human
***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 : The benefits of pharmacotherapy with tiotropium H and iHaler 18 μg for patients with chronic obstructive pulmonary disease ( COPD ) have been previously demonstrated . However , few data exist regarding the treatment of moderate disease ( Global Initiative for Chronic Obstructive Lung Disease ( GOLD ) stage II ) . Aims : To determine whether tiotropium improves lung function/patient-reported outcomes in patients with GOLD stage II COPD naive to maintenance therapy . Methods : A r and omised 24-week double-blind placebo-controlled trial of tiotropium 18 μg once daily ( via H and iHaler ) was performed in maintenance therapy – naive patients with forced expiratory volume in 1 s (FEV1)/forced vital capacity ( FVC ) ratio < 0.7 and post-bronchodilator FEV1 ⩾50 and < 80 % . Results : A total of 457 patients were r and omised ( 238 tiotropium , 219 placebo ; mean age 62 years ; FEV1 1.93 l ( 66 % predicted ) )  . Tiotropium was superior to placebo in mean change from baseline in post-dose FEV1 area under the curve from 0 to 3 h ( AUC0–3h ) at week 24 ( primary endpoint ) : 0.19 vs. −0.03 l ( least-squares mean difference 0.23 l , P<0.001 ) . FVC AUC0–3h , trough and peak FEV1 and FVC were significantly improved with tiotropium versus placebo ( P<0.001 ) . Compared with placebo , tiotropium  provided numerical improvements in physical activity ( P = NS ) . Physician ’s Global Assessment ( health status ) improved ( P=0.045 ) with less impairment on the Work Productivity and Activity Impairment question naire ( P=0.043 ) at week 24 . The incidence of exacerbations , cough , bronchitis and dyspnoea was lower with tiotropium than placebo . Conclusions : Tiotropium  improved lung function and patient-reported outcomes in maintenance therapy – naive patients with GOLD stage II COPD , suggesting benefits in initiating maintenance therapy early Background In some patients with COPD , the disease is characterized by exacerbations . Severe exacerbations warrant a hospitalization , with prolonged detrimental effects on physical activity . Interventions after an exacerbation may improve physical activity , with longst and ing health benefits . Physical activity counseling and real-time feedback were effective in stable COPD . No evidence is available on the use of this therapeutic modality in patients after a COPD exacerbation . Methods Thirty patients were r and omly assigned to  usual care or physical activity counseling  , by telephone contacts at a frequency of 3 times a week and real-time feedback . Lung function , peripheral muscle strength , functional exercise capacity , symptom experience and COPD -related health status were assessed during hospital stay and 1 month later . Results Both groups significantly recovered in physical activity ( PAsteps : control group : 1013 ± 1275 steps vs intervention group : 984 ± 1208 steps ( p = 0.0005 ) ; PAwalk : control group : 13 ± 14 min vs intervention group : 13 ± 16 min ( p = 0.0002 ) ) , functional exercise capacity ( control group : 64 ± 59 m ( p = 0.002 ) vs intervention group : 67 ± 84 m ( p = 0.02 ) ) and COPD -related health status ( CAT : control group : −5 [ −7 to 1 ] ( p = 0.02 ) vs intervention group : −3 [ −10 to 1 ] points ( p = 0.03 ) ) . No differences between groups were observed . Conclusion From our pilot study , we concluded that telephone based physical activity counseling with pedometer feedback after an exacerbation did not result in better improvements in physical activity and clinical outcomes compared to usual care . Because of the difficult recruitment and the negative intermediate analyses , this study was not continued . Trial registration Clinical trials.gov NCT02223962 . Registered 4 September 2013 Introduction Chronic obstructive pulmonary disease ( COPD ) is associated with exercise limitation and physical inactivity , which are believed to have significant long-term negative health consequences for patients . While a number of COPD treatments and exercise training programmes increase exercise capacity , there is limited evidence for their effects on physical activity levels , with no clear association between exercise capacity and physical activity in clinical trials . Physical activity depends on a number of behaviour , environmental and physiological factors . We describe the design of the PHYSACTO trial , which is investigating the effects of bronchodilators , either alone or with exercise training , in combination with a st and ardised behaviour-change self-management programme , on exercise capacity and physical activity in patients with COPD . It is hypothesised that