***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: Objective To determine the feasibility and efficacy of a six-month , cell phone-based exercise persistence intervention for patients with chronic obstructive pulmonary disease ( COPD ) following pulmonary rehabilitation . Methods Participants who completed a two-week run-in were r and omly assigned to either MOBILE-Coached  ( n = 9 ) or MOBILE-Self-Monitored  ( n = 8) . All participants met with a nurse to develop an individualized exercise plan , were issued a pedometer and exercise booklet , and instructed to continue to log their daily exercise and symptoms . MOBILE-Coached also received weekly reinforcement text messages on their cell phones ; reports of worsening symptoms were automatically flagged for follow-up . Usability and satisfaction were assessed . Participants completed incremental cycle and six minute walk ( 6MW ) tests , wore an activity monitor for 14 days , and reported their health-related quality of life ( HRQL ) at baseline , three , and six months . Results The sample had a mean age of 68 ±11 and forced expiratory volume in one second 18 % predicted . Participants reported that logging their exercise and symptoms ( FEV1 ) of 40 ± was easy and that keeping track of their exercise helped them remain active . There were no differences between groups over time in maximal workload , 6MW distance , or HRQL ( p > 0.05 ) ; however , MOBILE-Self-Monitored increased total steps/day whereas MOBILE-Coached logged fewer steps over six months ( p = 0.04 ) . Conclusions We showed that it is feasible to deliver a cell phone-based exercise persistence intervention to patients with COPD post-rehabilitation and that the addition of coaching appeared to be no better than self-monitoring . The latter finding needs to be interpreted with caution since this was a purely exploratory study . Trial registration Clinical Trials.gov ( NCT00373932 ) OBJECTIVE To investigate whether patients with chronic obstructive pulmonary disease on long-term oxygen therapy  would benefit from an early 8-week rehabilitation programme in terms of exercise performance , health-related quality of life and activities of daily living . METHODS Two weeks after onset of oxygen therapy , 20 patients were r and omized to rehabilitation ( group A ) or not ( group B ) .  Exercise performance  was measured using a 6-minute walking test .  Health-related quality of life was measured with the Chronic Respiratory Disease Question naire . Activity of daily living ability was measured with the Stanford Health Assessment Question naire . RESULTS The mean 6-minute walking distance increased by 35 % ( p < 0.01 ) in group A after rehabilitation . The mean increase in group B was only 8 % ( n.s . ) . Patients in group A reported less overall dyspnoea after rehabilitation ( p < 0.05 ) and , compared with group B , reported better activity of daily living ability ( p < 0.01 ) . CONCLUSION Patients with chronic obstructive pulmonary disease on long-term oxygen treatment may improve their walking distance , experience less dyspnoea and improve activity of daily living ability with an early rehabilitation programme Background COPD is characterized by variability in exercise capacity and physical activity ( PA ) , and acute exacerbations ( AEs ) . Little is known about the relationship between daily step count , a direct measure of PA , and the risk of AEs , including hospitalizations . Methods In an observational cohort study of 169 persons with COPD , we directly assessed PA with the StepWatch Activity Monitor , an ankle-worn accelerometer that measures daily step count . We also assessed exercise capacity with the  6-minute walk test ( 6MWT ) and  patient-reported PA  with the St. George 's Respiratory Question naire Activity Score ( SGRQ-AS ) . AEs and COPD -related hospitalizations were assessed and vali date d prospect ively over a median of 16 months . Results Mean daily step count was 5804±3141 steps . Over 209 person-years of observation , there were 263 AEs ( incidence rate 1.3±1.6 per person-year ) and 116 COPD -related hospitalizations ( incidence rate 0.56±1.09 per person-year ) . Adjusting for FEV1 % predicted and prednisone use for AE in previous year , for each 1000 fewer steps per day walked at baseline , there was an increased rate of AEs ( rate ratio 1.07 ; 95%CI = 1.003–1.15 ) and COPD -related hospitalizations ( rate ratio 1.24 ; 95%CI = 1.08–1.42 ) . There was a significant linear trend of decreasing daily step count by quartiles and increasing rate ratios for AEs ( P = 0.008 ) and COPD -related hospitalizations ( P = 0.003 ) . Each 30-meter decrease in 6MWT distance