A pilot randomised trial to assess the methods and procedures for evaluating the clinical effectiveness and cost-effectiveness of Exercise Assisted Reduction then Stop (EARS) among disadvantaged smokers. The feasibility of recruiting patients with early COPD to a pilot trial assessing the effects of a physical activity intervention. Comparing Individualized Rehabilitation to a Group Wellness Intervention for Persons with Multiple Sclerosis Community-based physical activity as adjunctive smoking cessation treatment: Rationale, design, and baseline data for the Lifestyle Enhancement Program (LEAP) randomized controlled trial Walk2Bactive: A randomised controlled trial of a physical activity-focused behavioural intervention beyond pulmonary rehabilitation in chronic obstructive pulmonary disease. A web-based physical activity intervention benefits persons with low self-efficacy in COPD: results from a randomized controlled trial Physical activity levels six months after a randomised controlled physical activity intervention for Pakistani immigrant men living in Norway Participation in a population-based physical activity programme as an aid for smoking cessation: a randomised trial Development and preliminary randomized controlled trial of a distress tolerance treatment for smokers with a history of early lapse. Exacerbations in patients with chronic obstructive pulmonary disease receiving physical therapy: a cohort-nested randomised controlled trial Efficacy of a physical exercise training programme COPD in primary care: study protocol of a randomized controlled trial Internet-Based Physical Activity Intervention Targeting Young Adult Cancer Survivors. Short-term efficacy of a computer-tailored physical activity intervention for prostate and colorectal cancer patients and survivors: a randomized controlled trial The impact of physical activity on fatigue and quality of life in lung cancer patients: a randomised controlled trial protocol The effects of nicotine, denicotinized tobacco, and nicotine-containing tobacco on cigarette craving, withdrawal, and self-administration in male and female smokers Short- and long-term effects of a physical activity counselling programme in COPD: a randomized controlled trial. Effectiveness of a combined exercise training and home-based walking programme on physical activity compared with standard medical care in moderate COPD: a randomised controlled trial.
BACKGROUND There have been few rigorous studies on the effects of behavioural support for helping smokers to reduce who do not immediately wish to quit . While reduction may not have the health benefits of quitting , it may lead smokers to want to quit . Physical activity ( PA ) helps to reduce cravings and withdrawal symptoms , and also reduces weight gain after quitting , but smokers may be less inclined to exercise . There is scope to develop and determine the effectiveness of interventions to support smoking reduction and increase physical activity  , for those not ready to quit . OBJECTIVE To conduct a pilot r and omised controlled trial ( RCT ) [ Exercise Assisted Reduction then Stop ( EARS ) smoking study ] to ( 1 ) design and evaluate the feasibility and acceptability of a PA and smoking-reduction counselling intervention [ for disadvantaged smokers who do not wish to quit but do want to reduce their smoking ( to increase the likelihood of quitting ) ] , and ( 2 ) to inform the design of a large RCT to determine the clinical effectiveness and cost-effectiveness of the intervention . DESIGN A single-centre , pragmatic , pilot trial with follow-up up to 16 weeks . A mixed methods approach assessed the acceptability and feasibility of the intervention and trial methods . Smokers were individually r and omised to intervention or control arms . SETTING General practice s , NHS buildings , community venues , and the Stop Smoking Service ( SSS ) within Plymouth , UK . PARTICIPANTS Aged > 18 years , smoking ≥ 10 cigarettes per day ( for ≥ 2 years ) who wished to cut down . We excluded individuals who were contraindicated for moderate PA , posed a safety risk to the research team , wished to quit immediately or use Nicotine Replacement Therapy , not registered with a general practitioner , or did not converse in English . INTERVENTION We design ed a client-centred , counselling-based intervention design ed to support smoking reduction and increases in PA . Support sessions were delivered by trained counsellors either face to face or by telephone . Both intervention and control arms were given information at baseline on specialist SSS support available should