title: Pedometer Step Count Targets during Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease. A Randomized 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 Validity of Six Activity Monitors in Chronic Obstructive Pulmonary Disease: A Comparison with Indirect Calorimetry Promoting physical activity in COPD: Insights from a randomized trial of a web-based intervention and pedometer use. Physical activity is increased by a 12-week semiautomated telecoaching programme in patients with COPD: a multicentre randomised controlled trial Pedometers to enhance physical activity in COPD: a randomised controlled trial Effects of low-intensity exercise and home-based pulmonary rehabilitation with pedometer feedback on physical activity in elderly patients with chronic obstructive pulmonary disease. Efficacy of an mHealth intervention to stimulate physical activity in COPD patients after pulmonary rehabilitation Home-based rehabilitation for COPD using minimal resources: a randomised, controlled equivalence trial 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. An Internet-Mediated Pedometer-Based Program Improves Health-Related Quality-of-Life Domains and Daily Step Counts in COPD: A Randomized Controlled Trial. A Patient-Centered Walking Program for COPD. 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. Long-term efficacy and effectiveness of a behavioural and community-based exercise intervention (Urban Training) to increase physical activity in patients with COPD: a randomised controlled trial The likelihood of improving physical activity after pulmonary rehabilitation is increased in patients with COPD who have better exercise tolerance A telerehabilitation intervention for patients with Chronic Obstructive Pulmonary Disease: a randomized controlled pilot trial
abstract: Rationale : Increasing physical activity is a key therapeutic aim in chronic obstructive pulmonary disease ( COPD ) .  Pulmonary rehabilitation ( PR ) improves exercise capacity , but there is conflicting evidence regarding its ability to improve physical activity levels . Objectives : To determine whether using pedometers as an adjunct to PR can enhance time spent in at least moderate‐intensity physical activity ( time expending ≥3 metabolic equivalents [ METs ] ) by people with COPD . Methods : In this single‐blind r and omized controlled trial , participants were assigned 1:1 to receive a control intervention ( PR comprising 8 wk , two supervised sessions per week ) or the trial intervention ( PR plus pedometer‐directed step targets , review ed weekly for 8 wk ) . In the r and omization process , we used minimization to balance groups for age , sex , FEV1 percent predicted , and baseline exercise capacity and physical activity levels . Outcome assessors and PR therapists were blinded to group allocation . The primary analysis was based on the intention‐to‐treat principle . Measurements and Main Results : The primary outcome was change from baseline to 8 weeks in accelerometer‐measured daily time expending at least 3 METs . A total of 152 participants ( 72 % male ; mean [ SD ] FEV1 percent predicted , 50.5 % [ 21.2 ] ; median [ first quartile , third quartile ] time expending ≥3 METs , 46 [ 21 , 92 ] min ) were enrolled and assigned to the intervention ( n = 76 ) or control ( n = 76 ) arm . There was no significant difference in change in time expending at least 3 METs between the intervention and control groups at 8 weeks ( median [ first quartile , third quartile ] difference , 0.5 [ −1.0 , 31.0 ] min ; P = 0.87 ) or at the 6‐month follow‐up ( 7.0 [ −9 , 27 ] min ; P = 0.16 ) . Conclusions : Pedometer‐directed step‐count targets during an outpatient PR program did not enhance moderate‐intensity physical activity levels in people with COPD . Clinical trial registered with www . clinical trials.gov ( NCT01719822 ) 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 Reduced physical activity is an important feature of Chronic Obstructive Pulmonary Disease ( COPD ) . Various activity monitors are available but their validity is poorly established . The aim was to evaluate the validity of six monitors in patients with COPD . We hypothesized triaxial monitors to be more valid compared to uniaxial monitors . Thirty-nine patients ( age 68±7years , FEV1 54±18%predicted ) performed a one-hour st and ardized activity protocol . Patients wore 6 monitors ( Kenz Lifecorder ( Kenz ) , Actiwatch , RT3 , Actigraph GT3X ( Actigraph ) , Dynaport MiniMod ( MiniMod ) , and SenseWear Armb and ( SenseWear ) ) as well as a portable metabolic system ( Oxycon Mobile ) . Validity was evaluated by correlation analysis between indirect calorimetry ( VO2 ) and the monitor outputs : Metabolic Equivalent of Task [ METs ] ( SenseWear , MiniMod ) , activity counts ( Actiwatch ) , vector magnitude units ( Actigraph , RT3 ) and arbitrary units ( Kenz ) over the whole protocol and slow versus fast walking . Minute-by-minute correlations were highest for the MiniMod ( r = 0.82 ) , Actigraph ( r = 0.79 ) , SenseWear ( r = 0.73 ) and RT3 ( r = 0.73 ) . Over the whole protocol , the mean correlations were best for the SenseWear ( r = 0.76 ) , Kenz ( r = 0.52 ) , Actigraph ( r = 0.49 ) and MiniMod ( r = 0.45 ) . The MiniMod ( r = 0.94 ) and Actigraph ( r = 0.88 ) performed better in detecting different walking speeds . The Dynaport MiniMod , Actigraph GT3X and SenseWear Armb and ( all triaxial monitors ) are the most valid monitors during st and ardized physical activities . The Dynaport MiniMod and Actigraph GT3X discriminate best between different walking speeds RATIONALE Low physical activity is highly prevalent among COPD patients and is associated with increased healthcare utilization and mortality and reduced HRQL . The addition of a website to pedometer use is effective at increasing physical activity ; however , the timeline of change and impact of environmental factors on efficacy is unknown . METHODS U.S. Veterans with COPD were r and omized ( 1:1 ) to receive either ( 1 ) a pedometer and website which provided goal - setting , feedback , disease-specific education , and an online community forum or ( 2 ) pedometer alone for 3 months . Primary outcome was change in daily step count . Secondary outcomes included 6MWT distance , HRQL , dyspnea , depression , COPD knowledge , exercise self-efficacy , social support , motivation , and confidence to exercise . Generalized linear mixed-effects models evaluated the effect of the pedometer plus website compared to pedometer alone . RESULTS Data from 109 subjects ( 98.5 % male , mean age 68.6 ± 8.3 years ) were analyzed . At 13 weeks , subjects in the pedometer plus website group had significant increases daily step count from baseline relative to the pedometer alone group ( 804 ± 356.5 steps per day , p = 0.02 ) . The pedometer plus website group had significant improvements in daily step count from baseline beginning in week 3 which were sustained until week 13 . In subgroup analyses , the pedometer plus website attenuated declines in daily step count during the transition from summer to fall . No significant differences in secondary outcomes were noted between groups . CONCLUSIONS A website added to pedometer use improves daily step counts , sustains walking over 3 months , and attenuates declines in physical activity due to season Rationale Reduced physical activity ( PA )  in patients with COPD is associated with a poor prognosis . Increasing PA is a key therapeutic target , but thus far few strategies have been found effective in this patient group . Objectives To investigate the effectiveness of a 12-week semiautomated telecoaching intervention on PA  in patients with COPD in a multicentre European r and omised controlled trial . Methods 343 patients from six centres , encompassing a wide spectrum of disease severity , were r and omly allocated to either a usual care group ( UCG ) or a telecoaching intervention group ( IG ) between June and December 2014 . This 12-week intervention included an exercise booklet and a step counter providing feedback both directly and via a dedicated smartphone application . The latter provided an individualised daily activity goal ( steps ) revised weekly and text messages as well as allowing occasional telephone contacts with investigators .  PA  was measured using accelerometry during 1 week preceding r and omisation and during week 12 . Secondary outcomes included exercise capacity and health status . Analyses were based on modified intention to treat . Main results Both groups were comparable at baseline in terms of factors influencing PA . At 12 weeks , the intervention yielded a between-group difference of mean , 95 % CI ( lower limit – upper limit ; ll-ul ) + 1469 , 95 % CI ( 971 to 1965 ) steps/day and + 10.4 , 95 % CI ( 6.1 to 14.7 ) min/day moderate PA ; favouring the IG ( all p≤0.001 ) . The change in 6-min walk distance was significantly different ( 13.4 , 95 % CI ( 3.40 to 23.5 ) m , p<0.01 ) , favouring the IG . In IG patients , an improvement could be observed in the functional state domain of the clinical COPD question naire ( p=0.03 ) compared with UCG . Other health status outcomes did not differ . Conclusions The amount and intensity of PA  can be significantly increased in patients with COPD using a 12-week semiautomated telecoaching intervention including a step counter and an application installed on a smartphone . Trial registration number : NCT02158065 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 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 Physical inactivity in patients with chronic obstructive pulmonary disease ( COPD ) is associated with poor health status and increased disease burden . The present study aims to test the efficacy of a previously developed mobile (m)Health intervention to improve or maintain physical activity in patients with COPD after pulmonary rehabilitation . A r and omised controlled trial was performed in 32 physiotherapy practice s in the Netherl and s. COPD patients were r and omised into intervention or usual care groups . The intervention consisted of a smartphone application for the patients and a monitoring website for the physiotherapists . Measurements were performed at 0 , 3 , 6 and 12 months . Physical activity , functional exercise capacity , lung function , health-related quality of life and body mass index were assessed . 