was associated with an increased rate ratio of 1.07 ( 95%CI = 1.01–1.14 ) for AEs and 1.18 ( 95%CI = 1.07–1.30 ) for COPD -related hospitalizations . Worsening of SGRQ-AS by 4 points was associated with an increased rate ratio of 1.05 ( 95%CI = 1.01–1.09 ) for AEs and 1.10 ( 95%CI = 1.02–1.17 ) for COPD -related hospitalizations . Conclusions Lower daily step count , lower 6MWT distance , and worse SGRQ-AS predict future AEs and COPD –related hospitalizations , independent of pulmonary function and previous AE history . These results support the importance of assessing PA in patients with COPD , and provide the rationale to promote PA as part of exacerbation-prevention strategies Background : Chronic obstructive pulmonary disease ( COPD ) is a leading cause of death and 70 % of the cost of COPD is due to hospitalizations . Self-reported daily physical activity  and health status have been reported as predictors of a hospitalization in COPD but are not routinely assessed . Objectives : We tested the hypothesis that  self-reported daily physical activity and health status assessed by a simple question were predictors of a hospitalization in a well-characterized cohort of patients with severe emphysema . Methods : Investigators gathered daily physical activity and health status data assessed by a simple question  in 597 patients with severe emphysema and tested the association of those patient-reported outcomes to the occurrence of a hospitalization in the following year . Multiple logistic regression analyses were used to determine predictors of hospitalization during the first 12 months after r and omization . Results : The two variables tested in the hypothesis were significant predictors of a hospitalization after adjusting for all univariable significant predictors : > 2 h of physical activity per week had a protective effect [ odds ratio ( OR ) 0.60 ; 95 % confidence interval ( 95 % CI ) 0.41–0.88 ] and self-reported health status as fair or poor had a deleterious effect ( OR 1.57 ; 95 % CI 1.10–2.23 ) . In addition , two other variables became significant in the multivariate model : total lung capacity ( every 10 % increase ) had a protective effect ( OR 0.88 ; 95 % CI 0.78–0.99 ) and self-reported anxiety had a deleterious effect ( OR 1.75 ; 95 % CI 1.13–2.70 ) . Conclusion : Self-reported daily physical activity and health status are independently associated with COPD hospitalizations . Our findings , assessed by simple questions , suggest the value of patient-reported outcomes in developing risk assessment tools that are easy to use BACKGROUND Daily physical activity ( DPA ) level is reduced in patients with COPD . The aim of this study was to investigate the association of DPA with functional and psychological variables in these patients . METHODS 155 COPD patients ( 102 males , median ( IQR ) age 62 years ( 54 - 69 years ) , predicted FEV1 60 % ( 40 - 75 % ) were included . We assessed DPA ( DigiWalker SW-200 ) , functional capacity and psychological factors .  RESULTS DPA level was significantly associated with all functional capacity variables and two psychological variables ( Perceived Physical Ability Subscale , depression subscale of the Hospital Anxiety and Depression Scale ) . The six-minute walking distance and St. George Respiratory Question naire activity score explained 37 % of the variance of DPA in a regression analysis . A structural equations model revealed that psychological variables indirectly explained DPA through functional capacity variables . DPA was stronger associated with functional capacity variables and weaker with psychological variables in patients with lower functional status than in patients with higher functional status . CONCLUSIONS Higher levels of DPA are associated with better functional capacity , but interestingly , DPA is also affected by psychological factors , though only indirectly , via functional capacity . The effect of specific treatment addressing psychological factors on DPA level and exercise tolerance needs further investigation . CLINICAL TRIAL REGISTRATION Clinical Trials.gov , NCT00614796 UNLABELLED Multidimensional instruments for determining the severity and prognosis of chronic obstructive pulmonary disease ( COPD ) must be used in daily clinical practice . OBJECTIVE To develop and vali date a new COPD severity score using variables readily obtained in clinical practice and to compare its predictive capacity with that of other multidimensional indexes . Data collected from a prospect i ve cohort of 611 stable COPD patients were used to derive a clinical prediction rule that was later vali date d in a separate prospect i ve cohort of 348 