***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 ) Background Regular physical activity ( PA ) is recommended for persons with chronic obstructive pulmonary disease ( COPD ) . Interventions that promote PA and sustain long-term adherence to PA are needed . Objective We examined the effects of an Internet-mediated , pedometer-based walking intervention , called Taking Healthy Steps , at 12 months . Methods Veterans with COPD ( N=239 ) were r and omized in a 2:1 ratio to the  intervention  or wait-list control . During the first 4 months , participants in the intervention group were instructed to wear the pedometer every day , upload daily step counts at least once a week , and were provided access to a website with four key components : individualized goal setting , iterative feedback , educational and motivational content , and an online community forum . The subsequent 8-month maintenance phase was the same except that participants no longer received new educational content . Participants r and omized to the wait-list control group were instructed to wear the pedometer , but they did not receive step-count goals or instructions to increase PA . The primary outcome was health-related quality of life ( HRQL ) assessed by the St George ’s Respiratory Question naire Total Score ( SGRQ-TS ) ; the secondary outcome was daily step count . Linear mixed-effect models assessed the effect of intervention over time . One participant was excluded from the analysis because he was an outlier . Within the intervention group , we assessed pedometer adherence and website engagement by examining percent of days with valid step-count data , number of log-ins to the website each month , use of the online community forum , and responses to a structured survey . Results Participants were 93.7 % male ( 223/238 ) with a mean age of 67 ( SD 9 ) years . At 12 months , there were no significant between-group differences in SGRQ-TS or daily step count . Between-group difference in daily step count was maximal and statistically significant at month 4 ( P<.001 ) , but approached zero in months 8 - 12 . Within the intervention group , mean 76.7 % ( SD 29.5 ) of 366 days had valid step-count data , which decreased over the months of study ( P<.001 ) . Mean number of log-ins to the website each month also significantly decreased over the months of study ( P<.001 ) . The online community forum was used at least once during the study by 83.8 % ( 129/154 ) of participants . Responses to questions assessing participants ’ goal commitment and intervention engagement were not significantly different at 12 months compared to 4 months . Conclusions An Internet-mediated , pedometer-based PA intervention , although efficacious at 4 months , does not maintain improvements in HRQL and daily step counts at 12 months . Waning pedometer adherence and website engagement by the intervention group were observed . Future efforts should focus on improving features of PA interventions to promote long-term behavior change and sustain engagement in PA . Clinical Trial Clinical trials.gov NCT01102777 ; https:// clinical trials.gov/ct2/show/NCT01102777 ( Archived by WebCite at http://www.webcitation.org/6iyNP9KUC Background Patients with chronic obstructive pulmonary disease ( COPD ) demonstrate reduced levels of  daily physical activity ( DPA )  compared to healthy controls . This results in a higher risk of hospital admission and shorter survival . Performing regular DPA reduces these risks . Objective To develop an eHealth intervention that will support patients with COPD to improve or maintain their DPA after pulmonary rehabilitation . Methods The design process consisted of literature research and the iterative developing and piloting phases of the Medical Research Council ( MRC ) model for complex clinical interventions and the involvement of end users . Participants were healthy adults and persons with COPD . Results The mobile phone interface met all the set requirements . Participants found that the app was stimulating and that reaching their DPA goals was rewarding . The mean ( SD ) scores on a 7-point scale for usability , ease of use , ease of learning , and contentment were 3.8 ( 1.8 ) , 5.1 ( 1.1 ) , 6.0 ( 1.6 ) , and 4.8 ( 1.3 ) , respectively . The mean ( SD ) correlation between the mobile phone and a vali date d accelerometer was 0.88 ( 0.12 ) in the final test . The idea of providing their health care professional with their DPA data caused no privacy issues in the participants . Battery life lasted for an entire day with the final version , and readability and comprehensibility of text and colors were favorable . Conclusions By employing a user-centered design approach , a mobile phone was found to be an adequate and feasible interface for an eHealth intervention . The mobile phone and app are easy to learn and use by patients with COPD . In the final test , the accuracy of the DPA measurement was good . The final version of the eHealth intervention is presently being tested by our group for efficacy in a r and omized controlled trial in COPD patients OBJECTIVES To evaluate the effectiveness of an exercise adherence intervention to maintain daily activity , adherence to exercise , and exercise capacity over 1 year after completion of an outpatient pulmonary rehabilitation program . DESIGN A 2-group , experimental design was used with r and omization into intervention and usual care groups . SETTING Outpatient pulmonary rehabilitation program in a university-affiliated medical center . PARTICIPANTS One hundred six subjects ( 98 men ; 98 with chronic obstructive pulmonary disease ) with a mean age of 67 years and chronic lung disease . INTERVENTION Twelve-week adherence intervention ( weekly phone calls and home visit ) including counseling on establishing , monitoring , and problem-solving in maintaining a home exercise program . MAIN OUTCOME MEASURES Primary outcomes included daily activity ( accelerometer ) , exercise adherence ( exercise diary ) , and exercise capacity ( six-minute walk test ) . All measures were performed at baseline , after the pulmonary rehabilitation program ( 8 wk ) , after the adherence intervention ( 20 wk ) , and at 1 year . RESULTS A rank-based analysis of covariance showed less decline at 20 weeks in exercise adherence ( intervention mean , + 3 min ; control mean , -13 min ; P=.015 ) and exercise capacity ( intervention mean , -10.7 m ; control mean , -35.4 m ; P=.023 ) . There were no differences in daily activity at 20 weeks or any differences in any primary variable at 1 year . CONCLUSIONS The intervention enhanced exercise adherence and exercise capacity in the short term but produced no long-term benefit . These findings are in part attributed to the disappointing measurement characteristics of the accelerometer used to measure daily activity . The intervention was acceptable to participants . Further study is needed to fashion interventions that have more persistent benefit Symptoms during physical activity and physical inactivity are hallmarks of chronic obstructive pulmonary disease ( COPD ) . Our aim was to evaluate the validity and usability of six activity monitors in patients with COPD against the doubly labelled water ( DLW ) indirect calorimetry method . 80 COPD patients ( mean±sd age 68±6 years and forced expiratory volume in 1 s 57±19 % predicted ) recruited in four centres each wore simultaneously three or four out of six commercially available monitors vali date d in chronic conditions for 14 consecutive days . A priori validity criteria were defined . These included the ability to explain total energy expenditure ( TEE ) variance through multiple regression analysis , using TEE as the dependent variable with total body water ( TBW ) plus several physical activity monitor outputs as independent variables ; and correlation with activity energy expenditure ( AEE ) measured by DLW . The Actigraph GT3X ( Actigraph LLC , Pensacola , FL , USA ) , and DynaPort MoveMonitor ( McRoberts BV , The Hague , the Netherl and s ) best explained the majority of the TEE variance not explained by TBW ( 53 % and 70 % , respectively ) and showed the most significant correlations with AEE ( r=0.71 , p<0.001 and r=0.70 , p<0.0001 , respectively ) . The results of this study should guide users in choosing valid activity monitors for research or for clinical use in patients with chronic diseases such as COPD . This study vali date s six activity monitors in the field against indirect calorimetry ( DLW ) in patients with COPD 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 BACKGROUND Low levels of physical activity ( PA ) are associated with poor outcomes in people with COPD . Interventions to increase PA could improve outcomes . METHODS We tested the efficacy of a novel Internet-mediated , pedometer-based exercise intervention .  Veterans with COPD ( N = 239 ) were r and omized in a 2:1 ratio to the ( 1 ) intervention group ( Omron HJ-720 ITC pedometer and Internet-mediated program ) or ( 2 ) wait-list control group ( pedometer ) . The primary outcome was health-related quality of life ( HRQL ) , assessed by the St. George 's Respiratory Question naire ( SGRQ ) , at 4 months . We examined the SGRQ total score ( SGRQ-TS ) and three domain scores : Symptoms , Activities , and Impact . The secondary outcome was daily step counts . Linear regression models assessed the effect of intervention on outcomes . RESULTS Participants had a mean age of 67 ± 9 years , and 94 % were men . There was no significant between-group difference in mean 4-month SGRQ-TS ( 2.3 units , P = .14 ) . Nevertheless , a significantly greater proportion of intervention participants than control subjects had at least a 4-unit improvement in SGRQ-TS , the minimum clinical ly important difference ( 53 % vs 39 % , respectively , P = .05 ) . For domain scores , the intervention group had a lower ( reflecting better HRQL ) mean than the control group by 4.6 units for Symptoms ( P = .046 ) and by 3.3 units for Impact ( P = .049 ) . There was no significant difference in Activities score between the two groups . Compared with the control subjects , intervention participants walked 779 more steps per day at 4 months ( P = .005 ) . CONCLUSIONS An Internet-mediated , pedometer-based walking program can improve domains 
    Output:
    
The effectiveness of smartphones in increasing PA level ( steps/day ) at short and long term is very limited .