157 patients started the study and 121 completed it . There were no significant positive effects of the intervention on physical activity ( at 0 months : intervention 5824±3418 steps per weekday , usual care 5717±2870 steps per weekday ; at 12 months : intervention 4819±2526 steps per weekday , usual care 4950±2634 steps per weekday ; p=0.811 ) or on the secondary end-points . There was a significant decrease over time in physical activity ( p<0.001 ) , lung function ( p<0.001 ) and mastery ( p=0.017 ) , but not in functional exercise capacity ( p=0.585 ) . Although functional exercise capacity did not deteriorate , our mHealth intervention did not improve or maintain physical activity in patients with COPD after a period of pulmonary rehabilitation . mHealth intervention does not improve or maintain physical activity in COPD patients after pulmonary rehabilitation Background Pulmonary rehabilitation is a cornerstone of care for COPD but uptake of traditional centre-based programmes is poor . We assessed whether home-based pulmonary rehabilitation , delivered using minimal re sources , had equivalent outcomes to centre-based pulmonary rehabilitation . Methods A r and omised controlled equivalence trial with 12 months follow-up . Participants with stable COPD were r and omly assigned to receive 8 weeks of pulmonary rehabilitation by either the st and ard outpatient centre-based model , or a new home-based model including one home visit and seven once-weekly telephone calls from a physiotherapist . The primary outcome was change in 6 min walk distance ( 6MWD ) . Results We enrolled 166 participants to receive centre-based rehabilitation  ( n=86 ) or  home-based rehabilitation ( n=80 ) . Intention-to-treat analysis confirmed non-inferiority of home-based rehabilitation for 6MWD at end-rehabilitation and the confidence interval ( CI ) did not rule out superiority ( mean difference favouring home group 18.6 m , 95 % CI −3.3 to 40.7 ) . At 12 months the CI did not exclude inferiority ( −5.1 m , −29.2 to 18.9 ) . Between-group differences for dyspnoea-related quality of life did not rule out superiority of home-based rehabilitation at programme completion ( 1.6 points , −0.3 to 3.5 ) and groups were equivalent at 12 months ( 0.05 points , −2.0 to 2.1 ) . The per- protocol analysis showed the same pattern of findings . Neither group maintained postrehabilitation gains at 12 months . Conclusions This home-based pulmonary rehabilitation model , delivered with minimal re sources , produced short-term clinical outcomes that were equivalent to centre-based pulmonary rehabilitation . Neither model was effective in maintaining gains at 12 months . Home-based pulmonary rehabilitation could be considered for people with COPD who can not access centre-based pulmonary rehabilitation . Trial registration number NCT01423227 , clinical trials.gov 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 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 Background : Pulmonary rehabilitation programs improve dyspnea and health status associated with chronic obstructive pulmonary disease ( COPD ) , but benefits wane when patients return to a sedentary lifestyle . This study tested a simple , low-re source , low-cost home walking program . Methods : In this single center , 3-month study , 115 COPD patients were r and omized to a control cohort or a goal setting cohort .  Each patient met with study staff and received 5 telephone calls at 2-week intervals . During these contacts , the Goal group was assisted by a wellness coach who helped them set personal activity goals . All patients wore a pedometer to record daily steps  , the primary study outcome . Results : Over the 12-week interval , the average step-per-days was 36 % higher for the Goal cohort patients ( Week 12 mean = 4390 ) than for Control patients ( mean = 3790 ) . No group differences emerged on the modified Medical Research Council ( mMRC ) dyspnea scale , the COPD Assessment Test , or the St. George 's Respiratory Question naire . Secondary analyses indicated that even patients with greater disease severity , including those with an mMRC score > 2 or forced expiratory volume in 1 second ( FEV1 ) % predicted below 50 % , increased their walking relative to Control patients . Almost half ( 48 % ) of Goal patients successfully reached at least one personal goal such as increasing stamina and activity , or decreasing shortness of breath or weight . Conclusions : A relatively low-re source wellness coaching , goal - setting intervention result ed in a small improvement in the activity level of COPD patients over a 12-week period including those with marked pulmonary impairment . Further investigation should be directed at underst and ing the optimal blend of in person and remote coaching needed to produce the greatest cost-to-benefit ratio 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 There is a need to increase and maintain physical activity in patients with chronic obstructive pulmonary disease ( COPD ) . We assessed 12-month efficacy and effectiveness of the Urban Training intervention