they have wished to quit . MAIN OUTCOME MEASURES The primary outcome was 4-week post-quit expired air carbon monoxide (CO)-confirmed abstinence from smoking . Secondary outcomes included vali date d behavioural , cognitive and emotional/affective and health-related quality of life measures and treatment costs . RESULTS The study r and omised 99 participants , 49 to the intervention arm and 50 to the control arm , with a 62 % follow-up rate at 16 weeks . In the intervention and control arms , 14 % versus 4 % , respectively [ relative risk = 3.57 ; 95 % confidence interval ( CI ) 0.78 to 16.35 ] , had expired CO-confirmed abstinence at least 4 and up to 8 weeks after quit day ; 22 % versus 6 % ( relative risk = 3.74 ; 95 % CI 1.11 to 12.60 ) made a quit attempt ; 10 % versus 4 % ( relative risk = 92.55 ; 95 % CI 0.52 to 12.53 ) achieved point-prevalent abstinence at 16 weeks ; and 39 % versus 20 % ( relative risk = 1.94 ; 95 % CI 1.01 to 3.74 ) achieved at least a 50 % reduction in the number of cigarettes smoked daily . The percentage reporting  using PA  for controlling smoking in the intervention versus control arms was 55 % versus 22 % , respectively at 8 weeks and 37 % versus 16 % , respectively , at 16 weeks . The counsellors generally delivered the intervention as planned and participants responded with a variety of smoking reduction strategies , sometimes supported by changes in PA . The intervention costs were approximately £ 192 per participant . Exploratory cost-effectiveness modelling indicates that the intervention may be cost-effective . CONCLUSIONS The study provided valuable information on the re sources needed to improve study recruitment and retention . Offering support for smoking reduction and PA appears to have value in promoting reduction and cessation in disadvantaged smokers not currently motivated to quit . A large RCT is needed to assess the clinical effectiveness and cost-effectiveness of the intervention in this population . TRIAL REGISTRATION IS RCT N 13837944 . FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment , Vol . 18 , No. 4 . See the NIHR Journals Library website for further project information 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 Purpose . Compare the efficacy of two interventions design ed to promote health and physical activity ( PA ) . Design . This study was a r and omized clinical trial using a time series design . Subjects were r and omized into individualized physical rehabilitation ( IPR ) and group wellness intervention ( GWI ) . Primary question naires were administered twice preintervention and twice postintervention . Physical fitness and PA frequency were assessed preintervention and postintervention . Setting . Clinic based in a metropolitan area . Subjects . Fifty volunteers with multiple sclerosis . Interventions . IPR consisted of four physical therapy sessions plus three telephone calls . GWI consisted of seven educational sessions . Measures . Primary : SF-36 Health Survey , Modified Fatigue Impact Scale , Mental Health Inventory . Secondary : physical assessment , PA frequency . Analysis . Stability of primary question naires between the two pretests was examined . Efficacy of interventions was evaluated by multivariate analysis of variance ( MANOVA ) and effect sizes . Results . Primary measures were stable between pretests . MANOVA showed nonsignificant differences between interventions . Eight weeks postintervention , both groups had improved PA , fatigue , resting heart rate , and strength . Effect sizes suggested that IPR had a greater effect on preventing decline of physical health , whereas GWI had a greater effect on improving mental health . Conclusion . Preliminary evidence indicated that health and PA improved in both groups . Effect sizes suggested that participants benefited more physically from IPR and more mentally from GWI . Future research should determine whether combining therapeutic exercise with group education improves both mental and physical health Despite advances in behavioral and pharmacological treatment for tobacco use and dependence , quit rates remain suboptimal . Increasing physical activity has shown some promise as a strategy for improving cessation outcomes . However , initial efficacy studies focused on intensive , highly structured exercise programs that may not be applicable to the general population of smokers . We describe the rationale and study design and report baseline participant characteristics from the Lifestyle Enhancement Program ( LEAP ) , a two-group , r and omized controlled trial . Adult smokers who engaged in low levels of leisure time physical activity were r and omly assigned to treatment conditions consisting of an individualized physical activity intervention delivered by health fitness instructors in community-based exercise facilities or an equal contact wellness control . All participants received st and ard cognitive behavioral smoking cessation counseling combined with nicotine replacement therapy . The primary outcomes are seven-day point prevalence abstinence at seven weeks , six- and 12 months . Secondary outcomes include self-reported physical activity , dietary intake , body mass index , waist circumference , percent body fat , and nicotine withdrawal symptoms .  