***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Background : The optimal way of assessing the impact of pulmonary rehabilitation on functional status in chronic obstructive pulmonary disease ( COPD ) is currently unknown . The minimal clinical ly important difference for the constant work rate cycling exercise test also needs to be investigated to facilitate its interpretation . A study was undertaken to evaluate the changes in the 6-min walking test and in the constant work rate cycle endurance test immediately following and 1 year after pulmonary rehabilitation , together with the importance of these changes in terms of health status in patients with COPD . Methods : Patients with COPD of mean ( SD ) age 65 ( 8) years and mean ( SD ) forced expiratory volume in 1 s ( FEV1 ) 45 (15)% predicted were recruited from a multicentre prospect i ve cohort study and evaluated at baseline , immediately after a pulmonary rehabilitation programme ( n = 157 ) and at 1 year ( n = 106 ) . The  6-min walking test and the cycle endurance test  were performed at each evaluation . Health status was evaluated with the St George Respiratory Question naire . Results : Following pulmonary rehabilitation , cycle endurance time increased ( 198 ( 352 ) s , p<0.001 ) and stayed over baseline values at 1 year ( p<0.001 ) . The 6-min walking distance also showed improvements following rehabilitation ( 25 ( 52 ) m , p<0.001 ) but returned to baseline values at the 1-year follow-up . Changes in cycle endurance time were more closely associated with changes in health status than with the 6-min walking test . An improvement of 100–200 s in the cycle endurance time was associated with clinical ly meaningful changes in the St George Respiratory Question naire scores . Conclusions : The cycle endurance test was more responsive than the 6-min walking test in detecting improvement in exercise tolerance following pulmonary rehabilitation , and was also better correlated with improvements in health status . An improvement in the cycle endurance time of 100–200 s appeared to be clinical ly meaningful Objective To evaluate an entirely outpatient-based program of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease COPD , using St . George ’s Respiratory question naire ( SGRQ ) , the 6-minutes walking test ( 6-MWT ) and BODE index as the primary outcome measures . Methods A prospect i ve , parallel-group controlled study of an outpatient rehabilitation program in 80 patients with COPD ( 67 men and 13 women ; mean age 64.8 ± 10.6 years ; FEV1 , 42.8 % ± 7.6 % of the predicted value . The active group ( n = 40 ) took part in a 14-week rehabilitation program [ 3 h/wk , 1.5 h of education and exercise and 1.5 h of cycling ] . The control group ( n = 40 ) was review ed routinely as medical out patients . The following evaluations were carried out at study entry and after14 weeks : ( 1 ) pulmonary function studies ; ( 2 ) 6-minutes walking test 6MWT ; ( 3 ) quality of life ; and ( 4 ) BODE index . Results The following patients completed the study : 35 patients ( 87.5 % ) from the active group ( mean age , 63.7 ± 11.9 years ; mean forced expiratory volume in one second ( FEV1 ) , 41.9 ± 2.6 % of the predicted value ) ; and 36 patients ( 88 % ) from the control group ( mean age , 65.9 ± 10.3 years ; mean FEV1 , 43.33 ± 3.6 % of the predicted value ) . We found no changes in pulmonary function parameters in the active group and the control one at 14weeks . On the other h and , there were significant changes within the components of the SGRQ ( 12.3 for the score total ) for the patients of the active group but not for the patients of the control one ( only 1.5 for the score total ) , we observed also a significant increase in the distance of the 6-MWT in the patients of the active group but not for the patients of the control one , and finally a decrease of two points ( from 6 to 4 ) was noted in the score of the active group ’s BODE index without any change in the control group ’s one . Conclusion An outpatient-based of 14-week rehabilitation program  significantly improved the quality of life and exercise tolerance without any change in the pulmonary function in patients with moderate COPD , and there was also a large decrease in the risk of death in rehabilitated patients as measured using the BODE index Changes in health according to World Health Organization ’s International Classification of Functioning , Disability and Health ( ICF ) after