title: Tiotropium in patients with moderate COPD naive to maintenance therapy: a randomised placebo-controlled trial The effects of a physical activity counseling program after an exacerbation in patients with Chronic Obstructive Pulmonary Disease: a randomized controlled pilot study Enhancing exercise tolerance and physical activity in COPD with combined pharmacological and non-pharmacological interventions: PHYSACTO randomised, placebo-controlled study design Effects of telephone health mentoring in community-recruited chronic obstructive pulmonary disease on self-management capacity, quality of life and psychological morbidity: a randomised controlled trial Pilot study of a cell phone-based exercise persistence intervention post-rehabilitation for COPD The effects of maintenance schedules following pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomised controlled trial Nocturnal non-invasive ventilation in addition to rehabilitation in hypercapnic patients with COPD Correction: Physical Activity Counselling during Pulmonary Rehabilitation in Patients with COPD: A Randomised Controlled Trial A telehealth program for self-management of COPD exacerbations and promotion of an active lifestyle: a pilot randomized controlled trial Reducing Sedentary Behavior Versus Increasing Moderate-to-Vigorous Intensity Physical Activity in Older Adults Patient-centered physical activity coaching in COPD (Walk On!): A study protocol for a pragmatic randomized controlled trial. Benefits and costs of home-based pulmonary rehabilitation in chronic obstructive pulmonary disease - a multi-centre randomised controlled equivalence trial Behaviour-change intervention in a multicentre, randomised, placebo-controlled COPD study: methodological considerations and implementation Portable oxygen therapy: use and benefit in hypoxaemic COPD patients on long-term oxygen therapy. Community based physiotherapeutic exercise in COPD self-management: a randomised controlled trial. A randomized clinical trial of an activity and exercise adherence intervention in chronic pulmonary disease. Physical Activity Counselling during Pulmonary Rehabilitation in Patients with COPD: A Randomised Controlled Trial Indacaterol improves lung hyperinflation and physical activity in patients with moderate chronic obstructive pulmonary disease - a randomized, multicenter, double-blind, placebo-controlled study Nordic Walking improves daily physical activities in COPD: a randomised controlled trial Pedometers to enhance physical activity in COPD: a randomised controlled trial Influence of Lightweight Ambulatory Oxygen on Oxygen Use and Activity Patterns of COPD Patients Receiving Long-Term Oxygen Therapy Self-efficacy enhancing intervention increases light physical activity in people with chronic obstructive pulmonary disease Effects of low-intensity exercise and home-based pulmonary rehabilitation with pedometer feedback on physical activity in elderly patients with chronic obstructive pulmonary disease. A randomized, controlled trial comparing long-term and short-term exercise in patients with chronic obstructive pulmonary disease. [Can individualized rehabilitation improve functional independence in elderly patients with COPD?]. Effects of 2 Exercise Training Programs on Physical Activity in Daily Life in Patients With COPD Essential amino acid supplementation in patients with severe COPD: a step towards home rehabilitation. Improving physical activity in patients with COPD with urban walking circuits. A lifestyle activity intervention in patients with chronic obstructive pulmonary disease. The effects of a lifestyle physical activity counseling program with feedback of a pedometer during pulmonary rehabilitation in patients with COPD: a pilot study. Reliability of the PEDro scale for rating quality of randomized controlled trials. Improvement in self-reported exercise participation with the combination of tiotropium and rehabilitative exercise training in COPD patients Comprehensive effects of supplemented essential amino acids in patients with severe COPD and sarcopenia. An Internet-Mediated Pedometer-Based Program Improves Health-Related Quality-of-Life Domains and Daily Step Counts in COPD: A Randomized Controlled Trial. Energy balance in depleted ambulatory patients with chronic obstructive pulmonary disease: the effect of physical activity and oral nutritional supplementation. Effectiveness of integrated disease management for primary care chronic obstructive pulmonary disease patients: results of cluster randomised trial Impact of resistance training in chronic obstructive pulmonary disease patients during periods of acute exacerbation. Patterns of domestic activity and ambulatory oxygen usage in COPD. Short- and long-term effects of a physical activity counselling programme in COPD: a randomized controlled trial. Enhancement of daily physical activity increases physical fitness of outclinic COPD patients: results of an exercise counseling program. Walk2Bactive: A randomised controlled trial of a physical activity-focused behavioural intervention beyond pulmonary rehabilitation in chronic obstructive pulmonary disease. A Simple Method for Home Exercise Training in Patients With Chronic Obstructive Pulmonary Disease: ONE-YEAR STUDY Internet-based dyspnea self-management support for patients with chronic obstructive pulmonary disease. Definition of a COPD self-management intervention: International Expert Group consensus Effectiveness of a partnership-based self-management programme for patients with mild and moderate chronic obstructive pulmonary disease: a pragmatic randomized controlled trial. The feasibility of recruiting patients with early COPD to a pilot trial assessing the effects of a physical activity intervention.
abstract: Background : The benefits of pharmacotherapy with tiotropium H and iHaler 18 μg for patients with chronic obstructive pulmonary disease ( COPD ) have been previously demonstrated . However , few data exist regarding the treatment of moderate disease ( Global Initiative for Chronic Obstructive Lung Disease ( GOLD ) stage II ) . Aims : To determine whether tiotropium improves lung function/patient-reported outcomes in patients with GOLD stage II COPD naive to maintenance therapy . Methods : A r and omised 24-week double-blind placebo-controlled trial of tiotropium 18 μg once daily ( via H and iHaler ) was performed in maintenance therapy – naive patients with forced expiratory volume in 1 s (FEV1)/forced vital capacity ( FVC ) ratio < 0.7 and post-bronchodilator FEV1 ⩾50 and < 80 % . Results : A total of 457 patients were r and omised ( 238 tiotropium , 219 placebo ; mean age 62 years ; FEV1 1.93 l ( 66 % predicted ) )  . Tiotropium was superior to placebo in mean change from baseline in post-dose FEV1 area under the curve from 0 to 3 h ( AUC0–3h ) at week 24 ( primary endpoint ) : 0.19 vs. −0.03 l ( least-squares mean difference 0.23 l , P<0.001 ) . FVC AUC0–3h , trough and peak FEV1 and FVC were significantly improved with tiotropium versus placebo ( P<0.001 ) . Compared with placebo , tiotropium  provided numerical improvements in physical activity ( P = NS ) . Physician ’s Global Assessment ( health status ) improved ( P=0.045 ) with less impairment on the Work Productivity and Activity Impairment question naire ( P=0.043 ) at week 24 . The incidence of exacerbations , cough , bronchitis and dyspnoea was lower with tiotropium than placebo . Conclusions : Tiotropium  improved lung function and patient-reported outcomes in maintenance therapy – naive patients with GOLD stage II COPD , suggesting benefits in initiating maintenance therapy early Background In some patients with COPD , the disease is characterized by exacerbations . Severe exacerbations warrant a hospitalization , with prolonged detrimental effects on physical activity . Interventions after an exacerbation may improve physical activity , with longst and ing health benefits . Physical activity counseling and real-time feedback were effective in stable COPD . No evidence is available on the use of this therapeutic modality in patients after a COPD exacerbation . Methods Thirty patients were r and omly assigned to  usual care or physical activity counseling  , by telephone contacts at a frequency of 3 times a week and real-time feedback . Lung function , peripheral muscle strength , functional exercise capacity , symptom experience and COPD -related health status were assessed during hospital stay and 1 month later . Results Both groups significantly recovered in physical activity ( PAsteps : control group : 1013 ± 1275 steps vs intervention group : 984 ± 1208 steps ( p = 0.0005 ) ; PAwalk : control group : 13 ± 14 min vs intervention group : 13 ± 16 min ( p = 0.0002 ) ) , functional exercise capacity ( control group : 64 ± 59 m ( p = 0.002 ) vs intervention group : 67 ± 84 m ( p = 0.02 ) ) and COPD -related health status ( CAT : control group : −5 [ −7 to 1 ] ( p = 0.02 ) vs intervention group : −3 [ −10 to 1 ] points ( p = 0.03 ) ) . No differences between groups were observed . Conclusion From our pilot study , we concluded that telephone based physical activity counseling with pedometer feedback after an exacerbation did not result in better improvements in physical activity and clinical outcomes compared to usual care . Because of the difficult recruitment and the negative intermediate analyses , this study was not continued . Trial registration Clinical trials.gov NCT02223962 . Registered 4 September 2013 Introduction Chronic obstructive pulmonary disease ( COPD ) is associated with exercise limitation and physical inactivity , which are believed to have significant long-term negative health consequences for patients . While a number of COPD treatments and exercise training programmes increase exercise capacity , there is limited evidence for their effects on physical activity levels , with no clear association between exercise capacity and physical activity in clinical trials . Physical activity depends on a number of behaviour , environmental and physiological factors . We describe the design of the PHYSACTO trial , which is investigating the effects of bronchodilators , either alone or with exercise training , in combination with a st and ardised behaviour-change self-management programme , on exercise capacity and physical activity in patients with COPD . It is hypothesised that bronchodilators in conjunction with a behaviour-change self-management programme will improve physical activity and that this effect will be amplified by the addition of exercise training . Methods and analysis Patients are being recruited from 34 sites in Australia , New Zeal and , the USA , Canada and Europe . Patients receiving a multicomponent intervention design ed to support behaviour change related to physical activity are r and omised to four treatment arms : placebo , tiotropium , tiotropium+olo date rol , and tiotropium+olo date rol+exercise