***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 Pulmonary rehabilitation ( PR ) is an effective intervention for the management of people with chronic obstructive pulmonary disease ( COPD ) . However , available re sources are often limited , and many patients bear with poor availability of programmes . Sustaining PR benefits and regular exercise over the long term is difficult without any exercise maintenance strategy . In contrast to traditional centre-based PR programmes , telerehabilitation may promote more effective integration of exercise routines into daily life over the longer term and broaden its applicability and availability . A few studies showed promising results for telerehabilitation , but mostly with short-term interventions . The aim of this study is to compare long-term telerehabilitation with unsupervised exercise training at home and with st and ard care . Methods / Design An international multicentre r and omised controlled trial conducted across sites in three countries will recruit 120 patients with COPD . Participants will be r and omly assigned to telerehabilitation , treadmill and control , and followed up for 2 years . The telerehabilitation intervention consists of individualised exercise training at home on a treadmill , telemonitoring by a physiotherapist via videoconferencing using a tablet computer , and self-management via a customised website . Patients in the  treadmill  arm are provided with a treadmill only to perform unsupervised exercise training at home . Patients in the control arm are offered st and ard care . The primary outcome is the combined number of hospitalisations and emergency department presentations . Secondary outcomes include changes in health status , quality of life , anxiety and depression , self-efficacy , subjective impression of change , physical performance , level of physical activity , and personal experiences in telerehabilitation . Discussion This trial will provide evidence on whether long-term telerehabilitation represents a cost-effective strategy for the follow-up of patients with COPD . The delivery of telerehabilitation services will also broaden the availability of PR and maintenance strategies , especially to those living in remote areas and with no access to centre-based exercise programmes . Trial registration Clinical Trials.gov : NCT02258646 Introduction The use of adequate self-management strategies for people with chronic obstructive pulmonary disease ( COPD ) reduces healthcare use , improves health-related quality of life ( HRQoL ) and recovery after acute exacerbations . However , not many people with COPD receive support that promotes the use of such strategies and therefore new methods to facilitate and promote the use of self-management strategies are highly warranted . This pilot trial aims to evaluate the feasibility of the study design and study procedures considering effectiveness of the novel intervention , the COPD -web . Methods and analysis The overall design is a pragmatic controlled pilot trial with pre assessment s and post assessment s and a parallel process evaluation . Patients with the diagnosis of COPD will be eligible for the study . The intervention group will be recruited when visiting one of the six participating primary care units in Sweden . The control group will be identified from the unit 's computerised registers . The intervention , the COPD -web , is an interactive web page with two sections ; one directed at people with COPD and one at healthcare professionals . The sections aim to support patients ’ self-management skills— and to facilitate the provision of support for self-management strategies , respectively . Effectiveness with regard to patients ’ symptoms , HRQoL , knowledge of and readiness for COPD -related self-management , health literacy , self-efficacy for physical activity and time spent in physical activity and time being sedentary , and further , healthcare professionals ’ knowledge of and readiness to support COPD -related self-management strategies will be assessed using question naires at 3 and 12 months . The process evaluation will include observations and interviews . Ethics and dissemination Ethical approval has been obtained . Findings will be presented at conferences , su bmi tted for publication in peer- review ed publications and presented to the involved healthcare professionals , patients and to patient organisations . Trial registration number Clinical Trials.gov : Introduction National guidance for chronic obstructive pulmonary disease ( COPD ) suggests that self-management support be provided for patients . Our institution has developed a st and ardised , manual-based , supported self-management programme : Self-Management Programme of Activity Coping and Education ( SPACE for COPD ( C ) ) . SPACE was previously piloted on a 1 - 2 - 1 basis , delivered by research ers , to individuals with COPD . Discussion s with stakeholders highlighted considerable interest in delivering the SPACE for COPD ( C ) intervention as a group-based self-management programme facilitated by healthcare