Participants consist of 392 sedentary smokers ( mean [ st and ard deviation ] age = 44.6 [ 10.2 ] = years ; 62 % female ; 31 % African American ) . Results reported here provide information regarding experiences recruiting smokers willing to change multiple health behaviors including smoking and physical activity 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 Promoting  physical activity ( PA ) is of top priority in chronic obstructive pulmonary disease ( COPD ) . This study examines the influence of an internet-delivered intervention on the relationship between exercise self-efficacy and changes in PA , physical health , and exercise capacity in COPD . 112 U.S. Veterans with COPD were r and omized to either a comparison ( pedometer alone ) or an intervention group ( pedometer plus access to an internet-mediated PA intervention ) . There was a significant interaction between baseline exercise self-efficacy and r and omization group on change in PA . In the comparison group , there was a significant relationship between higher baseline exercise self-efficacy and greater change in PA , whereas in the intervention group , improvements in PA were independent of level of baseline self-efficacy . Similar patterns were found with physical health and exercise capacity as outcomes . The use of an internet-mediated intervention significantly benefited persons with COPD who had low baseline self-efficacy to increase PA  and  physical health . Clinical trial registration The r and omized clinical trial was registered on Clinical Trials.gov ( NCT01772082 ) Background To our knowledge , no studies have aim ed at improving the PA level in south Asian immigrant men residing in Western countries , and few studies have considered the relevance of SCT constructs to the PA behaviour of this group in the long term . The observed low  physical activity ( PA ) level among south Asian immigrants in Western countries may partly explain the high prevalence of cardiovascular diseases ( CVD ) and type 2 diabetes ( T2D ) in this group . We have shown previously in a r and omised controlled trial , the Physical Activity and Minority Health study ( PAMH ) that a social cognitive based intervention can beneficially influence PA level and subsequently reduce waist circumference and insulin resistance in the short-term . In an extended follow-up of the PAMH study : we aim ed 1 ) to determine if the intervention produced long-term positive effects on PA level six months after intervention ( follow-up 2 ( FU2 ) ) , and 2 ) to identify the social cognitive mediators of any intervention effects . Methods Physically inactive Pakistani immigrant men ( n = 150 ) who were free of CVD and T2D were r and omly assigned to a five months PA intervention or a control group . Six months after the intervention ended , we telephoned all those who attended FU1 and invited them for a second follow-up test ( FU2 ) ( n = 133 ) . PA was measured using ActiGraph accelerometers . Statistical differences between groups were determined by use of ANCOVA . Results Significant differences ( baseline to FU2 ) between the groups were found for all PA variables ( e.g. , total PA level , sedentary time , PA intensity ) . Support from family and outcome expectancies increased more in the intervention group compared with the control group . Self-efficacy did not differ significantly between groups . Conclusions Our results show that a multi component PA programme can increase PA over the short and long term in a group of immigrant Pakistani men . However , we could not identify the factors that mediated these changes in PA . Protocol ID07112001326 , NCT ID : Objectives Exercise combined with nicotine therapy may help smoking cessation and minimise weight gain after quitting . Low participation in vigorous-intensity physical activity programmes precludes their population -wide applicability . In a r and omised controlled trial , we tested whether a population -based moderate-intensity physical activity programme increases quit rates among sedentary smokers receiving nicotine therapy .  