***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Chronic obstructive pulmonary disease ( COPD ) is a common cause of morbidity and mortality affecting a large number of individuals in both developed and developing countries and it represents a significant financial burden for patients , families and society . Pulmonary rehabilitation ( PR ) is a multidisciplinary program that integrates components of exercise training , education , nutritional support , psychological support and self-care , result ing in an improvement in dyspnea , fatigue and quality of life . Despite its proven effectiveness and the strong scientific recommendations for its routine use in the care of COPD , PR is generally underutilized and strategies for increasing access to PR are needed . Home-based self-monitored pulmonary rehabilitation is an alternative to outpatient rehabilitation . In the present study , patients with mild , moderate and severe COPD su bmi tted to either an outpatient or at-home PR program for 12 weeks were analyzed . Methods Patients who fulfilled the inclusion criteria were r and omized into three distinct groups : an  outpatient group who performed all activities at the clinic  , a home-based group who performed the activities at home and a control group . PR consisted of a combination of aerobic exercises and strengthening of upper and lower limbs 3 times a week for 12 weeks . Results There was a significant difference in the distance covered on the six-minute walk test ( p < 0.05 ) and BODE index ( p < 0.001 ) in the outpatient and at-home groups after participating in the rehabilitation program compared to baseline . Conclusion A home-based self-monitoring pulmonary rehabilitation program is as effective as outpatient pulmonary rehabilitation and is a valid alternative for the management of patients with COPD .RiassuntoRazionaleLa broncopneumopatia cronica ostruttiva ( BPCO ) è una causa frequente di morbilità e mortalità che colpisce un’ampia quota di popolazione sia nel mondo industrializzato che nei Paesi in via di sviluppo e rappresenta un peso economico di rilievo per pazienti , familiari e collettività . La riabilitazione respiratoria ( PR ) è un programma multidisciplinare che inegra componenti di riallenamento all’esercizio fisico , educazionale , supporto nutrizionale , supporto psicologico ed autoaiuto , che porta ad un miglioramento della dispnea , della affaticabilità e della qualità della vita . Nonostante la provata efficacia e le forti raccom and azioni delle società scientifiche al suo impiego routinario nel trattamento della BPCO , la PR è generalmente sottoutilizzata e si rendono perciò necessarie strategie per aumentarne l’utilizzo . La PR effettuata a domicilio ed auto-monitorata dal paziente stesso è un’alternativa alla classica riabilitazione ambulatoriale . In questo studio sono stati valuati pazienti con BPCO di grado lieve , moderato e grave sottoposti a un programma di PR ambulatoriale o domiciliare . MetodiI pazienti eligibili allo studio sono stati r and omizzati in tre gruppi : un gruppo ambulatoriale che effettuava tutte le attività in ospedale , un gruppo domiciliare che effettuava il programma a domicilio ed un gruppo di controllo . Il programma di PR consisteva in una combinazione di esercizi aerobici e di rafforzamento della muscolatura degli arti superiori e inferiori per 3 volte la settimana per 12 settimane . RisultatiSia nel gruppo che ha partecipato al PR ambulatoriale che in quello domiciliare si sono rilevate differenze significative rispetto alle misure di base nella distanza coperta con il test del cammino di 6 minuti ( p < 0.05 ) che nell’indice BODE ( p < 0.001 ) . Conclusion iUn programma di riabilitazione respiratoria automonitorato eseguito a domicilio ha efficacia sovrapponibile ad un programma ambulatoriale e può perciò essere considerato una valida alternativa nella gestione del paziente con BPCO OBJECTIVE The benefits of a domiciliary program of pulmonary rehabilitation for patients with severe to very severe chronic obstructive pulmonary disease ( COPD ) are uncertain . We aim ed to assess the short- and medium-term efficacy of such a program in this clinical setting . PATIENTS AND METHODS Patients with severe COPD ( stages III-IV , classification of the Global Initiative for Chronic Obstructive Lung Disease ) and incapacitating dyspnea ( scores 3 - 5 , Medical Research Council [ MRC ] scale ) were r and omized to a control or domiciliary rehabilitation group . The 9-week supervised pulmonary rehabilitation program included educational sessions , respiratory physiotherapy , and muscle training in weekly sessions in the patient 's home . We assessed the following variables at baseline , 9 weeks , and 6 months : lung function , exercise