Background There is currently an absence of accessible, social, and sustainable exercise options for people with chronic breathlessness. To address this need, we employed a co-design approach to developing a walking football (WF) intervention, mapping Patient and Public Involvement and Engagement (PPIE) activities to the UK standards for public involvement in an effort to maximise stakeholder engagement.

Methods We have become embedded into the support group Breathe Easy Darlington, consulting with members in an iterative process to develop the WF intervention via intermittent group meetings and partaking in four WF ‘taster’ sessions.

Results Initially, Breathe Easy members were sceptical, believing that due to football’s emphasis on turning-ability, plus how many required the use of oxygen and walking aids, they would not be capable of playing to a degree that would be deemed enjoyable. They also stated that they would not consider joining another WF group, but rather any intervention had to be exclusive to people with breathlessness, believing they lacked the ability and proficiencies needed to play alongside experienced walking football players.

With the taster sessions, most of these worries were left behind as Breathe Easy found the football enjoyable due to its self-pacing, combined with the added comfort of playing alongside others with similar symptoms. One participant went as far to say that ‘on the pitch, you forget about breathlessness’. We also filmed one session to produce a promotional video, encouraging potential future participants that they are fully capable of playing. Across the four sessions, the football was adapted iteratively as we received continuous feedback on details such as: how much rest time was needed (approximately 5-mins for 15-mins of activity); which football drills were preferred over others (having a goal to aim at was always preferred); and how it was important to set time aside at the end of each session for tea/coffee to enhance the sociability of the intervention.

It was also noted how playing football was a real test of balance – ‘I felt like I was going to fall most when I was going to kick the ball’ – however, this was not so challenging as to detriment football’s enjoyability.

Conclusion By becoming embedded into the support group Breathe Easy Darlington we were able to co-design a WF intervention that is exclusively for people with breathlessness; improving the intervention in an iterative process, increasing its likelihood of long-term success, and producing a potentially sustainable form of physical activity for people with breathlessness.