Methods Participants ( n=481 ; 57 % male ; mean age , 42.2 years ( SD 10.1 ) ; mean cigarette consumption , 27 ( SD 10.2 ) per day ) were offered a nine-week smoking cessation programme consisting of a weekly 15-minute counselling session and the prescription of nicotine replacement therapy . In addition , participants in the physical activity group ( n=229 ) also took part in a programme of moderate-intensity physical activity implemented at the national level , and offering nine weekly 60-minute sessions of physical activity . To ensure equal contact conditions , participants in the  control group ( n=252 ) attended weekly 60-minute health behaviour education sessions unrelated to physical activity . The primary outcome was continuous CO-verified smoking abstinence rates at 1-year follow-up . Results Continuous smoking abstinence rates were high and similar in the physical activity group and the control group at the end of the intervention ( 47 % versus 46 % , p=0.81 ) and at 1-year follow-up ( 27 % versus 29 % , p=0.71 ) . The mean weight gain after one year was 4.4 kg and 6.2 kg among sustained quitters of the physical activity and control groups , respectively ( p=0.06 ) . Conclusion Participation in a population -based moderate-intensity physical activity programme for 9 weeks in addition to a comprehensive smoking cessation programme did not significantly increase smoking cessation rates . A non-significant reduction in weight gain was observed among participants who quit smoking in the physical activity group . Trial registration Clinical Trials.gov ; US National Institutes for Health ( available online at http:// clinical trials.gov/ ; Clinical Trial Registration Number : NCT00521391 INTRODUCTION An inability to tolerate distress is a significant predictor of early smoking lapse following a cessation attempt . We conducted a preliminary r and omized controlled trial to compare a distress tolerance ( DT ) treatment that incorporated elements of exposure-based therapies and Acceptance and Commitment Therapy to st and ard smoking cessation treatment ( ST ) . METHODS Smokers with a history of early lapse in prior quit attempts received either DT ( N = 27 ; 9 2-hr group and 6 50-min individual sessions ) or ST ( N = 22 ; 6 90-min group and 1 20-min individual session ) , plus 8 weeks of transdermal nicotine patch . RESULTS At the end of behavioral treatment , odds of abstinence among participants receiving DT were 6.46 times greater than among participants receiving ST ( 66.7 % vs. 31.8 % ) , equivalent to a medium- to large-effect size . Odds of abstinence for DT were still 1.73 times greater at 8 weeks , corresponding to a small- to medium-effect size , although neither this difference nor those at 13 and 26 weeks were statistically significant . Furthermore , of those who lapsed to smoking during the first week postquit , DT participants had more than 4 times greater odds of abstinence than ST participants at the end of treatment . Relative to ST , DT participants also reported a larger decrease in experiential avoidance , a hypothesized DT treatment mediator , prior to quit day . The trajectory of negative mood and withdrawal symptoms in DT differed from ST and was largely consistent with hypotheses . CONCLUSIONS Reasons for the decrease in abstinence in DT after treatment discontinuation and suggestions for future research are discussed Background Physical exercise training aims at reducing disease-specific impairments and improving quality of life in patients with chronic obstructive pulmonary disease ( COPD ) . COPD exacerbations in particular negatively impact COPD progression . Physical therapy intervention seems indicated to influence exacerbations and their consequences . However , information on the effect of physical therapy on exacerbation occurrence is scarce . This study aims to investigate the potential of a protocol -directed physical therapy programme as a means to prevent or postpone exacerbations , to shorten the duration or to decrease the severity of exacerbations in patients with COPD who have recently experienced an exacerbation . Besides , this study focuses on the effect of protocol -directed physical therapy on health status and quality of life and on cost-effectiveness and cost-utility in patients with COPD who have recently experienced an exacerbation . Methods / Design A prospect i ve cohort of 300 COPD patients in all GOLD stages will be constructed . Patients will receive usual multidisciplinary COPD care including guideline -directed physical therapy .  