tolerance ( 3-minute walk test ) , dyspnea ( MRC score ) , and health-related quality of life with the Chronic Respiratory Question naire ( CRQ ) . RESULTS Thirty-eight patients with a mean ( SD ) age of 68 ( 6 ) years were enrolled . The mean MRC score was 4 ( 0.8 ) and mean forced expiratory volume in 1 second was 29 % of reference . Twenty-nine patients completed the study ( 6 months ) . Distance covered on the walk test increased significantly in the rehabilitation group ( P=.001 ) and the difference was maintained at 6 months . Dyspnea also improved significantly with rehabilitation ( P<.05 ) , but the reduction was not evident at 6 months . Statistically significant improvements in symptoms related to 2 CRQ domains were detected between baseline and 9 weeks : dyspnea ( 3.1 [ 0.8 ] vs 3.6 [ 0.7 ] ; P=.02 ) and fatigue ( 3.7 [ 0.8 ] vs 4.2 [ 0.9 ] ; P=.002 ) . A clinical ly relevant but not statistically significant change in mastery over disease was detected ( from 4.3 to 4.9 ) . All improvements were maintained at 6 months . CONCLUSIONS Home-based pulmonary rehabilitation for patients with severe to very severe COPD and severe functional incapacity leads to improvements in exercise tolerance and health-related quality of life that are maintained at 6 months Introduction Pulmonary rehabilitation ( PR ) is a multidisciplinary program of care for patients with chronic obstructive pulmonary disease ( COPD ) with the goal of improving the functional capacity and quality of life , as well as maintaining the clinical stability of COPD sufferers . However , not all patients are available for such a program despite discomfort with their condition . The aim of this study was to evaluate the effects of a home-based PR ( HBPR ) program on functional ability , quality of life , and respiratory muscle strength and endurance . Patients and methods Patients with COPD according to the Global Initiative of Chronic Obstructive Lung Disease were r and omized ( double-blind ) into two groups . One group performed a protocol at home with aerobic and muscle strength exercises and was called the intervention group ; the other group received only instructions to perform breathing and stretching exercises , characterizing it as the control group ( CG ) . We assessed the following variables at baseline and 2 months : exercise tolerance ( incremental shuttle walk test and upper limb test ) , respiratory muscle ( strength and endurance test ) , and health-related quality of life ( Airways Question naire 20 ) . Results There were no significant changes after the intervention in either of the two groups in exercise tolerance and quality of life . However , the intervention group had improved respiratory endurance compared with the CG , while the CG presented a decrease in the load sustained by the respiratory muscles after the HBPR . Conclusion A program of HBPR with biweekly supervision ( although not enough to provide significant improvements in physical capacity or quality of life ) played an important role in maintaining the stability of the clinical features of patients with COPD ; the patients had no worsening of symptoms during the intervention period according to the daily log AIM In this study , the effects of a 12-week hospital-based outpatient pulmonary rehabilitation program ( HRP ) are compared with those of a 12-week home-care rehabilitation program ( HCRP ) in COPD patients . A control group received no rehabilitation therapy . METHODS After r and omization and stratification , effects on lung function , exercise performance ( 4-min walking test and cycle ergometer test ) , dyspnea , and leg effort during exercise , and well-being were assessed in 45 COPD patients with moderate to severe airflow limitation ( mean [ SD ] FEV1 percent predicted , 42.8 [ 8.4 ] ) . RESULTS After HRP and HCRP , at 3 to 6 months after the start of the study , equal improvements were detected in exercise capacity and in Borg dyspnea and leg effort scores at similar work levels during the cycle test . However , whereas after HRP at longer term values tended to return to baseline outcome , after HCRP a further ongoing significant improvement in exercise capacity was observed , while Borg dyspnea scores remained significantly improved over 18 months . Improvements in cycle workload and dyspnea score were significantly better maintained after HCRP as compared with HRP . Lung function , arterial oxygen saturation , and heart frequency during exercise did not change . A significant improvement in well-being was maintained over 18 months in both rehabilitation groups . CONCLUSION Beneficial effects are achieved both after a HRP and a HCRP in COPD patients with moderate to severe airflow limitation . Yet we recommend to initiate