on  physical activity  in COPD patients . This r and omised controlled trial ( NCT01897298 ) allocated 407 COPD patients from primary and hospital setting s 1:1 to usual care  ( n=205 ) or Urban Training  ( n=202 ) . Urban Training consisted of a baseline motivational interview , advice to walk on urban trails design ed for COPD patients in outdoor public spaces and other optional components for feedback , motivation , information and support ( pedometer , calendar , physical activity brochure , website , phone text messages , walking groups and a phone number ) . The primary outcome was 12-month change in steps·day−1 measured by accelerometer . Efficacy analysis ( with per- protocol analysis set , n=233 classified as adherent to the assigned intervention ) showed adjusted ( 95 % CI ) 12-month difference + 957 ( 184–1731 ) steps·day−1 between Urban Training and usual care . Effectiveness analysis ( with intention-to-treat analysis set , n=280 patients completing the study at 12 months including unwilling and self-reported non-adherent patients ) showed no differences between groups . Leg muscle pain during walks was more frequently reported in Urban Training than usual care , without differences in any of the other adverse events . Urban Training , combining behavioural strategies with unsupervised outdoor walking , was efficacious in increasing physical activity after 12 months in COPD patients , with few safety concerns . However , it was ineffective in the full population including unwilling and self-reported non-adherent patients . Urban Training in COPD increased physical activity after 12 months but not in self-reported non-adherent patients Purpose Pulmonary rehabilitation ( PR ) enhances exercise tolerance in patients with COPD ; however , improvements in physical activity ( PA ) are not guaranteed . This study explored the relationship between baseline exercise tolerance and changes in PA after PR . Material s and methods Patient data from prospect i ve clinical trials in the PR setting s of Athens and Leuven ( 2008–2016 ) were analyzed . Vali date d PA monitors were worn for 1 week before and after a 12-week program . The proportion of patients who improved PA levels ≥1,000 steps/day ( “ PA responders ” ) after PR was compared between those with initial 6-minute walk distance [ 6MWDi ] < 350 m and ≥350 m. Baseline predictors of PA change were evaluated via univariate and multivariate logistic regression analyses . Results Two hundred thirty-six patients with COPD ( median [ IQR ] FEV1 44 [ 33–59 ] % predicted , age 65±8 years , 6MWDi 416 [ 332–486 ] m ) were included .  The proportion of “ PA responders ” after PR was significantly greater in those with higher vs lower 6MWDi ( 37.9 % vs 16.4 % , respectively ; P<0.001 ) . 6MWDi group classification was the strongest baseline independent predictor of PA improvement ( univariate OR 3.10 , 95 % CI 1.51–6.36 ) . Conclusion The likelihood of improving PA after PR is increased with greater 6MWDi . Baseline exercise tolerance appears as an important stratification metric for future research in this field Objective : First , to investigate the effects of a telerehabilitation intervention on health status and activity level of patients with Chronic Obstructive Pulmonary Disease ( COPD ) , compared to usual care . Second , to investigate how patients comply with the intervention and whether compliance is related to treatment outcomes . Design : a r and omized controlled pilot trial Subjects : Thirty-four patients diagnosed with COPD . Intervention : The telerehabilitation application consists of an activity coach ( 3D-accelerometer with smartphone ) for ambulant activity registration and real-time feedback , complemented by a web portal with a symptom diary for self-treatment of exacerbations . The intervention group used the application for 4 weeks . The control group received usual care . Main measures : Activity level measured by a pedometer ( in steps/day ) , health status by the Clinical COPD Question naire at baseline and after intervention . Compliance was expressed as the time the activity coach was worn . Results : Fourteen intervention and 16 control patients completed the study .  Activity level ( steps/day ) was not significantly affected by the intervention over time . There was a non-significant difference in improvement in health status between the intervention ( −0.34±0.55 ) and control group ( 0.02±0.57 , p=0.10 ) . Health status significantly improved within the intervention group ( p=0.05 ) . The activity coach was used more than prescribed ( 108 % ) and compliance was related to the increase in activity level for the first two feedback weeks ( r=0.62 , p=0.03 ) . Conclusions : This pilot study shows the potential of the telerehabilitation intervention : compliance with the activity coach was high , which directly related to an improvement in activity levels
target: A subgroup analysis reported significant differences in the promotion of physical activity based on baseline physical activity levels and the type of instrument used to assess levels of physical activity .
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