Patients in this cohort who have GOLD stage 2 to 4 ( post-bronchodilator FEV1/FVC < 0.7 and FEV1 < 80 % of predicted ) , who receive reimbursement by health insurance companies for physical therapy ( post-bronchodilator Tiffeneau-index < 0.6 ) and who experience a COPD exacerbation will be asked within 56 days to participate in a cohort-nested prospect i ve r and omised controlled trial ( RCT ) . In this RCT , the intervention group will receive a strict physical therapy programme for patients with COPD . This protocol -directed physical therapy ( pdPT ) will be compared to a control group that will receive sham-treatment , meaning no or very low-intensity exercise training ( ST ) . An economic evaluation will be embedded in the RCT . Anthropometric measurements , comorbidities , smoking , functional exercise capacity , peripheral muscle strength , physical activity level , health related quality of life , patients ’ perceived benefit , physical therapy compliance , motivation level , level of effective mucus clearance , exacerbation symptoms and health care contacts due to COPD will be recorded . Follow-up measurements are scheduled at 3 and 6 weeks , 3 , 6 , 12 and 24 months after inclusion . Discussion Ways to minimise potential problems regarding the execution of this study will be discussed . Trial registration The Netherl and s National Trial Register NTR1972 Background Chronic obstructive pulmonary disease ( COPD ) is recognized as a systemic illness with significant extra-pulmonary features , such as exercise intolerance and muscle weakness . Pulmonary rehabilitation has been shown to be very effective in counteracting these consequences in patients with more advanced COPD . However , limited data is available on the efficacy of a physical exercise training programme in patients with mild to moderate COPD in primary care . Furthermore , it is unknown if improved exercise capacity translates into enhanced daily physical activities . The aim of this paper is to describe the design of a r and omized controlled trial to assess the efficacy of a physical exercise training programme in patients with mild to moderate COPD . Methods / design In this r and omized controlled trial situated in the primary care setting , 102 patients with mild to moderate airflow obstruction ( FEV1 ≥ 50 % of predicted ) , dyspnoea and a physically inactive lifestyle will be r and omized to an intervention or control group . The intervention group receives a 4-month physical exercise training programme at a local physiotherapy practice , which includes exercise training , resistance training , breathing exercises and advises on how to increase the level of physical activity . The control group receives usual care , i.e. advises on how to increase the level of physical activity and a sham treatment at a local physiotherapy practice of which no physiological training stimulus can be expected . Primary outcome is functional exercise capacity at 4-months measured on the six-minute walk distance . Secondary outcomes include peripheral muscle strength , physical activity in daily life , health related quality of life , Medical Research Council ( MRC ) dyspnoea score and patients ’ perceived effectiveness . Follow-up measurement will take place at 6 months after baseline . Discussion This will be one of the first studies to evaluate the efficacy of a physical exercise training programme in patients with mild to moderate COPD completely recruited and assessed in primary care . The results of this trial may give a unique insight into the potential of the implementation of an easy , close-to-home rehabilitation programme . Trial registration The Netherl and s National Trial Register NTR1471 Purpose : Young adults who have been treated for cancer face several health and psychosocial risks . To minimize these risks , is it imperative that they address any modifiable risk factors , such as sedentary lifestyle . Unfortunately , more than half of young adult cancer survivors remain sedentary . To facilitate the adoption of physical activity ( PA ) in this population -potentially reducing health and psychosocial risks-we developed and pilot tested an internet-based PA intervention for young survivors . Patients and methods : Eighteen young adults , aged 18 to 39 , who had been diagnosed with cancer in the past 10 years were recruited . Participants were r and omized to receive access to the PA website for 12 weeks or information about other cancer-related websites . Intervention