HCRPs as improvements are maintained longer and are even further strengthened in this setting We examined the feasibility of home-based walking training to maintain the benefits of a short-term exercise training in patients with severe chronic obstructive pulmonary disease ( COPD ) . After initial recovery from an exacerbation , 46 patients were r and omized into a training and a control group , and 30 patients completed the programme ( mean + /- SD FEV1 , 36 + /- 7 % predicted ) . The training group performed a 10-day walking training programme in the hospital , followed by a 6-month programme of supervised walking training at home , integrated into daily activities . The control group did not have exercise training in the hospital or at home . Until 6 months after discharge , lung function , exercise performance and symptom scores were assessed . Six-minute walking distance in the training group improved from day 1 to day 10 ( P<0.001 ) and this effect was maintained over 6 months ( P<0.001 ) . On average , daily walking distance at home was 2308 m and walking was reported on 157 days . Quality of life ( QoL ) scores changed significantly over 6 months ( P<0.001 ) . The control group showed no significant changes in exercise performance or QoL scores throughout the whole study period . Therefore , ( i ) significant improvements in exercise performance and Chronic Respiratory Disease Question naire ( CRQ ) scores could be achieved after recovery from an exacerbation and ( ii ) these improvements were maintained after discharge , when supported by a home-based walking training OBJECTIVES To have a group of COPD patients undergo a simple program of home-based exercise training , using the shuttle walking test ( SWT ) to st and ardize the intensity of training . METHODS Sixty patients participated , r and omly distributed into two groups ( rehabilitation and control ) of 30 patients each . The following evaluations were carried out at baseline and at 12 weeks : ( 1 ) pulmonary function studies ; ( 2 ) SWT ; ( 3 ) submaximal intensity resistance test ; ( 4 ) cycle ergometer test ; ( 5 ) quality of life ; and ( 6 ) dyspnea . The rehabilitation group underwent a lower-extremity training program . Walking was selected as the type of exercise . The intensity of training was set at 70 % of the maximum speed attained on the SWT . Divided sessions were held , lasting 1 h , 6 days/wk , at home , with a checkup every 2 weeks . The duration of the program was 12 weeks . RESULTS The following patients completed the study : 20 patients ( 66.6 % ) from the rehabilitation group ( mean [ + /- SD ] ) age , 64.3 + /- 8.3 years ; mean FEV(1 ) , 41.7 + /- 15.6 % of predicted ) ; and 17 patients ( 56.6 % ) from the control group ( mean age , 63.1 + /- 6.9 years ; mean FEV(1 ) , 40 + /- 16.4 % of predicted ) . We found no changes in pulmonary function or effort parameters ( SWT or cycle ergometer ) in the rehabilitation group at 12 weeks . A twofold increase ( 1,274 + /- 980 to 2,651 + /- 2,056 m ; p < 0.001 ) was achieved in the submaximal intensity resistance test , with less dyspnea at the conclusion of the test ( p = 0.05 ) . Significant improvement also was achieved in basal dyspnea and , both statistically and clinical ly , in the quality of life . Significant changes were not achieved in the control group patients . CONCLUSIONS A simple home-based program of exercise training achieved improvement in exercise tolerance , posteffort dyspnea , basal dyspnea , and quality of life in COPD patients Background Pulmonary Rehabilitation for moderate Chronic Obstructive Pulmonary Disease in primary care could improve patients ’ quality of life . Methods This study aim ed to assess the efficacy of a 3-month Pulmonary Rehabilitation ( PR ) program with a further 9 months of maintenance ( RHBM group ) compared with both PR for 3 months without further maintenance ( RHB group ) and usual care in improving the quality of life of patients with moderate COPD .We conducted a parallel-group , r and omized clinical trial in Majorca primary health care 
    Output:
    
HCPR proved superior to controls based on functional capacity in the 6-Minute Walk Test and Incremental Shuttle Walk Test , and based on dyspnea and quality of life in the Saint George 's Respiratory Question naire and the Chronic Respiratory Question naire .
When HCPR and OPR were compared , there were no effect differences in functional capacity or quality of life .
Improvement was greater in patients with more bronchial obstruction measured by FEV1 .
HCPR improves functional capacity and quality of life and decreases the sensation of dyspnea .
Its benefits in functional capacity and quality of life are comparable to those obtained with OPR in individuals with COPD