training . The primary outcome is improvement in exercise capacity after 8 weeks , measured by endurance time during a shuttle walk test . The secondary outcome is improvement in physical activity , including objective accelerometer assessment and patient-reported functioning using the Functional Performance Inventory — Short Form and the novel hybrid PROactive instrument . Additionally , the influence of moderating variables ( ie , factors influencing a patient 's choice to be physically active ) on increases in physical activity is also explored . Ethics and dissemination The study has been approved by the relevant Institutional Review Boards , Independent Ethics Committee and Competent Authority according to national and international regulations . The findings of the trial will be disseminated through relevant peer- review ed journals and international conference presentations . Trial registration number NCT02085161 Objectives To assess benefits of telephone-delivered health mentoring in community-based chronic obstructive pulmonary disease ( COPD ) . Design Cluster r and omised controlled trial . Setting Tasmanian general practice s : capital city ( 11 ) , large rural ( 3 ) , medium rural ( 1 ) and small rural ( 16 ) . Participants Patients were invited ( 1207 ) from general practitioner ( GP ) data bases with COPD diagnosis and /or tiotropium prescription , response rate 49 % ( 586 ) , refused ( 176 ) and excluded ( criteria : smoking history or previous study , 68 ) . Spirometry testing ( 342 ) confirmed moderate or severe COPD in 182 ( 53 % ) patients . R and omisation By r and om numbers code , block stratified on location , allocation by sequentially numbered , opaque and sealed envelopes . Intervention Health mentor ( HM ) group received regular calls to manage illness issues and health behaviours from trained community health nurses using negotiated goal setting : problem solving , decision-making and action planning . Control : usual care ( UC ) group received GP care plus non-interventional brief phone calls . Outcomes Measured at 0 , 6 and 12 months , the Short Form 36 ( SF-36 ) and St George ’s Respiratory Question naire ( SGRQ , primary ) ; Partners In Health ( PIH ) Scale for self-management capacity , Hospital Anxiety and Depression Scale ( HADS ) , Center for Epidemiologic Studies -Depression ( CES-D ) question naire , Post-Traumatic Stress Disorder Checklist , Satisfaction with life and hospital admissions ( secondary ) . Results 182 participants with COPD ( age 68±8 years , 62 % moderate COPD and 53 % men ) were r and omised ( HM=90 and UC=92 ) . Mixed model regression analysis accounting for clustering , adjusting for age , gender , smoking status and airflow limitation assessed efficacy ( regression coefficient , β , reported per 6-month visit ) . There was no difference in quality of life between groups , but self-management capacity increased in the HM group ( PIH overall 0.15 , 95 % CI 0.03 to 0.29 ; knowledge domain 0.25 , 95 % CI 0.00 to 0.50 ) . Anxiety decreased in both groups ( HADS A 0.35 ; 95 % CI −0.65 to −0.04 ) and coping capacity improved ( PIH coping 0.15 ; 95 % CI 0.04 to 0.26 ) . Conclusions Health mentoring  improved self-management capacity but not quality of life compared to regular phone contact , which itself had positive effects where decline is generally expected Objective To determine the feasibility and efficacy of a six-month , cell phone-based exercise persistence intervention for patients with chronic obstructive pulmonary disease ( COPD ) following pulmonary rehabilitation . Methods Participants who completed a two-week run-in were r and omly assigned to either MOBILE-Coached  ( n = 9 ) or MOBILE-Self-Monitored  ( n = 8) . All participants met with a nurse to develop an individualized exercise plan , were issued a pedometer and exercise booklet , and instructed to continue to log their daily exercise and symptoms . MOBILE-Coached also received weekly reinforcement text messages on their cell phones ; reports of worsening symptoms were automatically flagged for follow-up . Usability and satisfaction were assessed . Participants completed incremental cycle and six minute walk ( 6MW ) tests , wore an activity monitor for 14 days , and reported their health-related quality of life ( HRQL ) at baseline , three , and six months . Results The sample had a mean age of 68 ±11 and forced expiratory volume in one second 18 % predicted . Participants reported that logging their exercise and symptoms ( FEV1 ) of 40 ± was easy and that keeping track of their exercise helped them remain active . There were no differences between groups over time in maximal workload , 6MW distance , or HRQL ( p > 0.05 ) ; however , MOBILE-Self-Monitored increased total steps/day whereas MOBILE-Coached logged fewer steps over six months ( p = 0.04 ) . Conclusions We showed that it is feasible to deliver a cell phone-based exercise persistence intervention to patients with COPD post-rehabilitation and that the addition of coaching appeared to be no better than self-monitoring . The latter finding needs to be interpreted with caution since this was a purely exploratory study . Trial registration Clinical Trials.gov ( NCT00373932 ) Objectives Pulmonary rehabilitation ( PR ) provides benefit for patients with chronic obstructive pulmonary disease ( COPD ) in terms of quality of life ( QoL ) and exercise capacity ; however , the effects diminish over time . Our aim was to evaluate a maintenance programme for patients who had completed PR . Setting Primary and secondary care PR programmes in Norfolk . Participants 148 patients with COPD who had completed at least 60 % of a st and ard PR programme were r and omised and data are available for 110 patients . Patients had greater than 20 pack year smoking history and less than 80 % predicted forced expiratory volume in 1 s but no other significant disease or recent respiratory tract infection . Interventions Patients were r and omised to receive a maintenance programme or st and ard care . The maintenance programme consisted of 2 h ( 1 h individually tailored exercise training and 1 h education programme ) every 3 months for 1 year . Primary and secondary outcome measures The Chronic Respiratory Question naire ( CRQ ) ( primary outcome ) , endurance shuttle walk test ( ESWT ) , EuroQol ( EQ5D ) , hospital anxiety and depression score ( HADS ) , body mass index ( BMI ) , body fat , activity levels ( overall score and activity diary ) and exacerbations were assessed before and after 12 months . Results There was no statistically significant difference between the groups for the change in CRQ dyspnoea score ( primary end point ) at 12 months which amounted to 0.19 ( −0.26 to 0.64 ) units or other domains of the CRQ . There was no difference in the ESWT duration ( −10.06 ( −191.16 to 171.03 ) seconds ) , BMI , body fat , EQ5D , MET-minutes , activity rating , HADS , exacerbations or admissions . Conclusions A maintenance programme of three monthly 2 h sessions does not improve outcomes in patients with COPD after 12 months . We do not recommend that our maintenance programme is adopted . Other methods of sustaining the benefits of PR are required . Trial registration number NCT00925171 Background : Long-term non-invasive positive pressure ventilation ( NIPPV ) might improve the outcomes of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease ( COPD ) with chronic respiratory failure . A study was undertaken to investigate whether nocturnal NIPPV in addition to pulmonary rehabilitation improves health-related quality of life , functional status and gas exchange compared with pulmonary rehabilitation alone in patients with COPD with chronic hypercapnic respiratory failure . Methods : 72 patients with COPD were r and omly assigned to nocturnal NIPPV in addition to rehabilitation ( n = 37 ) or rehabilitation alone ( n = 35 ) . Outcome measures were assessed before and after the 3-month intervention period . Results : The Chronic Respiratory Question naire total score improved 15.1 points with NIPPV + rehabilitation compared with 8.7 points with rehabilitation alone . The difference of 7.5 points was not significant ( p = 0.08 ) . However , compared with rehabilitation alone , the difference in the fatigue domain was greater with NIPPV + rehabilitation ( mean difference 3.3 points , p<0.01 ) , as was the improvement in the Maugeri Respiratory Failure question naire total score ( mean difference −10 % , p<0.03 ) and its cognition domain ( mean difference −22 % , p<0.01 ) . Furthermore , the addition of NIPPV improved daytime arterial carbon dioxide pressure ( mean difference −0.3 kPa ; p<0.01 ) and daily step count ( mean difference 1269 steps/day , p<0.01 ) . This was accompanied by an increased daytime minute ventilation ( mean difference 1.4 l ; p<0.001 ) . Conclusion : Non-invasive ventilation augments the benefits of pulmonary rehabilitation in patients with COPD with chronic hypercapnic respiratory failure as it improves several measures of health-related quality of life , functional status and gas exchange . Trial registration number : NCT00135538 Reference 1 . Burtin C , Langer D , van Remoortel H , Demeyer H , Gosselink R , Decramer M , et al. ( 2015 ) Physical Activity Counselling during Pulmonary Rehabilitation in Patients with COPD : A R and omised Controlled Trial . PLoS ONE 10(12 ) : e0144989 . doi : 10.1371/journal.pone.0144989 PMID : 26697853 Fig 2 . Relative changes in daily time spent walking , daily steps , daily time spent in at leastmoderate intense activities ( > 3.6metabolic equivalents ) and at least mild intense activities ( > 2.0metabolic equivalents ) after threemonths ( 3 m ) and after six months of rehabilitation ( 6 m ) compared to baseline . Data are expressed as percentage of change of least square means compared to baseline . No intervention*time effects were observed . * indicates time effect for the whole group ( p<0.05 compared to baseline ) The objective of this pilot study was to investigate the use of and satisfaction with a  chronic obstructive pulmonary disease ( COPD ) telehealth program applied in both primary and secondary care . The program consisted of four modules : 1 ) activity coach for ambulant activity monitoring and real-time coaching of daily activity behavior , 2 ) web-based exercise program for home exercising , 3 ) self-management of COPD exacerbations via a triage diary on the web portal , including self-treatment of exacerbations , and 4 ) teleconsultation .  