feasibility and acceptability was assessed only among those in the PA website group ; PA and psychosocial outcomes ( mood , fatigue ) were assessed in both groups . Results : Findings revealed that 86 % of participants in the PA website group would recommend the intervention to others and most ( 71 % ) were " satisfied " or " very satisfied " with it . Further , 100 % rated getting onto the website as " very easy " and 86 % rated the information on the site as " very easy " to underst and . The logging feature , followed by the goal - setting feature , were most often accessed by participants . Participants also rated the graphing and stage-matched manual features as helpful . Estimates of effect sizes for between-group differences at 12 weeks were medium for PA outcomes and large for psychosocial outcomes . Conclusions : This internet-based PA intervention targeting young adult cancer survivors is feasible and acceptable and may benefit this population Background Physical activity ( PA ) is beneficial in improving negative physical and psychological effects of cancer and cancer treatment , but adherence to PA guidelines is low . Computer-tailored PA interventions can reach large population s with little re sources . They match with patients ’ preference for home-based , unsupervised PA programs and are thus promising for the growing population of cancer survivors . The current study assessed the efficacy of a computer-tailored PA intervention in ( four subgroups of ) prostate and colorectal cancer survivors . Methods Prostate and colorectal cancer patients and survivors were r and omized to the OncoActive intervention group ( N = 249 ) , or a usual-care waiting-list control group ( N = 229 ) . OncoActive participants received a pedometer and computer-tailored PA advice , both Web-based via an interactive website and with printed material s. Minutes moderate-to-vigorous PA (  MVPA ) and days ≥30 min PA  were assessed with an accelerometer ( ActiGraph ) at baseline and 6 months . Further , question naires were used to assess self-reported PA , fatigue , distress , and quality of life at baseline , 3 and 6 months . Differences between both groups were assessed using linear regression analyses ( complete cases and intention-to-treat ) . In addition , efficacy in relation to age , gender , education , type of cancer , and time since treatment was examined . Results Three months after baseline OncoActive participants significantly increased their self-reported PA ( PA days : d = 0.46 ; MVPA : d = 0.23 ) . Physical functioning ( d = 0.23 ) and fatigue ( d = − 0.21 ) also improved significantly after three months . Six months after baseline , self-reported PA ( PA days : d = 0.51 ; MVPA : d = 0.37 ) and ActiGraph MVPA ( d = 0.27 ) increased significantly , and ActiGraph days ( d = 0.16 ) increased borderline significantly ( p = .05 ; d = 0.16 ) . Furthermore , OncoActive participants reported significantly improvements in physical functioning ( d = 0.14 ) , fatigue ( d = − 0.23 ) and depression ( d = − 0.32 ) . Similar results were found for intention-to-treat analyses . Higher increases in PA were found for colorectal cancer participants at 3 months , and for medium and highly educated  participants ’  PA at 6 months . Health outcomes at 6 months were more prominent in colorectal cancer participants and in women . Conclusions The OncoActive intervention was effective at increasing PA in prostate and colorectal cancer patients and survivors .  Health-related effects were especially apparent in colorectal cancer participants . The intervention provides opportunities to accelerate cancer recovery . Long-term follow-up should examine further sustainability of these effects . Trial registration The study was registered in the Dutch Trial Register ( NTR4296 ) on October 17 2018 Background People with lung cancer have substantial symptom burden and more unmet needs than the general cancer population . Physical activity ( PA ) has been shown to positively influence quality of life ( QOL ) , fatigue and daily functioning in the curative treatment of people with breast and colorectal cancers and lung diseases , as well as in palliative setting s. A r and omised controlled trial ( RCT ) is needed to determine if lung cancer patients benefit from structured PA intervention . The Physical Activity in Lung Cancer ( PAL ) trial is design ed to evaluate the impact of a 2-month PA intervention on fatigue and QOL in patients with non-resectable lung cancer . Biological mechanisms will also be studied . Methods / design A multi-centre RCT with patients r and omised to