four weeks of pulmonary rehabilitation ( PR ) were investigated . Gender differences in the response to PR , and the correlation between improvements in the two components of ICF ( Body functions and Activities and Participation ) were examined . Twenty-two men and 18 women with chronic obstructive pulmonary disease in Global Initiative for Chronic Obstructive Lung Disease ( GOLD ) stage II-IV attended in-patient , multidisciplinary PR consisting of endurance training four to five times/week at 70 % of peak work rate ( WRpeak ) , resistance training three to four times/week at 72 % of 15 repetitions maximum , educational sessions and individual counselling . The results were compared to those of 20 Chronic Obstructive Pulmonary Disease ( COPD ) patients included after the same criteria and investigated while waiting for admission to PR . In the rehabilitation group , we found significant improvements in health related quality of life ( HRQoL ) ( -7 units , St. George ’s Respiratory Question naire ) , arm ( 6 % ) and leg ( 15 % ) maximal voluntary contraction , peak oxygen uptake ( 6 % ) , WRpeak ( 60 % ) and treadmill endurance time ( 93 % ) . At iso-WR , ventilation and dyspnoea were significantly lower , but inspiratory capacity remained unchanged . Improvements in HRQoL correlated with increases in peak ventilation , but not in muscle strength or exercise capacity . Men improved their six-minute walking distance significantly in contrast to women . Clinical ly important improvements in HRQoL were found in two out of three of the men , and one out of three of the women . Four weeks of intensive PR generated significant health effects comparable to longer lasting programmes . Changes in exercise capacity and muscle strength were not related to improvements in HRQoL. The gender differences in the response to PR deserve attention in future studies BACKGROUND Current guidelines on pulmonary rehabilitation ( PR ) recommend upper extremity exercise training ( UEET ) in patients with COPD . However , the literature still questions the effectiveness of systematic UEET in this population . We studied the effects of 15 sessions of unsupported UEET on functional exercise capacity , the ability to perform activities of daily living ( ADL ) , and symptoms perceived during activities involving arms in patients with COPD . METHODS We conducted a r and omized trial that consisted of 3 weeks of inpatient PR , comparing the short-term effects of unsupported UEET plus PR ( intervention group ) to those of PR alone ( control group ) . A change in the 6-min ring test ( 6MRT ) was the primary outcome ; the ADL field test ( four shuttle stations ) , the dyspnea score as assessed by the Medical Research Council scale , the London Chest Activity of Daily Living scale ( LCADL ) , and the distance walked in 6 min served as secondary outcomes of the study . At the 6-month follow-up , we repeated the 6MRT and the LCADL . RESULTS Fifty patients with COPD were r and omly assigned to the two groups and completed the study . At the end of the study period , patients in the intervention group improved in the 6MRT and ADL field test compared with those patients in the control group ( p = 0.018 and p = 0.010 , respectively ) with reduced perception of fatigue ( p < or= 0.006 ) . At the 6-month follow-up , 6MRT ( p = 0.001 ) and LCADL ( p = 0.039 ) scores were still significantly better in the intervention group compared with the control group . CONCLUSIONS Our trial corroborates the effectiveness of unsupported UEET in specifically improving functional exercise capacity of patients with COPD . Moreover , it also provides evidence that this training modality may ameliorate and maintain the patients ' autonomy over and above st and ard PR . TRIAL REGISTRATION Clinical Trials.gov Identifier : NCT00825032 Background Pulmonary rehabilitation is known to be a beneficial treatment for COPD patients . To date , however , there is no agreement for how long a rehabilitation program should be implemented . In addition , current views are that pulmonary rehabilitation does not improve FEV1 or even slow its decline in COPD patients . The aim of the study was to examine the efficacy of a 3 year outpatient pulmonary rehabilitation ( PR ) program for COPD patients on pulmonary function , exercise capability , and body mass index ( BMI ) . Methods A matched controlled trial was performed with outcome assessment s evaluated at 6 , 12 , 18 , 24 , 30 , and 36 