Background Pulmonary Rehabilitation (PR) is recommended as an effective treatment for people with breathlessness, but it is typically only made available to for 6-8 weeks, with most patients failing to maintain exercise upon completion. This leads to any health benefits gained diminishing 3-6 months following completion of PR. To encourage exercise-maintenance post-PR, research investigating fun, engaging, and familiar interventions – such as walking football (WF) - for people with CB is needed. This study therefore aimed to explore the experience of playing walking football (WF) amongst people with CB, to further understand its potential as an exercise-maintenance intervention.

Methods An ethnographic approach was used consisting of observations and informal conversation with individuals taking part in a WF programme exclusive to people with CB. All participants had recently completed PR. WF sessions were organised weekly, for two hours, consisting of fun warm-up games, football-drills, and small-sided matches. Detailed field notes were taken and analysed thematically via hybrid induction/deduction. Deductive development of themes was informed by the COM-B model of behaviour change.

Results 21 hours of observations were conducted with six participants (5 male; mean age 71.3y). In addition, 12 peer researchers (members of a breathlessness support group) took part in the WF. Three themes were generated. (1) Conditional Mastery, (2) Social Connectedness and (3) Discovery. These themes indicated that participants had developed greater mastery over CB, learned new physical skills, gained health related knowledge, recalled previous physical skills, realised the benefits of sustained exercise through graded and ungraded tasks, and developed relationships which provided social support, camaraderie, and accountability. The study participants broadly indicated that the challenges and sociality of WF facilitated an enjoyable experience which distracted from breathlessness intensity.

Conclusion WF facilitated an enjoyable experience of exercise which distracted from breathlessness symptoms with participants stating that it allowed them to exercise more. It is possible that WF has the potential to engender sustained exercise following PR. Findings are limited by the relatively few hours of observations impacting generalisability, however, ethnography is a highly immersive technique which is useful to understand culture. Given that this methodological approach has been seldom applied in respiratory rehabilitation, future research might seek to apply it more frequently as it could offer greater insight into the more nuanced reasons why people engage in certain activities.