Twenty-nine COPD patients were r and omly assigned to either the intervention group ( telehealth program for 9 months ) or the control group ( usual care ) . Page hits on the web portal showed the use of the program , and the Client Satisfaction Question naire showed satisfaction with received care . The telehealth program with decision support showed good satisfaction ( mean 26.4 , maximum score 32 ) . The program was accessed on 86 % of the treatment days , especially the diary . Patient adherence with the exercise scheme was low ( 21 % ) . Health care providers seem to play an important role in patients ’ adherence to telehealth in usual care . Future research should focus on full-scale implementation in daily care and investigating technological advances , like gaming , to increase adherence Objective : To compare the effects of behavioral interventions targeting decreased sedentary behavior versus increased moderate-to-vigorous intensity physical activity ( MVPA ) in older adults . Method : Inactive older adults ( N = 38 , 68 ± 7 years old , 71 % female ) were r and omized to 12-week interventions targeting decreased sedentary behavior ( Sit Less ) or increased MVPA ( Get Active ) . The SenseWear armb and was used to objective ly assess activity in real time . Assessment s included a blinded armb and , the Community Health Activites Model Program for Senior ( CHAMPS ) question naire , 400-meter walk , and the Short Physical Performance Battery ( SPPB ) . Results : Objective ly measured MVPA increased in Get Active ( 75 ± 22 min/week , p < .001 ) ; self-reported MVPA increased in both groups ( p < .05 ) . Sedentary behavior did not change in either group ( all p > .05 ) . Only the Sit Less group improved the SPPB score ( 0.5 ± 0.3 , p = .046 ) . Discussion : Targeting reduced sedentary behavior had a greater effect on physical function among inactive but high functioning older adults over 12 weeks . Future studies of longer duration and combining increased MVPA with reduced sedentary behavior are needed BACKGROUND Physical inactivity is significantly associated with more frequent hospitalizations and increased mortality in COPD even after adjusting for disease severity . While practice guidelines recommend regular physical activity for all patients with COPD , health systems are challenged in operationalizing an effective and sustainable approach to assist patients in being physically active . METHODS A pragmatic r and omized controlled trial design was used to determine the effectiveness of a 12-month home and community-based physical activity coaching intervention ( Walk On ! ) compared to st and ard care for 1650 patients at high risk for COPD exacerbations from a large integrated health care system . Eligible patients with a COPD -related hospitalization , emergency department visit , or observational stay in the previous 12months were automatically identified from the electronic medical records ( EMR ) system and r and omized to treatment arms . The Walk On ! intervention included collaborative monitoring of step counts , semi-automated step goal recommendations , individualized reinforcement from a physical activity coach , and peer/family support . RESULTS The primary composite outcome included all-cause hospitalizations , emergency department visits , observational stays , and death in the 12months following r and omization . Secondary outcomes included COPD -related utilization , cardio-metabolic markers , physical activity , symptoms , and health-related quality of life . With the exception of patient reported outcomes , all utilization and clinical variables were automatically captured from the EMR . CONCLUSIONS If successful , findings from this multi-stakeholder driven trial of a generalizable and scalable physical activity intervention , carefully design ed with sufficient flexibility , intensity , and support for a large ethnically diverse sample could re-define the st and ard of care to effectively address physical inactivity in COPD Background Pulmonary rehabilitation is widely advocated for people with chronic obstructive pulmonary disease ( COPD ) to improve exercise capacity , symptoms and quality of life , however only a minority of individuals with COPD are able to participate . Travel and transport are frequently cited as barriers to uptake of centre-based programs . Other models of pulmonary rehabilitation , including home-based programs , have been proposed in order to improve access to this important treatment . Previous studies of home-based pulmonary rehabilitation in COPD have demonstrated improvement in exercise capacity and quality of life , but not all elements of the program were conducted in the home environment . It is uncertain whether a pulmonary rehabilitation program delivered in its entirety at home is cost effective and equally capable of producing benefits in exercise capacity , symptoms and quality of life as a hospital-based program . The aim of this study is to compare the costs and benefits of home-based and hospital-based pulmonary rehabilitation for people with COPD . Methods / Design This r and omised , controlled , equivalence trial conducted at two centres will recruit 166 individuals with spirometrically confirmed COPD . Participants will be r and omly allocated to hospital-based or home-based pulmonary rehabilitation . Hospital programs will follow the traditional outpatient model consisting of twice weekly supervised exercise training and education for eight weeks . Home-based programs will involve one home visit followed by seven weekly telephone calls , using a motivational interviewing approach to enhance exercise participation and facilitate self management . The primary outcome is change in 6-minute walk distance immediately following intervention . Measurements of exercise capacity , physical activity , symptoms and quality of life will be taken at baseline , immediately following the intervention and at 12 months , by a blinded assessor . Completion rates will be compared between programs . Direct healthcare costs and indirect ( patient-related ) costs will be measured to compare the cost-effectiveness of each program . Discussion This trial will identify whether home-based pulmonary rehabilitation can deliver equivalent benefits to centre-based pulmonary rehabilitation in a cost effective manner . The results of this study will contribute new knowledge regarding alternative models of pulmonary rehabilitation and will inform pulmonary rehabilitation guidelines for COPD .Trial registration Clinical Trials.gov : NCT01423227 Introduction Chronic obstructive pulmonary disease is generally progressive and associated with reduced physical activity . Both pharmacological therapy and exercise training can improve exercise capacity ; however , these are often not sufficient to change the amount of daily physical activity a patient undertakes . Behaviour-change self-management programmes are design ed to address this , including setting motivational goals and providing social support . We present and discuss the necessary method ological considerations when integrating behaviour-change interventions into a multicentre study . Methods and analysis PHYSACTO is a 12-week phase IIIb study assessing the effects on exercise capacity and physical activity of once-daily tiotropium+olo date rol 5/5 µg with exercise training , tiotropium+olo date rol 5/5 µg without exercise training , tiotropium 5 µg or placebo , with all pharmacological interventions administered via the Respimat inhaler . Patients in all intervention arms receive a behaviour-change self-management programme to provide an optimal environment for translating improvements in exercise capacity into increases in daily physical activity . To maximise the likelihood of success , special attention is given in the programme to : ( 1 ) the Site Case Manager , with careful monitoring of programme delivery ; ( 2 ) the patient , incorporating patient-evaluation/programme-evaluation measures to guide the Site Case Manager in the self-management intervention ; and ( 3 ) quality assurance , to help identify and correct any problems or shortcomings in programme delivery and ensure the effectiveness of any corrective steps . This paper documents the comprehensive methods used to optimise and st and ardise the behaviour-change self-management programme used in the study to facilitate dialogue on the inclusion of this type of programme in multicentre studies . Ethics and dissemination The study has been approved by the relevant Institutional Review Boards , Independent Ethics Committee and Competent Authority according to national and international regulations . The results of this study will be disseminated through relevant , peer- review ed journals and international conference presentations . Trial registration number NCT02085161 In 159 chronic obstructive pulmonary disease ( COPD ) patients ( 139 males , mean age 62 + /- 8 yrs , arterial oxygen tension ( PaO2 ) 7.2 + /- 0.9 kPa ) , on long-term oxygen therapy ( LTOT ) , we evaluated the effects of portable oxygen therapy both on the daily duration of oxygen therapy and on daily activities . They were given two types of LTOT at r and om : group A ( n = 75 ) , oxygen concentrators only ( OC ) ; group B ( n = 84 ) , either small oxygen cylinders plus OC ( B1 = 51 ) or liquid oxygen ( B2 = 33 ) . The patients were followed-up for one year by means of : a ) medical examination every three months ; b ) monthly home interviews concerning the daily duration of oxygen therapy , the utilization of the devices and the daily activities of the patients ; c ) a measurement of the  daily oxygen usage .  The results show that : 1 ) there are no significant clinical and functional differences between groups A and B at the onset of and throughout the study ; 2 ) in group B the daily use of oxygen therapy is significantly longer than in group A ( 17 + /- 3.5 h.day-1 vs 14 + /- 3 h.day-1 , p less than 0.01 ) without any difference between groups B1 and B2 ; 3 ) outdoor walking activities are different between groups A and B , at least in those patients using oxygen more than 18 h.day-1 . Only 60 % of patients in group B ( 55 % of B1 ; 67 % of B2 ) use their portable devices outdoors and for walking . No strict predictive criterion of this use is found in our study . ( ABSTRACT TRUNCATED AT 250 WORDS Little is known about effects of community-based physiotherapeutic exercise programmes incorporated in COPD self-management programmes . In a r and omised trial , the effect of such a programme ( COPE-active ) on exercise capacity and various secondary outcomes including daily activity as a marker of behaviour change was evaluated . All patients attended four 2-h self-management sessions . In addition the intervention group participated in the COPE-active programme offered by physiotherapists of private practice s , consisting of a 6-month " compulsory " period ( 3 sessions/week ) and subsequently a 5-month " optional " period ( 2 sessions/week ) . Because COPE-active was intended to change behaviour with regard to exercise , one session/week in both periods consisted of unsupervised home-based exercise training .  