bronchodilators in conjunction with a behaviour-change self-management programme will improve physical activity and that this effect will be amplified by the addition of exercise training . Methods and analysis Patients are being recruited from 34 sites in Australia , New Zeal and , the USA , Canada and Europe . Patients receiving a multicomponent intervention design ed to support behaviour change related to physical activity are r and omised to four treatment arms : placebo , tiotropium , tiotropium+olo date rol , and tiotropium+olo date rol+exercise training . The primary outcome is improvement in exercise capacity after 8 weeks , measured by endurance time during a shuttle walk test . The secondary outcome is improvement in physical activity , including objective accelerometer assessment and patient-reported functioning using the Functional Performance Inventory — Short Form and the novel hybrid PROactive instrument . Additionally , the influence of moderating variables ( ie , factors influencing a patient 's choice to be physically active ) on increases in physical activity is also explored . Ethics and dissemination The study has been approved by the relevant Institutional Review Boards , Independent Ethics Committee and Competent Authority according to national and international regulations . The findings of the trial will be disseminated through relevant peer- review ed journals and international conference presentations . Trial registration number NCT02085161 Objectives To assess benefits of telephone-delivered health mentoring in community-based chronic obstructive pulmonary disease ( COPD ) . Design Cluster r and omised controlled trial . Setting Tasmanian general practice s : capital city ( 11 ) , large rural ( 3 ) , medium rural ( 1 ) and small rural ( 16 ) . Participants Patients were invited ( 1207 ) from general practitioner ( GP ) data bases with COPD diagnosis and /or tiotropium prescription , response rate 49 % ( 586 ) , refused ( 176 ) and excluded ( criteria : smoking history or previous study , 68 ) . Spirometry testing ( 342 ) confirmed moderate or severe COPD in 182 ( 53 % ) patients . R and omisation By r and om numbers code , block stratified on location , allocation by sequentially numbered , opaque and sealed envelopes . Intervention Health mentor ( HM ) group received regular calls to manage illness issues and health behaviours from trained community health nurses using negotiated goal setting : problem solving , decision-making and action planning . Control : usual care ( UC ) group received GP care plus non-interventional brief phone calls . Outcomes Measured at 0 , 6 and 12 months , the Short Form 36 ( SF-36 ) and St George ’s Respiratory Question naire ( SGRQ , primary ) ; Partners In Health ( PIH ) Scale for self-management capacity , Hospital Anxiety and Depression Scale ( HADS ) , Center for Epidemiologic Studies -Depression ( CES-D ) question naire , Post-Traumatic Stress Disorder Checklist , Satisfaction with life and hospital admissions ( secondary ) . Results 182 participants with COPD ( age 68±8 years , 62 % moderate COPD and 53 % men ) were r and omised ( HM=90 and UC=92 ) . Mixed model regression analysis accounting for clustering , adjusting for age , gender , smoking status and airflow limitation assessed efficacy ( regression coefficient , β , reported per 6-month visit ) . There was no difference in quality of life between groups , but self-management capacity increased in the HM group ( PIH overall 0.15 , 95 % CI 0.03 to 0.29 ; knowledge domain 0.25 , 95 % CI 0.00 to 0.50 ) . Anxiety decreased in both groups ( HADS A 0.35 ; 95 % CI −0.65 to −0.04 ) and coping capacity improved ( PIH coping 0.15 ; 95 % CI 0.04 to 0.26 ) . Conclusions Health mentoring  improved self-management capacity but not quality of life compared to regular phone contact , which itself had positive effects where decline is generally expected 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 ) Objectives Pulmonary rehabilitation ( PR ) provides benefit for patients with chronic obstructive pulmonary disease ( COPD ) in terms of quality of life ( QoL ) and exercise capacity ; however , the effects diminish over time . Our aim was to evaluate a maintenance programme for patients who had completed PR . Setting Primary and secondary care PR programmes in Norfolk . Participants 148 patients with COPD who had completed at least 60 % of a st and ard PR programme were r and omised and data are available for 110 patients . Patients had greater than 20 pack year smoking history and less than 80 % predicted forced expiratory volume in 1 s but no other significant disease or recent respiratory tract infection . Interventions Patients were r and omised to receive a maintenance programme or st and ard care . The maintenance programme consisted of 2 h ( 1 h individually tailored exercise training and 1 h education programme ) every 3 months for 1 year . Primary and secondary outcome measures The Chronic Respiratory Question naire ( CRQ ) ( primary outcome ) , endurance shuttle walk test ( ESWT ) , EuroQol ( EQ5D ) , hospital anxiety and depression score ( HADS ) , body mass index ( BMI ) , body fat , activity levels ( overall score and activity diary ) and exacerbations were assessed before and after 12 months . Results There was no statistically significant difference between the groups for the change in CRQ dyspnoea score ( primary end point ) at 12 months which amounted to 0.19 ( −0.26 to 0.64 ) units or other domains of the CRQ . There was no difference in the ESWT duration ( −10.06 ( −191.16 to 171.03 ) seconds ) , BMI , body fat , EQ5D , MET-minutes , activity rating , HADS , exacerbations or admissions . Conclusions A maintenance programme of three monthly 2 h sessions does not improve outcomes in patients with COPD after 12 months . We do not recommend that our maintenance programme is adopted . Other methods of sustaining the benefits of PR are required . Trial registration number NCT00925171 Background : Long-term non-invasive positive pressure ventilation ( NIPPV ) might improve the outcomes of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease ( COPD ) with chronic respiratory failure . A study was undertaken to investigate whether nocturnal NIPPV in addition to pulmonary rehabilitation improves health-related quality of life , functional status and gas exchange compared with pulmonary rehabilitation alone in patients with COPD with chronic hypercapnic respiratory failure . Methods : 72 patients with COPD were r and omly assigned to nocturnal NIPPV in addition to rehabilitation ( n = 37 ) or rehabilitation alone ( n = 35 ) . Outcome measures were assessed before and after the 3-month intervention period . Results : The Chronic Respiratory Question naire total score improved 15.1 points with NIPPV + rehabilitation compared with 8.7 points with rehabilitation alone . The difference of 7.5 points was not significant ( p = 0. 
    Output:
    
agent
Interventions that included ET and PA counseling during PR were effective strategies to improve PA in COPD
***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 : The benefits of pharmacotherapy with tiotropium H and iHaler 18 μg for patients with chronic obstructive pulmonary disease ( COPD ) have been previously demonstrated . However , few data exist regarding the treatment of moderate disease ( Global Initiative for Chronic Obstructive Lung Disease ( GOLD ) stage II ) . Aims : To determine whether tiotropium improves lung function/patient-reported outcomes in patients with GOLD stage II COPD naive to maintenance therapy . Methods : A r and omised 24-week double-blind placebo-controlled trial of tiotropium 18 μg once daily ( via H and iHaler ) was performed in maintenance therapy – naive patients with forced expiratory volume in 1 s (FEV1)/forced vital capacity ( FVC ) ratio < 0.7 and post-bronchodilator FEV1 ⩾50 and < 80 % . Results : A total of 457 patients were r and omised ( 238 tiotropium , 219 placebo ; mean age 62 years ; FEV1 1.93 l ( 66 % predicted ) )  . Tiotropium was superior to placebo in mean change from baseline in post-dose FEV1 area under the curve from 0 to 3 h ( AUC0–3h ) at week 24 ( primary endpoint ) : 0.19 vs. −0.03 l ( least-squares mean difference 0.23 l , P<0.001 ) . FVC AUC0–3h , trough and peak FEV1 and FVC were significantly improved with tiotropium versus placebo ( P<0.001 ) . Compared with placebo , tiotropium  provided numerical improvements in physical activity ( P = NS ) . Physician ’s Global Assessment ( health status ) improved ( P=0.045 ) with less impairment on the Work Productivity and Activity Impairment question naire ( P=0.043 ) at week 24 . The incidence of exacerbations , cough , bronchitis and dyspnoea was lower with tiotropium than placebo . Conclusions : Tiotropium  improved lung function and patient-reported outcomes in maintenance therapy – naive patients with GOLD stage II COPD , suggesting benefits in initiating maintenance therapy early Background In some patients with COPD , the disease is characterized by exacerbations . Severe exacerbations warrant a hospitalization , with prolonged detrimental effects on physical activity . Interventions after an exacerbation may improve physical activity , with longst and ing health benefits . Physical activity counseling and real-time feedback were effective