usual care or a 2-month PA programme  , involving supervised PA sessions including a behavioural change component and home-based PA . QOL question naires , disease and functional status and body composition will be assessed at baseline , 2 , 4 and 6 months follow-up . The primary endpoint is comparative levels of fatigue between the 2 arms . Secondary endpoints include : QOL , functional abilities and physical function . Exploratory endpoints include : anxiety , depression , distress , dyspnoea , PA behaviour , fitness , hospitalisations , survival , cytokines and insulin-like growth factor levels . Discussion This study will provide high-level evidence of the effect of PA programmes on cancer-related fatigue and QOL in patients with advanced lung cancer . If positive , the study has the potential to change care for people with cancer using a simple , inexpensive intervention to improve their QOL and help them maintain independent function for as long as possible . Trial registration Australian New Zeal and Clinical Trials Registry No. The effects of the acute administration of nicotine [ through nicotine inhalers ( NI ) and placebo inhalers ( PI ) ] , nicotine-containing tobacco ( NT ) , and denicotinized tobacco ( DT ) , on smokers ' subjective responses and motivation to smoke were examined in 22 smokers ( 12 male , 10 female ; 11 low dependent , 11 high dependent ) . During four r and omized blinded sessions , participants self-administered NI , PI , NT , or DT , and assessed their effects using Visual Analogue Scales and the Brief Question naire of Smoking Urges . They could then self-administer their preferred br and of cigarettes using a progressive ratio task . NT and DT were each associated with increased satisfaction and relaxation as well as decreased craving relative to the inhalers and NT increased ratings of stimulation relative to each of the other products . Both NT and DT delayed the onset of preferred tobacco self-administration relative to NI and PI but only NT reduced the total amount self-administered . Sex differences were evident in the effects of DT on withdrawal-related cravings with women experiencing greater DT-induced craving relief than men . Findings suggest that DT is effective in acutely reducing many smoking abstinence symptoms , especially in women , but a combination of nicotine and non-nicotine tobacco ingredients may be necessary to suppress smoking behavior 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 estimate the effectiveness of a 10-week combined exercise training and home-based walking programme on daily physical activity ( PA ) compared with st and ard medical care in patients with moderate chronic obstructive pulmonary disease ( COPD ) . DESIGN R and omised controlled trial . SETTING Primary care physiotherapy . PARTICIPANTS Consecutive patients with stable COPD at Gold Stage II with a score of two or more on the Medical Research Council Dyspnoea Scale . INTERVENTION Ten-week combined exercise training and home-based walking programme compared with st and ard medical care . MAIN OUTCOMES At baseline and after 10 weeks , daily PA was evaluated by accelerometry using three levels of intensity and expressed as metabolic equivalent of task . In addition , daily activities ( Physical Activity Scale for the Elderly ) , functional exercise capacity ( 6-minute Walk Test ) , health-related quality of life ( Chronic Respiratory Question naire ) and exercise self-efficacy ( Exercise Self-Regulatory Efficacy Scale ) were measured . RESULTS Fifty-two patients { 34 females ; mean age 70.2 [ st and ard deviation ( SD ) 9.5 ] years ; mean forced expiratory volume in 1second 67 % ( SD 9.2 ) of predicted } were r and omised .  PA , adjusted for baseline differences , increased significantly in the intervention group compared with the control group , by 26.1minutes/day [ 95 % confidence interval ( CI ) 7.3 to 44.9 ] . The increase in functional capacity between groups was clinical ly relevant ( 34.0 m , 95 % CI 2.3 to 65.6 ) in favour of the intervention group . CONCLUSIONS A combined exercise training and home-based walking programme in primary care physiotherapy improved PA in patients with moderate COPD . Clinical trial registration number NL24766.018.08
There is strong evidence that physical activity acutely reduces cigarette craving
AIMS To conduct an up date d systematic review and the first meta- analysis of experimental trials investigating the acute effects of short bouts of physical activity ( PA ) on strength of desire ( SoD ) and desire to smoke ( DtS ) using individual participant data ( IPD ) .