A web-based physical activity intervention benefits persons with low self-efficacy in COPD: results from a randomized controlled trial Walk2Bactive: A randomised controlled trial of a physical activity-focused behavioural intervention beyond pulmonary rehabilitation in chronic obstructive pulmonary disease. Clinician-Facilitated Physical Activity Intervention Versus Pulmonary Rehabilitation for Improving Physical Activity in COPD: A Feasibility Study The impact of physical activity on fatigue and quality of life in lung cancer patients: a randomised controlled trial protocol Efficacy of a physical exercise training programme COPD in primary care: study protocol of a randomized controlled trial Patient-centered physical activity coaching in COPD (Walk On!): A study protocol for 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. Enhancing exercise tolerance and physical activity in COPD with combined pharmacological and non-pharmacological interventions: PHYSACTO randomised, placebo-controlled study design The physical activity counselling (PAC) randomized controlled trial: rationale, methods, and interventions. Efficacy of an mHealth intervention to stimulate physical activity in COPD patients after pulmonary rehabilitation Enhancement of daily physical activity increases physical fitness of outclinic COPD patients: results of an exercise counseling program. The effects of a physical activity counseling program after an exacerbation in patients with Chronic Obstructive Pulmonary Disease: a randomized controlled pilot study Exacerbations in patients with chronic obstructive pulmonary disease receiving physical therapy: a cohort-nested randomised 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. Cluster randomized controlled trial of a multilevel physical activity intervention for older adults Pedometers to enhance physical activity in COPD: a randomised controlled trial The effect of mere measurement from a cardiovascular examination program on physical activity and sedentary time in an adult population
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 ) 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 Abstract Pulmonary rehabilitation ( PR ) may not suit all individuals with chronic obstructive pulmonary disease ( COPD ) and may not result in increased physical activity . Higher levels of physical activity are associated with reduced mortality and morbidity . The aim of this study was to assess the feasibility of conducting a trial to investigate the effectiveness of a clinician-facilitated physical activity intervention ( PAI ) versus PR in improving physical activity in patients with COPD referred to PR . In this r and omised controlled mixed methods feasibility study , all patients referred to PR who were eligible and willing were assessed at baseline and then r and omised to the PAI or to PR . The assessment s were repeated post-intervention and at 3-month follow-up . The main outcome was step count measured by Actigraph . Semi-structured interviews were conducted post-intervention . The N = 50 patients ; mean ( SD ) age , 64.1(8.6 ) years , 24 M were recruited and r and omised ; N = 23 ( PAI ) and n = 26 ( PR ) : one patient was excluded from the analysis as that person did not meet the GOLD diagnostic criteria . Key feasibility criteria were met ; recruitment was 11 % , dropouts in PAI were 26 % ( n = 6 ) and 50 % ( n = 13/26 ) PR . Participants in both groups experienced a range of health benefits from their respective programmes . The PAI appears to be effective in increasing step counts in people with COPD : mean change ( st and ard deviation ) [ confidence interval ] for the PAI group was 972.0(3230.3)[–1080.3 to 3024.4 ] , n = 12 and 4.3(662.7)[-440.9 to 449.5 ] , n = 11 for the PR group . The PAI met all domains of fidelity . This study provides key information to inform a future-r and omised controlled trial in physical activity 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. 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 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 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 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 Primary care is a promising venue to build patient motivation and confidence to increase physical activity ( PA ) . Physician PA counselling has demonstrated some success ; however , maintenance of behaviour change appears to require more intensive interventions . In reality , most physicians do not have the necessary training nor the time for this type of counselling . The purpose of this paper is to outline the rationale , methods , and interventions for the ongoing physical activity counselling ( PAC ) r and omized controlled trial ( RCT ) , which aims to assess the impact of integrating a PA counsellor into a primary care practice . This RCT has 2 arms : ( i ) brief PA counselling ( 2 - 4 min ) from a health care provider and ( ii ) brief PA counselling+intensive PA counselling from a PA counsellor ( 3 months ) . The impact of this intervention is being evaluated using the comprehensive RE- AIM framework . One hundred twenty insufficiently active adult