professionals ( HCPs ) in primary care setting s. The study aims are to explore the feasibility , acceptability and efficacy for the intervention to be delivered and supported by HCPs and to examine whether group-based delivery of SPACE for COPD ( C ) , with sustained support , improves patient outcomes following the SPACE for COPD ( C ) intervention . Methods and analysis A prospect i ve , multi-site , single-blinded r and omised controlled trial ( RCT ) will be conducted , with follow-up at 6 and 9 months . Participants will be r and omly assigned to either the control group ( usual care ) or intervention group ( a six-session , group-based SPACE for COPD (C)self-management programme delivered over 5 months ) . The primary outcome is change in COPD assessment test at 6 months . A discussion session will be conducted with HCPs who deliver the intervention to discuss and gain insight into any potential facilitators/barriers to implementing the intervention in practice . Furthermore , we will conduct semi-structured focus groups with intervention participants to underst and feasibility and acceptability . All qualitative data will be analysed thematically . Ethics and dissemination The project has received a favourable opinion from South Hampshire B Research Ethics Committee , REC reference : 14/SC/1169 and full R&D approval from the University Hospitals of Leicester NHS Trust : 152408 . Study results will be disseminated through appropriate peer- review ed journals , national and international respiratory/physiotherapy conferences , via the Collaboration and Leadership in Applied Health Research and Care and through social media . Trial registration IS RCT N17942821 ; pre- results Rationale : Increasing physical activity is a key therapeutic aim in chronic obstructive pulmonary disease ( COPD ) .  Pulmonary rehabilitation ( PR ) improves exercise capacity , but there is conflicting evidence regarding its ability to improve physical activity levels . Objectives : To determine whether using pedometers as an adjunct to PR can enhance time spent in at least moderate‐intensity physical activity ( time expending ≥3 metabolic equivalents [ METs ] ) by people with COPD . Methods : In this single‐blind r and omized controlled trial , participants were assigned 1:1 to receive a control intervention ( PR comprising 8 wk , two supervised sessions per week ) or the trial intervention ( PR plus pedometer‐directed step targets , review ed weekly for 8 wk ) . In the r and omization process , we used minimization to balance groups for age , sex , FEV1 percent predicted , and baseline exercise capacity and physical activity levels . Outcome assessors and PR therapists were blinded to group allocation . The primary analysis was based on the intention‐to‐treat principle . Measurements and Main Results : The primary outcome was change from baseline to 8 weeks in accelerometer‐measured daily time expending at least 3 METs . A total of 152 participants ( 72 % male ; mean [ SD ] FEV1 percent predicted , 50.5 % [ 21.2 ] ; median [ first quartile , third quartile ] time expending ≥3 METs , 46 [ 21 , 92 ] min ) were enrolled and assigned to the intervention ( n = 76 ) or control ( n = 76 ) arm . There was no significant difference in change in time expending at least 3 METs between the intervention and control groups at 8 weeks ( median [ first quartile , third quartile ] difference , 0.5 [ −1.0 , 31.0 ] min ; P = 0.87 ) or at the 6‐month follow‐up ( 7.0 [ −9 , 27 ] min ; P = 0.16 ) . Conclusions : Pedometer‐directed step‐count targets during an outpatient PR program did not enhance moderate‐intensity physical activity levels in people with COPD . Clinical trial registered with www . clinical trials.gov ( NCT01719822 ) BACKGROUND Treatment of COPD requires multiple pharmacological and non-pharmacological intervention strategies . One target is physical inactivity because it leads to disability and contributes to poor physical and mental health . Unfortunately , less than 1 % of eligible patients have access to gold-st and ard pulmonary rehabilitation . METHODS A single-site parallel group r and omized trial was design ed to determine if a self-management lifestyle physical activity intervention would improve physical functioning and dyspnea . During the first six weeks after enrollment patients receive COPD self-management education delivered by a health coach using a workbook and weekly telephone calls . Patients are then r and omized to usual care or the physical activity intervention . The 20 week physical activity intervention is delivered by the health coach using a workbook supported by alternating one-on-one telephone counseling and computer assisted telephone calls . Theoretical foundations include social cognitive theory and the transtheoretical model . RESULTS Primary outcomes include change in Chronic Respiratory Question naire ( CRQ ) dyspnea domain and 6-minute walk distance measured at 6- , 12- , and 18-months after r and omization . Secondary outcomes include other CRQ domains ( fatigue , emotion , and mastery ) , SF-12 , and health care