patients . In the multivariate analyses , six independent predictive factors were correlated with overall and respiratory mortality : health status , physical activity , dyspnea , airway obstruction ( FEV(1 ) ) , age , and hospitalizations for COPD exacerbations in the previous two years . These create the HADO-AH score . Based on the β parameter obtained in the multivariate model , a score was assigned to each predictive variable . The area under the curve for 5-year mortality was 0.79 ( 95 % CI , 0.74 - 0.83 ) in the derivation cohort and 0.76 ( 95 % CI , 0.71 - 0.81 ) in the validation cohort . The HADO-AH score was a significantly better predictor of mortality than the HADO-score and the Body-mass index , Obstruction , Dyspnea , Exercise-index were statistically significant ( p < 0.0004 and p = 0.021 , respectively ) , but was similar to the Age , Dyspnea , and Obstruction-index ( p = 0.345 ) . The HADO-AH score provides estimates of all-cause and respiratory mortality that are equal to , or better than , those of other multidimensional instruments . Because it uses only easily accessible measures , it could be useful at all levels of care In 159 chronic obstructive pulmonary disease ( COPD ) patients ( 139 males , mean age 62 + /- 8 yrs , arterial oxygen tension ( PaO2 ) 7.2 + /- 0.9 kPa ) , on long-term oxygen therapy ( LTOT ) , we evaluated the effects of portable oxygen therapy both on the daily duration of oxygen therapy and on daily activities . They were given two types of LTOT at r and om : group A ( n = 75 ) , oxygen concentrators only ( OC ) ; group B ( n = 84 ) , either small oxygen cylinders plus OC ( B1 = 51 ) or liquid oxygen ( B2 = 33 ) . The patients were followed-up for one year by means of : a ) medical examination every three months ; b ) monthly home interviews concerning the daily duration of oxygen therapy , the utilization of the devices and the daily activities of the patients ; c ) a measurement of the  daily oxygen usage .  The results show that : 1 ) there are no significant clinical and functional differences between groups A and B at the onset of and throughout the study ; 2 ) in group B the daily use of oxygen therapy is significantly longer than in group A ( 17 + /- 3.5 h.day-1 vs 14 + /- 3 h.day-1 , p less than 0.01 ) without any difference between groups B1 and B2 ; 3 ) outdoor walking activities are different between groups A and B , at least in those patients using oxygen more than 18 h.day-1 . Only 60 % of patients in group B ( 55 % of B1 ; 67 % of B2 ) use their portable devices outdoors and for walking . No strict predictive criterion of this use is found in our study . ( ABSTRACT TRUNCATED AT 250 WORDS Background The current mainstay of therapy for chronic obstructive pulmonary disease ( COPD ) is long-acting bronchodilators . To date , the effect of indacaterol , a β2-agonist , on activities of daily living in COPD patients is not well understood . The aim of this study was to evaluate the efficacy of indacaterol with regard to activities of daily living in patients with COPD . Methods In this nonr and omized open-label study , 23 patients with COPD were instructed to carry an accelerometer for 4 weeks without indacaterol therapy and then for another period of 4 weeks while receiving indacaterol therapy . Results The number of steps , duration of moderate or greater physical activity , and energy expenditure were significantly increased after treatment with indacaterol compared with baseline data in all patients with COPD ; the metabolic equivalent of task was also significantly enhanced after treatment with indacaterol . Conclusion This study provides early evidence that indacaterol improves daily physical activity in patients with COPD Little is known about effects of community-based physiotherapeutic exercise programmes incorporated 
    Output:
    
Hyperinflation , exercise capacity , dyspnoea , previous exacerbations , gas exchange , systemic inflammation , quality of life and self-efficacy were consistently related to physical activity , but often based on cross-sectional studies and low- quality evidence .
As outcomes , COPD exacerbations and mortality were consistently associated with low levels of physical activity based on moderate quality evidence .
Physical activity was associated with other outcomes such as dyspnoea , health-related quality of life , exercise capacity and FEV1 but based on cross-sectional studies and low to very low quality evidence .
Physical activity level in COPD is consistently associated with mortality and exacerbations , but there is poor evidence about determinants of physical activity , including the impact of treatment