patients , aged 18 to 69 y and recruited during regular primary care visits have been r and omized . Dependent measures include psychological mediators , PA participation , quality of life , and physical and metabolic outcomes . The PAC project represents an innovative , theoretically-based approach to promoting PA in primary care , focusing on psychological mediators of change . We anticipate that key lessons from this study will be useful for shaping future public health interventions , theories , and research 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 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 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 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 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 Background Older adults are the least active population group . Interventions in residential setting s may support a multi-level approach to behavior change . Methods In a cluster r and omized control trial , 11 San Diego retirement communities were assigned to a physical activity ( PA ) intervention or a healthy aging attention control condition .  Participants were 307 adults over 65 years old . The multilevel PA intervention was delivered with the assistance of peer leaders , who were trained older adult from the retirement communities . Intervention components included individual counseling & self-monitoring with pedometers , group education sessions , group walks , community advocacy and pedestrian community change projects . Intervention condition by time interactions were tested using generalized mixed effects regressions . The primary outcomes was accelerometer measured physical activity . Secondary outcomes were blood pressure and objective ly measured physical functioning . Results Over 70 % of the sample were 80 years or older .  PA  significantly increased in the intervention condition ( 56 min of moderate-vigorous PA per week ; 119 min of light PA ) compared with the control condition and remained significantly higher across the 12 month study . Men and participants under 84 years old benefited most from the intervention . There was a significant decrease in systolic ( p < .007 ) and diastolic ( p < .02 ) blood pressure at 6 months . Physical functioning improved but the changes were not statistically significant . Conclusions Intervention fidelity was high demonstrating feasibility . Changes in PA and blood pressure achieved were comparable to other studies with much younger participants . Men , in particular , avoided a year-long decline in PA.Trial registration clincialtrials.gov Identifier : NCT01155011 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 Background Measuring physical activity ( PA ) and sedentary time ( ST ) by self-report or device as well as assessing related health factors may alter those behaviors . Thus , in intervention trials assessment s may bias intervention effects . The aim of our study was to examine whether leisure-time PA , transport-related PA , and overall ST measured via self-report vary after assessment s and whether a brief tailored letter intervention has an additional effect . Methods Among a sample of subjects with no history of myocardial infa rct ion , stroke , or vascular intervention , a number of 175 individuals participated in a study comprising multiple repeated assessment s. Of those , 153 were analyzed ( mean age 54.5 years , st and ard deviation = 6.2 ; 64 % women ) . At baseline , participants attended a cardiovascular examination ( st and ardized measurement of blood pressure and waist circumference , blood sample taking ) and wore an accelerometer for seven days . At baseline and after 1 , 6 , and 12 months , participants completed the International Physical Activity Question naire . A r and om sub sample received a tailored counseling letter intervention at month 1 , 3 , and 4 . Changes in PA and ST from baseline to 12-month follow-up were analyzed using r and om-effects modelling . Results From baseline to 1-month assessment , leisure-time PA did not change ( Incidence rate ratio = 1.13 , p = .432 ) , transport-related PA increased ( Incidence rate ratio = 1.45 , p = .023 ) , and overall ST tended to decrease ( b = − 1.96 , p = .060 ) . Further , overall ST decreased from month 6 to month 12 ( b = − 0.52 , p = .037 ) . Time trends of the intervention group did not differ significantly from those of the assessment -only group . Conclusions Results suggest an effect of measurements on PA and ST . Data of r and om-effects modelling results revealed an increase of transport-related PA after baseline to 1-month assessment . Decreases in overall ST may result from repeated assessment s. A brief tailored letter intervention seemed to have no additional effect . Thus , measurement effects should be considered when planning intervention studies and interpreting intervention effects . Trial registration Clinical Trials.gov NCT02990039 . Registered 7 December 2016 . Retrospectively registered
Interventions that included ET and PA counseling during PR were effective strategies to improve PA in COPD
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 .