Of 153 patients , 74 intervention and 68 control patients completed the one-year follow-up . Statistically significant between-group differences in incremental shuttle walk test-distance ( 35.1 m ; 95 % CI ( 8.4 ; 61.8 ) ) and daily activity ( 1190 steps/day ; 95 % CI ( 256 ; 2125 ) ) were found in favour of the intervention group . Over the 12-month period a significant difference of the chronic respiratory question naire ( CRQ ) dyspnoea-score ( 0.33 points ; 95 % CI ( 0.01 ; 0.64 ) ) and a non-significant difference of the endurance shuttle walk test ( 135 m ( 95 % CI ( -29 ; 298 ) ) was found . No differences were found in the other CRQ-components , anxiety and depression scores and percentage of fat free mass . This study demonstrates that a community-based reactivation programme improves exercise capacity in patients with moderately to severe COPD . Even more important , the programme improves actual daily activity after one-year which indicates behaviour change with regard to daily exercise . Registered trail number : IS RCT N81447311 OBJECTIVES To evaluate the effectiveness of an exercise adherence intervention to maintain daily activity , adherence to exercise , and exercise capacity over 1 year after completion of an outpatient pulmonary rehabilitation program . DESIGN A 2-group , experimental design was used with r and omization into intervention and usual care groups . SETTING Outpatient pulmonary rehabilitation program in a university-affiliated medical center . PARTICIPANTS One hundred six subjects ( 98 men ; 98 with chronic obstructive pulmonary disease ) with a mean age of 67 years and chronic lung disease . INTERVENTION Twelve-week adherence intervention ( weekly phone calls and home visit ) including counseling on establishing , monitoring , and problem-solving in maintaining a home exercise program . MAIN OUTCOME MEASURES Primary outcomes included daily activity ( accelerometer ) , exercise adherence ( exercise diary ) , and exercise capacity ( six-minute walk test ) . All measures were performed at baseline , after the pulmonary rehabilitation program ( 8 wk ) , after the adherence intervention ( 20 wk ) , and at 1 year . RESULTS A rank-based analysis of covariance showed less decline at 20 weeks in exercise adherence ( intervention mean , + 3 min ; control mean , -13 min ; P=.015 ) and exercise capacity ( intervention mean , -10.7 m ; control mean , -35.4 m ; P=.023 ) . There were no differences in daily activity at 20 weeks or any differences in any primary variable at 1 year . CONCLUSIONS The intervention enhanced exercise adherence and exercise capacity in the short term but produced no long-term benefit . These findings are in part attributed to the disappointing measurement characteristics of the accelerometer used to measure daily activity . The intervention was acceptable to participants . Further study is needed to fashion interventions that have more persistent benefit Background Pulmonary rehabilitation programs only modestly enhance daily physical activity levels in patients with chronic obstructive pulmonary disease ( COPD ) . This r and omised controlled trial investigates the additional effect of an individual activity counselling program during pulmonary rehabilitation on physical activity levels in patients with moderate to very severe COPD . Methods Eighty patients ( 66±7 years , 81 % male , forced expiratory volume in 1 second 45±16 % of predicted ) referred for a six‐month multidisciplinary pulmonary rehabilitation program were r and omised . The intervention group was offered an additional eight-session activity counselling program . The primary outcomes were daily walking time and time spent in at least moderate intense activities . Results Baseline daily walking time was similar in the intervention and control group ( median 33 [ interquartile range 16–47 ] vs 29 [ 17–44 ] ) whereas daily time spent in at least moderate intensity was somewhat higher in the intervention group ( 17[4–50 ] vs 12[2–26 ] min ) . No significant intervention*time interaction effects were observed in daily physical activity levels . In the whole group , daily walking time and time spent in at least moderate intense activities did not significantly change over time . Conclusions The present study identified no additional effect of eight individual activity counselling sessions during pulmonary rehabilitation to enhance physical activity levels in patients with COPD . Trial Registration clinical trials.gov Background Indacaterol is a long-acting beta-2 agonist for once-daily treatment of COPD . We evaluated the effects of indacaterol 150 μg on lung hyperinflation compared with placebo and open-label tiotropium 18 μg . We measured physical activity during treatment with indacaterol 150 μg and matched placebo . Methods We performed a r and omized , three-period , cross-over study ( 21 days of treatment separated by two wash-out periods of 13 days ) with indacaterol 150 μg or matching placebo and tiotropium 18 μg . Lung function was assessed by body plethysmography and spirometry  . Physical activity was measured for one week by a multisensory armb and at the end of both treatment periods with indacaterol/matched placebo . The primary endpoint was peak inspiratory capacity at the end of each treatment period . Results 129 patients ( mean age , 61 years ; mean post-bronchodilator FEV1 , 64 % ) , were r and omized and 110 patients completed the study . Peak inspiratory capacity was 0.22 L greater with Indacaterol at day 21 compared to placebo ( p < 0.001 ) . Similar results were observed for tiotropium . Both bronchodilators also significantly improved other parameters of lung hyperinflation compared with placebo . All parameters of physical activity were significantly increased during treatment with indacaterol versus placebo . Conclusions Indacaterol 150 μg improved lung hyperinflation in patients with moderate COPD , which was associated with an increase of physical activity . Trial registration Clinical Trials.gov registration number : NCT01012765 Background In patients with COPD progressive dyspnoea leads to a sedentary lifestyle . To date , no studies exist investigating the effects of Nordic Walking in patients with COPD . Therefore , the aim was to determine the feasibility of Nordic Walking in COPD patients at different disease stages . Furthermore we aim ed to determine the short- and long-term effects of Nordic Walking on COPD patients ' daily physical activity pattern as well as on patients exercise capacity . Methods Sixty COPD patients were r and omised to either Nordic Walking  or to a  control group . Patients of the Nordic Walking group ( n = 30 ; age : 62 ± 9 years ; FEV1 : 48 ± 19 % predicted ) underwent a three-month outdoor Nordic Walking exercise program consisting of one hour walking at 75 % of their initial maximum heart rate three times per week , whereas controls had no exercise intervention . Primary endpoint : daily physical activities ( measured by a vali date d tri-axial accelerometer ) ; secondary endpoint : functional exercise capacity ( measured by the six-minute walking distance ; 6MWD ) . Assessment time points in both groups : baseline , after three , six and nine months . Results After three month training period , in the Nordic Walking group time spent walking and st and ing as well as intensity of walking increased ( Δ walking time : + 14.9 ± 1.9 min/day ; Δ st and ing time : + 129 ± 26 min/day ; Δ movement intensity : + 0.40 ± 0.14 m/s2 ) while time spent sitting decreased ( Δ sitting time : -128 ± 15 min/day ) compared to baseline ( all : p < 0.01 ) as well as compared to controls ( all : p < 0.01 ) . Furthermore , 6MWD significantly increased compared to baseline ( Δ 6MWD : + 79 ± 28 meters ) as well as compared to controls ( both : p < 0.01 ) . These significant improvements were sustained six and nine months after baseline . In contrast , controls showed unchanged daily physical activities and 6MWD compared to baseline for all time points . Conclusions Nordic Walking is a feasible , simple and effective physical training modality in COPD . In addition , Nordic Walking has proven to positively impact the daily physical activity pattern of COPD patients under short- and long-term observation . Clinical trial registration Nordic Walking improves daily physical activities in COPD : a r and omised controlled trial - IS RCT Physical inactivity is a cardinal feature of chronic obstructive pulmonary disease ( COPD ) , and is associated with increased morbidity and mortality . Pedometers , which have been used in healthy population s , might also increase physical activity in patients with COPD . COPD patients taking part in a 3-month individualised programme to promote an increase in their daily physical activity were r and omised to either a st and ard programme of physical activity encouragement alone , or a pedometer-based programme . Assessment s were performed by investigators blinded to treatment allocation . Change in average 1-week daily step count , 6-min walking distance ( 6MWD ) , modified Medical Research Council scale , St George ’s respiratory question naire ( SGRQ ) and COPD assessment test ( CAT ) were compared between groups . 102 patients were recruited , of whom 97 completed the programme ( pedometer group : n=50 ; control group : n=47 ) ; 60.8 % were male with a mean±sd age of 68.7±8.5 years , and forced expiratory volume in 1 s ( FEV1 ) 66.1±19.4 % and FEV1/forced vital capacity 55.2±9.5 % . Both groups had comparable characteristics at baseline . The pedometer group had significantly greater improvements in : physical activity 3080±3254 steps·day−1 versus 138.3±1950 steps·day−1 ( p<0.001 ) ; SGRQ −8.8±12.2 versus −3.8±10.9 ( p=0.01 ) ; CAT score −3.5±5.5 versus −0.6±6.6 ( p=0.001 ) ; and 6MWD 12.4±34.6 versus −0.7±24.4 m ( p=0.02 ) than patients receiving activity encouragement only . A simple physical activity enhancement programme using pedometers can effectively improve physical activity level and quality of life in COPD patients  . Pedometer-based programme produced clinical ly important improvements in physical activity and health status in COPD Abstract Lightweight ambulatory oxygen devices are provided on the assumptions that they enhance compliance and increase activity , but data to support these assumptions are lacking . We studied 22 patients with severe chronic obstructive pulmonary disease receiving long-term oxygen therapy ( 14 men , average age = 66.9 y , FEV1 = 33.6%pred , PaO2 at rest = 51.7 torr ) who were using E-cylinders as their portable oxygen . Subjects were recruited at 5 sites and studied over a 2-week baseline period and for 6 months after r and omizing them to either continuing to use 22-lb E-cylinders towed on a cart or to carrying 3.6-lb aluminum cylinders . Utilizing novel electronic devices , ambulatory and stationary oxygen use was monitored continuously over the 2 weeks prior to and the 6 months following r and omization . Subjects wore tri-axial accelerometers to monitor physical activity during waking hours for 2–3 weeks prior to , and at 3 and 