months . Eighty patients with moderate to severe COPD ( age 63 ± 7 years ; FEV1 48 % ± 14 ) were recruited . The control group received st and ard care only , while in addition , the case study group received PR for duration of three years . These groups were matched for age , sex , BMI , FEV1 % and number of pack-years smoked . Results The decline in FEV1 after the three years was significantly lower in the PR group compared to control , 74 ml versus 149 ml , respectively ( p < 0.001 ) . Maximal sustained work and endurance time improved after a short period of PR and was maintained throughout the study , in contrast to the control group ( p < 0.01 ) . A decreased BMI was noted in the control group after three years , while in the PR group a mild improvement was seen ( p < 0.05 ) . Conclusion Three years of outpatient pulmonary rehabilitation result ed in modifying the disease progression of COPD , as well as improving physical performance in these patients BACKGROUND Inhaled hypertonic saline is used for bronchial challenge and sputum induction in patients with chronic obstructive pulmonary disease ( COPD ) . We studied the effects of saline aerosol inhalation before each exercise session in an 8-week pulmonary rehabilitation program . METHODS This was a double-blind r and omized parallel controlled trial , conducted at an out-patient clinic . Sixty-eight subjects with COPD ( mean age 67 + /- 6.5 y , percent of predicted FEV(1 ) 47 + /- 21 ) were r and omized to inhale either 3 % hypertonic saline ( 34 subjects ) or normal saline ( 34 subjects ) before each exercise session in an 8-week exercise program that had 3 sessions per week . We measured 6-min walk distance , dyspnea , and quality of life ( with the Medical Outcomes Study 36-item short-form health survey ) . RESULTS After the 8-week exercise program , both groups ' mean 6-min walk distance had significantly increased : from 195 + /- 92 m to 251 + /- 97 m ( P < .001 ) in the hypertonic-saline group , and from 237 + /- 93 m to 441 + /- 121 m in the normal-saline group ( P < .001 ) . The normal-saline group had greater improvement than the hypertonic-saline group ( P < .001 ) . Dyspnea score improved from 3.1 + /- 0.9 to 2.3 + /- 0.8 ( P < .01 ) in the hypertonic-saline group , and from 3.5 + /- 0.2 to 2.3 + /- 1.0 ( P < .01 ) in the normal-saline group . Quality of life also significantly improved , except for the physical-functioning and social aspect domains in the hypertonic-saline group . Adverse effects ( cough or bronchospasm ) occurred in 4 patients ( 12 % ) in the hypertonic-saline group . CONCLUSIONS The improvement in 6-min walk distance was greater with normal saline than with hypertonic saline . Hypertonic saline was associated with adverse effects . It is unclear whether the only predictor of improved functional exercise capacity was exercise training . ( Clinical Trials.gov number , NCT00639236 . ) OBJECTIVE To determine the safety and usefulness of a home-based pulmonary rehabilitation program for patients with very severe chronic obstructive pulmonary disease ( COPD ) who receive long-term treatment with oxygen .  METHODS A r and omized prospect i ve study that included 50 patients with very severe COPD undergoing long-term treatment with oxygen .  At the start of the program and after 12 months , the following evaluations were performed : pulmonary function tests , submaximal exercise capability , and quality of life . The rehabilitation program lasted for 1 year , with periodic home visits by a physiotherapist and included respiratory reeducation training of the respiratory muscles and muscular training . RESULTS Forty-two patients completed the study ( 27 in the rehabilitation group and 15 in the control group ) . There were no initial differences between the 2 groups . No complications arising from the performance of the exercises were observed . The rehabilitation group showed a clinical ly significant increase in the distance covered in the 6-minute walk test ( 313 ± 72 m vs 392 ± 82 m , P = .0001 ) and a clinical ly significant reduction in 
    Output:
    
The st and ard rehabilitation programs showed positive effects on all of the outcomes evaluated , except for mortality ( because of the small number of analyses ) .
However , we found no differences among the various rehabilitation programs regarding their effects on the outcomes studied .
Rehabilitation programs can be considered important tools for the treatment of COPD .