in stable COPD . No evidence is available on the use of this therapeutic modality in patients after a COPD exacerbation . Methods Thirty patients were r and omly assigned to  usual care or physical activity counseling  , by telephone contacts at a frequency of 3 times a week and real-time feedback . Lung function , peripheral muscle strength , functional exercise capacity , symptom experience and COPD -related health status were assessed during hospital stay and 1 month later . Results Both groups significantly recovered in physical activity ( PAsteps : control group : 1013 ± 1275 steps vs intervention group : 984 ± 1208 steps ( p = 0.0005 ) ; PAwalk : control group : 13 ± 14 min vs intervention group : 13 ± 16 min ( p = 0.0002 ) ) , functional exercise capacity ( control group : 64 ± 59 m ( p = 0.002 ) vs intervention group : 67 ± 84 m ( p = 0.02 ) ) and COPD -related health status ( CAT : control group : −5 [ −7 to 1 ] ( p = 0.02 ) vs intervention group : −3 [ −10 to 1 ] points ( p = 0.03 ) ) . No differences between groups were observed . Conclusion From our pilot study , we concluded that telephone based physical activity counseling with pedometer feedback after an exacerbation did not result in better improvements in physical activity and clinical outcomes compared to usual care . Because of the difficult recruitment and the negative intermediate analyses , this study was not continued . Trial registration Clinical trials.gov NCT02223962 . Registered 4 September 2013 Introduction Chronic obstructive pulmonary disease ( COPD ) is associated with exercise limitation and physical inactivity , which are believed to have significant long-term negative health consequences for patients . While a number of COPD treatments and exercise training programmes increase exercise capacity , there is limited evidence for their effects on physical activity levels , with no clear association between exercise capacity and physical activity in clinical trials . Physical activity depends on a number of behaviour , environmental and physiological factors . We describe the design of the PHYSACTO trial , which is investigating the effects of bronchodilators , either alone or with exercise training , in combination with a st and ardised behaviour-change self-management programme , on exercise capacity and physical activity in patients with COPD . It is hypothesised that bronchodilators in conjunction with a behaviour-change self-management programme will improve physical activity and that this effect will be amplified by the addition of exercise training . Methods and analysis Patients are being recruited from 34 sites in Australia , New Zeal and , the USA , Canada and Europe . Patients receiving a multicomponent intervention design ed to support behaviour change related to physical activity are r and omised to four treatment arms : placebo , tiotropium , tiotropium+olo date rol , and tiotropium+olo date rol+exercise training . The primary outcome is improvement in exercise capacity after 8 weeks , measured by endurance time during a shuttle walk test . The secondary outcome is improvement in physical activity , including objective accelerometer assessment and patient-reported functioning using the Functional Performance Inventory — Short Form and the novel hybrid PROactive instrument . Additionally , the influence of moderating variables ( ie , factors influencing a patient 's choice to be physically active ) on increases in physical activity is also explored . Ethics and dissemination The study has been approved by the relevant Institutional Review Boards , Independent Ethics Committee and Competent Authority according to national and international regulations . The findings of the trial will be disseminated through relevant peer- review ed journals and international conference presentations . Trial registration number NCT02085161 Objectives To assess benefits of telephone-delivered health mentoring in community-based chronic obstructive pulmonary disease ( COPD ) . Design Cluster r and omised controlled trial . Setting Tasmanian general practice s : capital city ( 11 ) , large rural ( 3 ) , medium rural ( 1 ) and small rural ( 16 ) . Participants Patients were invited ( 1207 ) from general practitioner ( GP ) data bases with COPD diagnosis and /or tiotropium prescription , response rate 49 % ( 586 ) , refused ( 176 ) and excluded ( criteria : smoking history or previous study , 68 ) . Spirometry testing ( 342 ) confirmed moderate or severe COPD in 182 ( 53 % ) patients . R and omisation By r and om numbers code , block stratified on location , allocation by sequentially numbered , opaque and sealed envelopes . Intervention