6 months after , r and omization . Seventeen subjects completed the study . At baseline , subjects used 17.2 hours of stationary and 2.5 hours of ambulatory oxygen daily . At 6 months , ambulatory oxygen use was 1.4 ± 1.0 hrs in those r and omized to E-cylinders and 1.9 ± 2.4 hrs in those using lightweight oxygen ( P = NS ) . Activity monitoring revealed low activity levels prior to r and omization and no significant increase over time in either group . In this group of severe chronic obstructive pulmonary disease patients , providing lightweight ambulatory oxygen did not increase either oxygen use or activity . Future efforts might focus on strategies to encourage oxygen use and enhance activity in this patient group . This trial is registered at Clinical Trials.gov ( NCT003257540 ) Background People with chronic obstructive pulmonary disease lead sedentary lives and could benefit from increasing their physical activity . The purpose of this study was to determine if an exercise-specific self-efficacy enhancing intervention could increase physical activity and functional performance when delivered in the context of 4 months of upper body resistance training with a 12-month follow-up . Methods In this r and omized controlled trial , subjects were assigned to : exercise-specific self-efficacy enhancing intervention with upper body resistance training ( SE-UBR ) , health education with upper body resistance training ( ED-UBR ) , or health education with gentle chair exercises ( ED-Chair ) . Physical activity was measured with an accelerometer and functional performance was measured with the Functional Performance Inventory . Forty-nine people with moderate to severe chronic obstructive pulmonary disease completed 4 months of training and provided valid accelerometry data , and 34 also provided accelerometry data at 12 months of follow-up . The self-efficacy enhancing intervention emphasized meeting physical activity guidelines and increasing moderate-to-vigorous physical activity . Results Differences were observed in light physical activity ( LPA ) after 4 months of training , time by group interaction effect ( P=0.045 ) . The SE-UBR group increased time spent in LPA by + 20.68±29.30 minutes/day and the other groups decreased time spent in LPA by −22.43±47.88 minutes/day and -25.73±51.76 minutes/day . Changes in LPA were not sustained at 12-month follow-up . There were no significant changes in moderate-to-vigorous physical activity , sedentary time , or functional performance . Subjects spent most of their waking hours sedentary : 72%±9 % for SE-UBR , 68%±10 % for ED-UBR , and 74%±9 % for ED-Chair . Conclusion The self-efficacy enhancing intervention produced a modest short-term increase in LPA . Further work is needed to increase the magnitude and duration of effect , possibly by targeting LPA PURPOSE We evaluated the effects of low-intensity and home-based pulmonary rehabilitation ( PR ) on physical activity ( PA ) and the feedback provided by a pedometer in stable elderly patients with chronic obstructive pulmonary disease ( COPD ) . METHODS We assessed PA using a newly developed triaxial accelerometer ( A-MES ™ , Kumamoto , Japan ) , which measures the time spent walking , st and ing , sitting and lying down .  Twenty-seven elderly patients with COPD ( age 74 ± 8 yrs ; % FEV1 56.6 ± 18.7 % ) participated . They were r and omly selected to undergo PR ( pulmonary rehabilitation only ) or PR + P ( PR plus the feedback from using a pedometer ) . Their PA and pulmonary function , exercise capacity ( 6-min walking distance ; 6MWD ) , quadriceps femoris muscle force ( QF ) were evaluated before the PR began ( baseline ) and at 1 year later . We compared the patients ' changes in PA and other factors between the baseline values and those obtained 1 year later and analyzed the relationships between the changes in PA and other factors in the both groups . RESULTS The increase in the time spent walking in the PR + P group ( 51.3 ± 63.7 min/day ) was significantly greater than that of PR group ( 12.3 ± 25.5 min/day ) after the PR . The improvement rate of daily walking time after PR was significantly correlated with that of the 6MWD and QF in all subjects . CONCLUSIONS These data suggest that low-intensity and home-based PR with the feedback from using pedometer was effective in improving PA , and the improvements of physiological factors were correlated with increased walking time in stable elderly patients with COPD PURPOSE To compare the effects of short-term ( 3 months ) and long-term ( 18 months ) involvement in an exercise program on self-reported disability and physical function in patients with chronic obstructive pulmonary disease ( COPD ) . METHODS A total of 140 patients with COPD were studied in a r and omized , single-blinded clinical trial . Self-reported disability and physical function were assessed using a  21-item question naire , a 6-minute walk , timed stair climb , and an overhead task .  RESULTS At the completion of the trial , participants in the long-term intervention reported 12 % less disability than those in the short-term intervention ( adjusted mean with 95 % confidence interval , 1.53 ( 1.43 - 1.63 ) versus 1.71 ( 1.61 to 1.81 ) units , respectively ; P=.016 ) , walked 6 % farther during 6-minutes ( 1,815.0 [ 1,750.4 - 1,879.6 ] vs 1,711.5 [ 1,640.7 - 1,782.3 ] feet , respectively ) , climbed steps 11 % faster ( 11.6 [ 11.0 - 12.2 ] vs 12.9 [ 12.3 - 13.5 ] seconds , respectively ) , and completed an overhead task 8 % faster ( 46.8 [ 44.4 - 49.2 ] vs 50.4 [ 47.8 - 53.0 ] seconds , respectively ) than those in the short-term intervention . CONCLUSION An 18 month exercise program results in greater improvements in self-reported disability and physical function in patients with COPD when compared with a 3-month exercise program . As such , long-term exercise should be recommended for all patients with COPD Study objectives The aims of this study were to establish whether pulmonary rehabilitation ( PR ) improves domestic function and daily activity levels in COPD and whether individually targeted exercise is more effective than general exercise . Design Prospect i ve r and omized , controlled trial . Setting Outpatient PR program in secondary care . Participants One-hundred eighty patients ( mean [ ±SD ] age , 68.3 ± 8.6 years ; FEV 1 , 0.95 ± 0.4 L ; FEV 1 /FVC ratio , 0.51 ± 0.15 ; 111 male patients ; 69 female patients ) with stable COPD . One hundred twenty-one patients completed the study . Interventions Patients were r and omized to a conventional 7-week general exercise program ( [ GEP ] n=90 ) or an individually targeted exercise program ( [ ITEP ] n=90 ) . Measurement and results Daily activity was measured using ambulatory activity monitors ( Z80 –32k V1 Int ; Gaehwiler Electronics ; Hombrechtikon , Switzerl and ) . These were lightweight devices , which contained a uniaxial accelerometer . Domestic function was assessed by the Canadian Occupational Performance Measure ( COPM ) . Exercise performance was assessed by the incremental shuttle walk test ( ISWT ) and the endurance shuttle walk test and health status by the chronic respiratory question naire – self-reported . Activity monitor counts increased by 29.18 % ( 95 % confidence interval [ CI ] , 3.19 to 55.17 ; p=0.03 ) for the GEP and 40.63 % ( 95 % CI , 7.42 to 73.83 ; p=0.02 ) for the ITEP . Mean COPM performance scores increased by 1.71 ( 95 % CI , 1.37 to 2.05 ; p=0.0001 ) for the GEP and 1.46 ( 95 % CI , 1.05 to 1.87 ; p=0.0001 ) for the ITEP . Mean COPM satisfaction scores increased by 2.27 ( 95 % CI , 1.74 to 2.81 ; p=0.0001 ) for the GEP and 2.04 ( 95 % CI , 1.56 to 2.52 ; p=0.0001 ) for the ITEP . ISWT scores increased by 81.72 m ( range , 63.83 to 99.62 ) for the GEP and by 85.52 m ( range , 67.62 to 103.42 ) for the ITEP . No statistically significant difference was found between the general exercise group and the individually targeted exercise group for any outcome measure . Conclusions Pulmonary rehabilitation improves domestic function and physical activity . This study also demonstrates that general exercise training is as effective as individually targeted training BACKGROUND : The effects of different exercise training programs on the level of physical activity in daily life in patients with COPD remain to be investigated . OBJECTIVE : In patients with COPD we compared the effects of 2 exercise/training regimens ( a high-intensity whole-body endurance- and -strength program , and a low-intensity calisthenics- and -breathing-exercises program ) on physical activity in daily life , exercise capacity , muscle force , health-related quality of life , and functional status . METHODS : We r and omized 40 patients with COPD to perform either endurance- and -strength training ( no. = 20 , mean ± SD FEV1 40 ± 13 % of predicted ) at 60–75 % of maximum capacity ,  or calisthenics- and -breathing-exercises training  ( no. = 20 , mean ± SD FEV1 39 ± 14 % of predicted ) . Both groups underwent 3 sessions per week for 12 weeks . Before and after the training programs the patients underwent activity monitoring with motion sensors , incremental cycle-ergometry , 6-min walk test , and peripheral-muscle-force test , and responded to question naires on health-related quality of life and functional status ( activities of daily living , pulmonary functional status , and dyspnea ) . RESULTS : Time spent active and energy expenditure in daily life were not significantly altered in either group . Exercise capacity and muscle force significantly improved only in the endurance- and -strength group . Health-related quality of life and functional status improved significantly in both groups . CONCLUSIONS : Neither training program significantly improved time spent active or energy expenditure in daily life . The training regimens similarly improved quality of life and functional status . Exercise capacity and muscle force significantly improved only in the high-intensity endurance- and -strength group BACKGROUND Pulmonary Rehabilitation ( " Rehabilitation " ) can improve both lung function and quality of life in patients suffering from chronic obstructive pulmonary disease ( COPD ) even if only a very small proportion of patients have access to Rehabilitation . Supplementation of Essential Amino Acids ( EAAs ) might allow COPD patients to achieve some typical Rehabilitation outcomes such as a better physical performance and an improved health status . METHODS 88 COPD out- patients ( GOLD class 3 - 4 ) with a body mass index ( BMI ) < 23 Kg/m2 were r and omised to receive EAAs ( n = 44 ) or placebo ( n = 44 ) for twelve weeks . Primary outcome measures were changes in both physical activities in daily life ( measured by Sense Wear Armb and in terms of mean steps walked in one week ) and in quality of life ( measured by the St George 's Respiratory Question naire , SGRQ ) . RESULTS After 12 weeks , the physical performance was significantly increased vs baseline only in patients who received EAAs ( 1140.33 + /- 524.69 and 638.68 + /- 662.1 steps/day , respectively ; p = 0.02 ) , being also the comparison vs the placebo group highly significant ( p = 0.003 ) . Similarly , the SGRQ score improved significantly only in EAA patients ( 69.35 + /- 9.51 vs baseline 72.04 + /- 8.62 ; p < 0.01 ) , and changes were significantly different from those measured in the placebo group ( p < 0.001 ) . Furthermore , when compared to those who received placebo , EAAs patients significantly increased their fat-free mass ( p = 0.04 ) , muscle strength ( p < 0.01 ) , saturation of oxygen ( p = 0.05 ) , serum albumin ( p < 0.001 ) , and also ameliorated their original cognitive dysfunction ( p = 0.02 ) . CONCLUSIONS Oral supplementation with EAAs contribute to improve the daily-life performance in domiciliary severe COPD patients who can not enter any Rehabilitation programme , together with their quality of life ; nutritional and cognitive status , and muscle strength BACKGROUND Even after a rehabilitation program , levels of physical activity in COPD progressively decrease unless strategies to encourage activity are implemented . We analyzed the effects of the implementation of urban walking circuits on levels of physical activity and exercise capacity of patients with severe and very severe COPD after a rehabilitation program .  