MOSSS) to measure functional social support.

Participants who lived with others took 903 more steps per day compared with those who lived alone. In addition, participants who had a spouse or partner caregiver were 11 times more likely to participate in pulmonary rehabilitation compared with those who did not have a caregiver (odds ratio [OR], 11.03).

Higher MOSSS total scores were associated with marginally lower odds of smoking (OR, 0.99) and higher odds of receiving a pneumococcal vaccination (OR, 1.02). The researchers note that social support was not associated with receiving an influenza vaccination or medication adherence.

“Our findings reinforce the critical importance of the social environment in shaping patients’ success with self-care,” the study authors wrote.

“While our study should be replicated in larger, more representative samples, we believe that efforts to engage patients in these core self-care behaviors must at the very least, routinely assess for and tangibly assist patients in marshalling the necessary social support to maximize their chances of effecting positive change,” the investigators concluded.


  1. Chen Z, Fan VS, Belza B, Pike K, Nguyen HQ. Association between social support and self-care behaviors in adults with chronic obstructive pulmonary disease. Ann Am Thorac Soc. 2017. [Epub ahead of print]