Health mentor ( HM ) group received regular calls to manage illness issues and health behaviours from trained community health nurses using negotiated goal setting : problem solving , decision-making and action planning . Control : usual care ( UC ) group received GP care plus non-interventional brief phone calls . Outcomes Measured at 0 , 6 and 12 months , the Short Form 36 ( SF-36 ) and St George ’s Respiratory Question naire ( SGRQ , primary ) ; Partners In Health ( PIH ) Scale for self-management capacity , Hospital Anxiety and Depression Scale ( HADS ) , Center for Epidemiologic Studies -Depression ( CES-D ) question naire , Post-Traumatic Stress Disorder Checklist , Satisfaction with life and hospital admissions ( secondary ) . Results 182 participants with COPD ( age 68±8 years , 62 % moderate COPD and 53 % men ) were r and omised ( HM=90 and UC=92 ) . Mixed model regression analysis accounting for clustering , adjusting for age , gender , smoking status and airflow limitation assessed efficacy ( regression coefficient , β , reported per 6-month visit ) . There was no difference in quality of life between groups , but self-management capacity increased in the HM group ( PIH overall 0.15 , 95 % CI 0.03 to 0.29 ; knowledge domain 0.25 , 95 % CI 0.00 to 0.50 ) . Anxiety decreased in both groups ( HADS A 0.35 ; 95 % CI −0.65 to −0.04 ) and coping capacity improved ( PIH coping 0.15 ; 95 % CI 0.04 to 0.26 ) . Conclusions Health mentoring  improved self-management capacity but not quality of life compared to regular phone contact , which itself had positive effects where decline is generally expected 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 ) Objectives Pulmonary rehabilitation ( PR ) provides benefit for patients with chronic obstructive pulmonary disease ( COPD ) in terms of quality of life ( QoL ) and exercise capacity ; however , the effects diminish over time . Our aim was to evaluate a maintenance programme for patients who had completed PR . Setting Primary and secondary care PR programmes in Norfolk . Participants 148 patients with COPD who had completed at least 60 % of a st and ard PR programme were r and omised and data are available for 110 patients . Patients had greater than 20 pack year smoking history and less than 80 % predicted forced expiratory volume in 1 s but no other significant disease or recent respiratory tract infection . Interventions Patients were r and omised to receive a maintenance programme or st and ard care . The maintenance programme consisted of 2 h ( 1 h individually tailored exercise training and 1 h education programme ) every 3 months for 1 year . Primary and secondary outcome measures The Chronic Respiratory Question naire ( CRQ ) ( primary outcome ) , endurance shuttle walk test ( ESWT ) , EuroQol ( EQ5D ) , hospital anxiety and depression score ( HADS ) , body mass index ( BMI ) , body fat , activity levels ( overall score and activity diary ) and exacerbations were assessed before and after 12 months . Results There was no statistically significant difference between the groups for the change in CRQ dyspnoea score ( primary end point ) at 12 months which amounted to 0.19 ( −0.26 to 0.64 ) units or other domains of the CRQ . There was no difference in the ESWT duration ( −10.06 ( −191.16 to 171.03 ) seconds ) , BMI , body fat , EQ5D , MET-minutes , activity rating , HADS , exacerbations or admissions . Conclusions A maintenance programme of three monthly 2 h sessions does not improve outcomes in patients with COPD after 12 months . We do not recommend that our maintenance programme is adopted . Other methods of sustaining the benefits of PR are required . Trial registration number NCT00925171 Background : Long-term non-invasive positive pressure ventilation ( NIPPV ) might improve the outcomes of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease ( COPD ) with chronic respiratory failure . A study was undertaken to investigate whether nocturnal NIPPV in addition to pulmonary rehabilitation improves health-related quality of life , functional status and gas exchange compared with pulmonary rehabilitation alone in patients with COPD with chronic hypercapnic respiratory failure . Methods : 72 patients with COPD were r and omly assigned to nocturnal NIPPV in addition to rehabilitation ( n = 37 ) or rehabilitation alone ( n = 35 ) . Outcome measures were assessed before and after the 3-month intervention period . Results : The Chronic Respiratory Question naire total score improved 15.1 points with NIPPV + rehabilitation compared with 8.7 points with rehabilitation alone . The difference of 7.5 points was not significant ( p = 0. 
    Output:
    