METHOD A total of 83 patients were r and omized to either urban circuits group ( UCG ) or usual care in the non-circuit group ( NCG )  , after completing a 2-week rehabilitation program . Results were evaluated 9 months after completion of the rehabilitation program and were compared with a control group of 54 patients not enrolled in the rehabilitation program .  RESULTS At the end of follow-up , UCG patients increased their physical activity by a mean of 32.4 ( SE = 5.9 ) min per day and 1.09 ( SE = 0.22 ) days walked per week ; 33.9 ( SE = 5.6 ) min per day and 1.12 ( SE = 0.24 ) days per week more compared to the NCG ( p < 0.001 ) . There was a significant positive correlation between the results of the 6-min walking test and minutes walked per day in the UCG ( r(2 ) = 0.52 , p < 0.05 ) but not in the NCG ( r(2 ) = 0.094 , p > 0.05 ) . Controls showed a significant decrease in exercise capacity and physical activity over the follow-up . CONCLUSIONS Urban circuits are an easy , inexpensive strategy , which demonstrated to be useful to stimulate physical activity in our population of severe and very severe COPD patients and result ed in increased exercise capacity even 9 months after completion of a rehabilitation program BACKGROUND Chronic obstructive pulmonary disease ( COPD ) patients have lower levels of physical activity compared to age-matched controls , and they limit physical activities requiring normal exertion . Our purpose was to compare the effectiveness of a traditional exercise therapy ( TET ) program with a behavioral lifestyle activity program ( LAP ) in promoting physical activity . METHODS Moderate physical activity ( kcal/week ) was assessed in 176 COPD patients using the Community Health Activities Model for Seniors question naire . Patients were r and omized to either a  three month TET program that meet thrice weekly or a LAP . The LAP was design ed to teach behavioral skills that encouraged the daily accumulation of self-selected physical activities of at least moderate intensity . Interventionist contact was similar ( 36 h ) between the two groups . Patients were assessed at baseline and 3 , 6 and 12 months . RESULTS Compared to baseline values , self-reported moderate physical activity increased three months post-r and omization with no significant difference ( p = 0.99 ) found between the TET ( 2501 + /- 197 kcal/week ) and the LAP ( 2498 + /- 211 kcal/week ) . At 6 and 12 months post-r and omization , there were no significant differences ( p = 0.37 and 0.69 , respectively ) in self-reported levels of moderate physical activity between the TET ( 2210 + /- 187 and 2213 + /- 218 kcal/week , respectively ) and the LAP ( 2456 + /- 198 and 2342 + /- 232 kcal/week , respectively ) . CONCLUSION Although there was no difference between treatment groups , the TET and the LAP were both effective at in increasing moderate levels of physical activity at 3 months and maintaining moderate physical activity levels 12 months post-r and omization . This clinical trial is registered with Clinical Trials.gov . Its identifier is NCT00328484 OBJECTIVE To study the effects of a lifestyle physical activity counseling program with feedback of a pedometer during pulmonary rehabilitation . METHODS Twenty-one chronic obstructive pulmonary disease ( COPD ) patients were r and omized to an experimental group that followed a regular rehabilitation program plus the counseling intervention or to a control group that only followed rehabilitation . The primary outcome was daily physical activity assessed by pedometers . Secondary outcomes were physical fitness , health-related quality of life , activities of daily living , depression and self-efficacy . RESULTS The experimental group showed an increase of 1,430 steps/day ( + 69 % from baseline ) , whereas the control group showed an increase of 455 steps/day ( + 19 % ) ( p = 0.11 for group x time interaction ) . The secondary outcomes showed no differences . CONCLUSION AND PRACTICE IMPLICATION S This study showed that the use of the pedometer , in combination with exercise counseling and the stimulation of lifestyle physical activity , is a feasible addition to pulmonary rehabilitation which may improve outcome and maintenance of rehabilitation results BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . Background Improvements in ventilatory mechanics with tiotropium increases exercise tolerance during pulmonary rehabilitation . We wondered whether tiotropium also increased physical activities outside of pulmonary rehabilitation . Methods COPD patients participating in 8 weeks of pulmonary rehabilitation were studied in a r and omized , double-blind , placebo-controlled trial of tiotropium 18 μg daily ( tiotropium = 47 , placebo = 44 ) . Study drug was administered for 5 weeks prior to , 8 weeks during , and 12 weeks following pulmonary rehabilitation . Patients completed a question naire documenting participation in pre-defined activities outside of pulmonary rehabilitation during the 2 weeks prior to each visit . Patients who su bmi tted an activity question naire at week 4 and on at least one subsequent visit were included in the analysis . For each patient , the number of sessions was multiplied with the duration of each activity and then summed to give overall activity duration . Results Patients ( n = 46 ) had mean age of 67 years , mean baseline FEV1 of 0.84 L ( 33 % predicted ) . Mean ( SE ) increase in duration of activities ( minutes during 2 weeks prior to each visit ) from week 4 ( prior to PR ) to week 13 ( end of PR ) was 145 ( 84 ) minutes with tiotropium and 66 ( 96 ) minutes with placebo . The increase from week 4 to week 25 ( end of follow-up ) was 262 ( 96 ) and 60 ( 93 ) minutes for the respective groups . Increases in activity duration from week 4 to weeks 17 , 21 , and 25 were statistically significant with tiotropium . No statistical differences over time were observed within the placebo-treated group and differences between groups were not significant . Conclusions Tiotropium appears to amplify the effectiveness of pulmonary rehabilitation as seen by increases in patient self-reported participation in physical activities AIM Aim of the study was to investigate whether or not oral supplementation of essential amino acids ( EAAs ) may improve body composition , muscle metabolism , physical activity , cognitive function , and health status in a population of subjects with severe chronic obstructive pulmonary disease ( COPD ) and sarcopenia . METHODS Thirty-two patients ( 25 males ) ( FEV1/FVC < 40 % predicted ) , age 75 + /- 7 years , were r and omised ( n = 16 in both groups ) to receive 4 gr/bid EAAs or placebo according to a double-blind design . When entered the study ( T0 ) , after four ( T4 ) , and after twelve ( T12 ) weeks of treatments , body weight , fat free-mass ( FFM ) , plasma lactate concentration ( micromol/l ) , arterial PaCO2 and PaO2 , physical activity ( n degree steps/day ) , cognitive function ( Mini Mental State Examination ; MMSE ) , health status ( St. George 's Respiratory Question naire ; SGRQ ) were measured . RESULTS EAAs supplemented , but not patients assuming placebo , progressively improved all baseline variables overtime . In particular , at T12 of EAAs supplementation , body weight ( BW ) increased by 6 Kg ( p = 0.002 ) , FFM by 3.6 Kg ( p = 0.05 ) , plasma lactate decreased from 1.6 micromol/l to 1.3 micromol/l ( p = 0.023 ) , PaO2 increased by 4.6 mmHg ( p = 0.01 ) , physical activity increased by 80 % ( p = 0.01 ) . Moreover , the score for cognitive dysfunction improved from 19.1 scores to 20.8 ( p = 0.011 ) , while the SRGQ score also improved from 723 to 69.6 even though this trend did not reach the statistical significance . CONCLUSIONS . A three-month EAAs supplementation may have comprehensive effects on nutritional status ; muscle energy metabolism ; blood oxygen tension , physical autonomy ; cognitive function , and perception of health status in patients with severe COPD and secondary sarcopenia BACKGROUND Low levels of physical activity ( PA ) are associated with poor outcomes in people with COPD . Interventions to increase PA could improve outcomes . METHODS We tested the efficacy of a novel Internet-mediated , pedometer-based exercise intervention .  Veterans with COPD ( N = 239 ) were r and omized in a 2:1 ratio to the ( 1 ) intervention group ( Omron HJ-720 ITC pedometer and Internet-mediated program ) or ( 2 ) wait-list control group ( pedometer ) . The primary outcome was health-related quality of life ( HRQL ) , assessed by the St. George 's Respiratory Question naire ( SGRQ ) , at 4 months . We examined the SGRQ total score ( SGRQ-TS ) and three domain scores : Symptoms , Activities , and Impact . The secondary outcome was daily step counts . Linear regression models assessed the effect of intervention on outcomes . RESULTS Participants had a mean age of 67 ± 9 years , and 94 % were men . There was no significant between-group difference in mean 4-month SGRQ-TS ( 2.3 units , P = .14 ) . Nevertheless , a significantly greater proportion of intervention participants than control subjects had at least a 4-unit improvement in SGRQ-TS , the minimum clinical ly important difference ( 53 % vs 39 % , respectively , P = .05 ) . For domain scores , the intervention group had a lower ( reflecting better HRQL ) mean than the control group by 4.6 units for Symptoms ( P = .046 ) and by 3.3 units for Impact ( P = .049 ) . There was no significant difference in Activities score between the two groups . Compared with the control subjects , intervention participants walked 779 more steps per day at 4 months ( P = .005 ) . CONCLUSIONS An Internet-mediated , pedometer-based walking program can improve domains of HRQL and daily step counts at 4 months in people with COPD . TRIAL REGISTRY Clinical Trials.gov ; No. : NCT01102777 ; URL : www . clinical trials.gov Patients with chronic obstructive pulmonary disease ( COPD ) often suffer from weight loss . The aim of the present study was to gain insight into the energy balance of depleted ambulatory COPD patients , in relation to their habitual level of physical activity and consumption of oral nutritional supplements .  