BACKGROUND: Physical activity (PA) coaching, defined as a structured one-to-one intervention using behavior-change techniques, may increase PA in people with chronic obstructive pulmonary disease (COPD). This systematic review aimed to assess the effects of individual PA coaching components. METHODS: Randomized clinical trials comparing PA coaching versus usual care in COPD were searched. Effect direction plots synthesized results, and meta-analyses were conducted for selected outcomes, subgroup analyses exploring individual PA coaching components. RESULTS: Thirty-two studies involving 5483 people with COPD (67 +/- 9 years; 55% male; 53 +/- 18 FEV1%predicted) were included. PA coaching, mostly delivered remotely, weekly, for 12 weeks, consisted of education, exercise, feedback, goal setting/review, motivational interviews, problem-solving, self-monitoring, and social support. Effect direction plots showed a positive impact of PA coaching on PA (73%, 95% CI 58 to 89% of studies), with minimal or no effects on emotional, physical, symptoms, and health-related quality of life domains. Meta-analyses revealed a significant increase in steps/day (MD (95% CI) 806.84 (478.99 to 1134.70) steps/day, I2 66, p < 0.01); however, no clinically relevant changes were observed in other outcomes. Compliance rate across studies was 86% 95% CI 83% to 89%. Subgroups analyses for self-monitoring (MD (95% CI) 861 (555 to 1166) steps/day; I2 66, p < 0.01) and goal setting/review (MD (95% CI) 916 (563 to 1296) steps/day; I2 69, p < 0.01) demonstrated significant and clinically relevant improvements in steps/day. Significant between-group differences in whether self-monitoring (chi2 9.84, p < 0.01) and goal setting/review (chi2 7.59, p < 0.01) were included suggest these components may moderate PA coaching effectiveness. CONCLUSIONS: PA coaching increases daily steps in people with COPD without significantly affecting emotional, physical, symptoms or health-related quality of life domains. Including self-monitoring and goal setting/review may enhance its effectiveness.

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