utilization . Other measures include process outcomes and clinical characteristics . CONCLUSIONS This theory driven self-management lifestyle physical activity intervention is design ed to reach patients unable to complete center-based pulmonary rehabilitation . Results will advance knowledge and methods for dissemination of a potentially cost-effective program for patients with COPD OBJECTIVES To review the accuracy of diagnoses of chronic obstructive pulmonary disease ( COPD ) in primary care in Australia , and to describe smokers ' experiences with and preferences for smoking cessation . DESIGN , SETTING AND PARTICIPANTS Patients were invited to participate if they were at least 40 years old and had visited participating general practice clinics in Melbourne at least twice during the previous 12 months , reported being current or ex-smokers with a smoking history of at least 10 pack-years , or were being managed for COPD . Interviews based on a structured question naire and case finding ( FEV1/FEV6 measurement ) were followed , when appropriate , by  spirometry testing  and assessment of health-related quality of life , dyspnoea and symptoms . RESULTS 1050 patients attended baseline interviews ( February 2015 - April 2017 ) at 41 practice s. Of 245 participants managed for COPD , 130 ( 53.1 % ) met the spirometry-based definition ( post-bronchodilator FEV1/FVC < 0.7 ) or had a clinical correlation ; in 37 % of cases COPD was not confirmed , and no definitive result was obtained for 9.8 % of patients . Case finding and subsequent spirometry testing identified 142 new COPD cases ( 17.6 % of participants without prior diagnosis ; 95 % CI , 15.1 - 20.5 % ) . 690 participants ( 65.7 % ) were current smokers , of whom 360 had attempted quitting during the previous 12 months ; 286 ( 81.0 % of those attempting to quit ) reported difficulties during previous quit attempts . Nicotine replacement therapy ( 205 , 57.4 % ) and varenicline ( 110 , 30.8 % ) were the most frequently employed pharmacological treatments ; side effects were common . Hypnotherapy was the most popular non-pharmacological option ( 62 smokers , 17 % ) ; e-cigarettes were tried by 38 ( 11 % ) . 187 current smokers ( 27.6 % ) would consider using e-cigarettes in future attempts to quit . CONCLUSIONS COPD was both misdiagnosed and missed . Case finding and effective use of spirometry testing could improve diagnosis . Side effects of smoking cessation medications and difficulties during attempts to quit smoking are common . Health professionals should emphasise evidence -based treatments , and closely monitor quitting difficulties and side effects of cessation aids . TRIAL REGISTRATION Australian New Zeal and Clinical Trials Registry ACTRN12614001155684 Introduction COPD is a leading cause of morbidity and mortality . Self-management interventions are considered important in order to limit the progression of the disease . Computer-tailored interventions could be an effective tool to facilitate self-management . Methods This r and omized controlled trial tested the effectiveness of a web-based , computer-tailored COPD self-management intervention on physical activity and smoking behavior .  Participants were recruited from an online panel and through primary care practice s. Those at risk for or diagnosed with COPD , between 40 and 70 years of age , proficient in Dutch , with access to the Internet , and with basic computer skills ( n=1,325 ) , were r and omly assigned to either the intervention group ( n=662 ) or control group ( n=663 ) . The intervention group received the web-based self-management application , while the control group received no intervention . Participants were not blinded to group assignment . After 6 months , the effect of the intervention was assessed for the primary outcomes , smoking cessation and physical activity , by self-reported 7-day point prevalence abstinence and the International Physical Activity Question naire – Short Form . Results Of the 1,325 participants , 1,071 ( 80.8 % ) completed the 6-month follow-up question naire . No significant 
    Output:
    
Step count was the most frequently reported outcome , but it was commonly assessed using devices with documented inaccuracy for this variable .
One study demonstrated an improvement following six months of physical activity counselling ( MD 11 minutes per day , 95 % CI 7 to 15 ; 1 study , 280 participants ; moderate-certainty evidence ) , but we found mixed results for the addition of physical activity counselling to pulmonary rehabilitation .
These interventions also demonstrated improvements in other measures of physical activity .
Improvements in physical activity have not been systematic ally demonstrated following any particular intervention .
There was limited evidence for improvement in physical activity with strategies including exercise training , physical activity counselling and pharmacological management .
There was scant evidence for a continued effect over time following completion of interventions , a likely requirement for meaningful health benefits for people with COPD