Clinical ly stable and weight-stable patients ( n 20 ; BMI 19.8+/- SD 2.0 kg/m2 ) were studied 1 and 3 months after rehabilitation or recovery in the clinic and were at r and om assigned to a control or intervention group with regard to nutritional supplementation .  Energy intake was measured with a 7 d food record .  Energy expenditure was estimated from a simultaneous 7 d assessment of physical activity with a tri-axial accelerometer for movement registration in combination with measured BMR . Body mass was measured at several time points . The body mass remained stable in both groups after 1 or 3 months and mean energy balances were comparable for both groups . The mean body-mass change between month 1 and 3 was negatively related to the mean physical activity level ( r -0.49 ; P=0.03 ) . Weight change over the 3 months was negatively associated with the physical activity level . These results suggest that knowledge about the individual physical activity level is necessary for the estimation of the energy need of the COPD patient Objective To investigate the long term effectiveness of integrated disease management delivered in primary care on quality of life in patients with chronic obstructive pulmonary disease ( COPD ) compared with usual care . Design 24 month , multicentre , pragmatic cluster r and omised controlled trial Setting 40 general practice s in the western part of the Netherl and s Participants Patients with COPD according to GOLD ( Global Initiative for COPD ) criteria . Exclusion criteria were terminal illness , cognitive impairment , alcohol or drug misuse , and inability to fill in Dutch question naires . Practice s were included if they were willing to create a multidisciplinary COPD team . Intervention General practitioners , practice nurses , and specialised physiotherapists in the intervention group received a two day training course on incorporating integrated disease management in practice , including early recognition of exacerbations and self management , smoking cessation , physiotherapeutic reactivation , optimal diagnosis , and drug adherence . Additionally , the course served as a network platform and collaborating healthcare providers design ed an individual practice plan to integrate integrated disease management into daily practice . The control group continued usual care ( based on international guidelines ) . Main outcome measures The primary outcome was difference in health status at 12 months , measured by the Clinical COPD Question naire ( CCQ ) ; quality of life , Medical Research Council dyspnoea , exacerbation related outcomes , self management , physical activity , and level of integrated care ( PACIC ) were also assessed as secondary outcomes . Results Of a total of 1086 patients from 40 clusters , 20 practice s ( 554 patients ) were r and omly assigned to the intervention group and 20 clusters ( 532 patients ) to the usual care group . No difference was seen between groups in the CCQ at 12 months ( mean difference –0.01 , 95 % confidence interval –0.10 to 0.08 ; P=0.8 ) . After 12 months , no differences were seen in secondary outcomes between groups , except for the PACIC domain “ follow-up/coordination ” ( indicating improved integration of care ) and proportion of physically active patients . Exacerbation rates as well as number of days in hospital did not differ between groups . After 24 months , no differences were seen in outcomes , except for the PACIC follow-up/coordination domain . Conclusion In this pragmatic study , an integrated disease management approach delivered in primary care showed no additional benefit compared with usual care , except improved level of integrated care and a self reported higher degree of daily activities . The contradictory findings to earlier positive studies could be explained by differences between interventions ( provider versus patient targeted ) , selective reporting of positive trials , or little room for improvement in the already well developed Dutch healthcare system . Trial registration Netherl and s Trial Register NTR2268 OBJECTIVE To evaluate the effects of whole-body resistance training on exercise capacity , health-related quality of life ( HRQOL ) , and muscle strength in patients hospitalized for exacerbation of chronic obstructive pulmonary disease . DESIGN R and omized controlled trial . SETTING University hospital . PARTICIPANTS Patients ( N=46 ) were r and omized to either a control group ( CG ) or training group ( TG ) , and 29 patients completed the study . INTERVENTION Training consisted of weight-lifting exercises for 6 muscle groups in the upper and lower limbs ( 2 sets of 8 repetitions each ) , and the initial load was set at 80 % of the 1-repetition maximum load . MAIN OUTCOME MEASURES Patients were evaluated on the second day of hospitalization , at hospital discharge , and 30 days postdischarge . Patients were evaluated on the basis of the 6-minute walking distance ( 6MWD ) , HRQOL , muscle strength , systemic inflammatory markers , and level of physical activity in daily life ( PADL ) . RESULTS The CG showed a reduction in the strength of lower-limb muscles ( P<.05 ) but not in the 6MWD ( P>.05 ) . In contrast , patients from the TG improved strength in the lower-limb muscles and 6MWD during and 30 days after hospitalization ( P<.05 ) . The TG also improved the impact domain in HRQOL after hospitalization . No improvement in PADL was observed in the TG . Finally , a reduction in the blood levels of inflammatory markers was observed only in the TG after hospitalization . CONCLUSIONS Our results suggest that resistance training during hospitalization improves the 6MWD , HRQOL , and lower-limb muscle strength , without altering the levels of systemic inflammation . However , future research should explore this intervention in larger r and omized trials BACKGROUND The aim of this study was to examine patterns of domestic activity and ambulatory oxygen usage in patients with COPD in their domestic environment . METHODS Twenty patients ( 14 men ; mean age , 73.4 years [ SD , 6.8 years ] ; FEV1 , 1.0 L [ SD , 0.5 L ] ) with stable COPD were recruited after completing a 7-week pulmonary rehabilitation program . Patients were either hypoxic at rest or had desaturation during exercise . Patients were r and omized to an 8-week , double-blind , placebo-controlled trial of cylinder oxygen vs cylinder air .  Total domestic physical activity and health-related quality of life ( HRQL ) measures were recorded before and after intervention . RESULTS There were no significant changes in domestic activity or HRQL measures after the intervention for either cylinder oxygen or cylinder air , except for a worsening of the Chronic Respiratory Question naire dyspnea domain on cylinder air . There was a significant increase in mean duration ( minutes per day ) of cylinder use ( p < 0.05 ) between weeks 1 vs 7 and weeks 1 vs 8 for the oxygen group . However , when comparing the two groups together , there were no between-group differences in cylinder use or time spent outside the home . Over the 8 weeks the majority of patients were using the cylinders in the home rather than outside , however , the number of times patients reported using the cylinders outside the home increased over the 8 weeks for the oxygen group . CONCLUSION In the short term , ambulatory oxygen therapy is not associated with improvements in physical activity , HRQL , or time spent away from home . However , the use of  cylinder oxygen increased over the 8 weeks compared to cylinder air . Patients need time to learn how to use oxygen , and ambulatory oxygen appears to enhance activities rather than increase them BACKGROUND We were interested in the effects of a physical activity ( PA ) counselling programme in three groups of COPD patients from general practice ( primary care ) , outpatient clinic ( secondary care ) and pulmonary rehabilitation ( PR ) . METHODS In this r and omized controlled trial 155 COPD patients , 102 males , median ( IQR ) age 62 ( 54 - 69 ) y , FEV1predicted 60 ( 40 - 75 ) % were assigned to a 12-weeks ' physical activity counselling programme or usual care .  Physical activity ( pedometer ( Yamax SW200 ) and metabolic equivalents ) , exercise capacity ( 6-min walking distance ) and quality of life ( Chronic Respiratory Question naire and Clinical COPD Question naire ) were assessed at baseline , after three and 15 months . RESULTS A significant difference between the counselling and usual care group in daily steps ( 803 steps , p = 0.001 ) and daily physical activity ( 2214 steps + equivalents , p = 0.001 ) ) from 0 to 3 months was found in the total group , as well as in the outpatient ( 1816 steps , 2616 steps + equivalents , both p = 0.007 ) and PR ( 758 steps , 2151 steps + equivalents , both p = 0.03 ) subgroups . From 0 to 15 months no differences were found in physical activity . However , when patients with baseline physical activity>10,000 steps per day ( n = 8) , who are already sufficiently active , were excluded , a significant long-term effect of the counselling programme on daily physical activity existed in the total group ( p = 0.02 ) . Differences in exercise capacity and quality of life were found only from 0 to 3 months , in the outpatient subgroup . CONCLUSION Our PA counselling programme  effectively enhances PA level in COPD patients after three months . Sedentary patients at baseline still benefit after 15 months . Clinical Trials.gov : registration number NCT00614796 OBJECTIVE To investigate whether a 12-week pedometer-based exercise counseling strategy is feasible and effectively enhances daily physical activity in outclinic Chronic Obstructive Pulmonary Disease ( COPD ) patients who do not participate in a rehabilitation program in a controlled way . METHODS 35 outclinic COPD patients ( 21 males , mean age 62 years , GOLD I-III , mean FEV(1)% predicted 64.7 ) were r and omized for a 12-week individual pedometer-based exercise counseling program promoting daily physical activities or usual care .  Daily physical activity ( DigiWalker SW-200 ) , physical fitness , health-related quality of life , self-efficacy , fatigue , depression and motivation to be physically active were assessed before and after the intervention . RESULTS After the intervention , COPD patients in the exercise counseling group showed a significant increase in their mean number of steps/day ( from 7087 to 7872 ) , whereas the usual care group showed a decrease ( from 7539 to 6172 ) . Significant differences favoring the exercise counseling group were demonstrated in arm strength , leg strength , health-related quality of life and intrinsic motivation to be physically active . CONCLUSION Our study shows that a 12-week pedometer-based exercise counseling strategy is feasible and effectively enhances daily physical activity , physical fitness , health-related quality of life and intrinsic motivation in outclinic COPD patients who do not participate in a rehabilitation program . PRACTICE IMPLICATION S The feasibility of our exercise counseling strategy is good and patients were motivated to participate The aim of this study was to investigate the impact of a physical activity (PA)-focused behavioural intervention during and after  pulmonary rehabilitation ( PR ) on PA levels ( primary aim ) , health-related outcomes and self-efficacy ( secondary aims ) of patients with COPD . Thirty-two patients were r and omly assigned to an experimental group ( EG ) or control group ( CG ) . The EG received a PA-focused behavioural intervention during PR ( 3 months ) and follow-up support ( 3 months ) . The CG received PR ( 3 months ) . Daily PA was collected : number of steps ; time spent in moderate-to-vigorous PA ( MVPA ) , total PA and sedentary activities ( SA ) . Secondary outcomes comprised exercise capacity , muscle strength , health-related quality of life ( HRQOL ) and self-efficacy . Measures were collected at baseline , 3 and 6 months . Compared with the CG , the EG improved the number of steps ( p = 0.006 ) and time spent in MVPA ( p = 0.007 ) , total PA ( p = 0.014 ) and SA ( p = 0.018 ) at 3 months . Differences were maintained after follow-up support ( 0.025 ≤ p ≤ 0.040 ) , except for SA ( p = 0.781 ) . Exercise capacity , muscle strength and HRQOL were increased at 3 and 6 months ( p ≤ 0.002 ) with no between-group differences ( 0.148 ≤ p ≤ 0.987 ) . No changes were observed in self-efficacy ( p = 0.899 ) . A PA-focused behavioural intervention during and after PR may improve patients ' PA levels . Further research is warranted to assess the sustainability of the findings PURPOSE : The success of long-term exercise training ( ExT ) programs resides in the integration between exercise prescription and patient compliance with home training . One of the crucial issues for the patients is the underst and ing of appropriate exercise intensity . We compared 2 methods of home ExT , based on walking . METHODS : Forty-seven patients with chronic obstructive pulmonary disease were recruited and underwent respiratory function , exercise capacity evaluation with a 6-minute walk test , and treadmill tests . Physical activity was monitored by a multisensor Armb and ( SenseWear , Body Media , Pittsburgh , PA ) . Patients were r and omly assigned to 2 different home training methods and assessed again after 6 and 12 months ; group A1 : speed walking paced by a metronome , and group A2 : walking a known distance in a fixed time . RESULTS : Thirty-six patients completed the study . All subjects showed a significant improvement in the 6-minute walk test after 1 year but the improvement was higher in A1 than in A2 ( P < .05 ) . Physical activity levels were significantly higher at T12 versus baseline only in group A1 ( P < .05 ) . CONCLUSIONS : The use of a metronome to maintain the rate of walking during home ExT seems to be beneficial , allowing patients to achieve and sustain the optimal exercise intensity , and result ing in greater improvement compared to simply using a fixed time interval exercise CONTEXT People with chronic obstructive pulmonary disease experience dyspnea  with activities despite optimal medical management . OBJECTIVES The purpose of this study was to test the efficacy of two 12-month dyspnea self-management programs ( DSMPs ) , Internet-based ( eDSMP ) and face-to-face ( fDSMP ) , compared with a general health education ( GHE ) control on the primary outcome of dyspnea with activities . METHODS Participants with chronic obstructive pulmonary disease were r and omized to eDSMP ( n=43 ) , fDSMP ( n=41 ) , or GHE ( n=41 ) . The content of the DSMPs were similar and focused on education , skills training , and coaching on dyspnea self-management strategies , including exercise , and only differed in the delivery mode . Dyspnea with activities was measured with the Chronic Respiratory Question naire at three , six , and 12 months . Secondary outcomes included exercise behavior and performance , health-related quality of life , self-efficacy for dyspnea management , and perception of support for exercise . The study was registered at Clinical trials.gov ( NCT00461162 ) . RESULTS There were no differences in dyspnea with activities across groups over 12 months ( P=0.48 ) . With the exception of arm endurance ( P=0.04 ) , exercise behavior , performance , and health-related quality of life did not differ across groups ( P>0.05 ) . Self-efficacy for managing dyspnea improved for the DSMPs compared with GHE ( P=0.06 ) . DSMP participants perceived high levels of support for initiating and maintaining an exercise program . CONCLUSION The DSMPs did not significantly reduce dyspnea with activities compared with attention control . However , the high participant satisfaction with the DSMPs combined with positive changes in other outcomes , including self-efficacy for managing dyspnea and exercise behavior , highlight the need for additional testing of individually tailored technology-enabled interventions to optimize patient engagement and improve clinical ly relevant outcomes There is an urgent need for consensus on what defines a chronic obstructive pulmonary disease ( COPD ) self-management intervention . We aim ed to obtain consensus regarding the conceptual definition of a COPD self-management intervention by engaging an international panel of COPD self-management experts using Delphi technique features and an additional group meeting . In each consensus round the experts were asked to provide feedback on the proposed definition and to score their level of agreement ( 1=totally disagree ; 5=totally agree ) . The information provided was used to modify the definition for the next consensus round . Thematic analysis was used for free text responses and descriptive statistics were used for agreement scores . In total , 28 experts participated . The consensus round response rate varied r and omly over the five rounds ( ranging from 48 % ( n=13 ) to 85 % ( n=23 ) ) , and mean definition agreement scores increased from 3.8 ( round 1 ) to 4.8 ( round 5 ) with an increasing percentage of experts allocating the highest score of 5 ( round 1 : 14 % ( n=3 ) ; round 5 : 83 % ( n=19 ) ) . In this study we reached consensus regarding a conceptual definition of what should be a COPD self-management intervention , clarifying the requisites for such an intervention . Operationalisation of this conceptual definition in the near future will be an essential next step . Consensus of a conceptual definition of what should be a COPD self-management intervention with its requisites AIMS To evaluate the effectiveness of a 6-month , partnership-based self-management programme for patients with mild and moderate chronic obstructive pulmonary disease . BACKGROUND Self-management is a widely valued concept used to address contemporary issues of chronic health problems . Findings of self-management programmes for people with chronic obstructive pulmonary disease are inconclusive . DESIGN Pragmatic r and omized control trial . METHODS Patients , 45 - 65 years old , with mild and moderate chronic obstructive pulmonary disease were invited with a family member . Experimental group ( n = 48 ) participated in a 6-month , partnership-based self-management programme consisting of : ( a ) three to four conversations between nurse and patient-family member ; ( b ) 6 months of smoking cessation ; and ( c ) interdisciplinary team-patient-family member group meeting . Control group ( n = 52 ) received usual care . Data were collected at months zero , six and 12 . The trial lasted from June 2009-March 2013 . RESULTS Patients with mild and moderate chronic obstructive pulmonary disease who participated in the partnership-based self-management programme perceived less intrusiveness of the disease and its treatment than patients in the control group . Patients in the experimental group did not have better health-related quality of life , less anxiety or depression , increased physical activity , fewer exacerbations or better smoking status than patients in the control group . Patients in both groups found participation in the research useful and important . CONCLUSION The partnership-based self-management programme had benefits concerning perception of the intrusiveness of chronic obstructive pulmonary disease and its treatment on lifestyles , activities and interests for young patients with the disease in its early stages . High satisfaction in control group , low family attendance and the relatively short treatment period may explain the less than expected benefits of the programme AIM To determine the feasibility of recruiting patients with early chronic obstructive pulmonary disease ( COPD ) to the Health Enhancing Activity in Lung THerapy ( HEALTH ) exercise and education programme . METHODS Patients with early COPD were identified from general practice s. Those meeting the study inclusion criteria were administered tiotropium throughout the study period . Participants were r and omised to either an eight-week health enhancing and physical activity ( HEPA ) programme , or to a control group ( usual care ) .  Behavioural , physiological and psychosocial outcome measures were reported pre and post-intervention . RESULTS Out of 27 practice s approached , 16 ( 59.3 % ) agreed to participate . Of 215 potentially eligible patients contacted , 60 ( 27.9 % ) replied . Twenty ( 33.3 % ) were r and omised to either HEPA intervention ( n=10 ) or usual care ( n=10 ) . Fourteen patients attended a postintervention assessment . CONCLUSION This study provides valuable information on the feasibility of conducting such a trial involving a physical activity intervention
target: Interventions that included ET and PA counseling during PR were effective strategies to improve PA in COPD
background: BACKGROUND Physical inactivity is associated with poor outcomes in COPD , and as a result , interventions to improve physical activity ( PA ) are a current research focus .
  However , many trials have been small and inconclusive .
  OBJECTIVE The aim of this systematic review and meta- analysis was to study the effects of r and omized controlled trials ( RCTs ) targeting PA in COPD .