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: 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 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 Reduced physical activity is an important feature of Chronic Obstructive Pulmonary Disease ( COPD ) . Various activity monitors are available but their validity is poorly established . The aim was to evaluate the validity of six monitors in patients with COPD . We hypothesized triaxial monitors to be more valid compared to uniaxial monitors . Thirty-nine patients ( age 68±7years , FEV1 54±18%predicted ) performed a one-hour st and ardized activity protocol . Patients wore 6 monitors ( Kenz Lifecorder ( Kenz ) , Actiwatch , RT3 , Actigraph GT3X ( Actigraph ) , Dynaport MiniMod ( MiniMod ) , and SenseWear Armb and ( SenseWear ) ) as well as a portable metabolic system ( Oxycon Mobile ) . Validity was evaluated by correlation analysis between indirect calorimetry ( VO2 ) and the monitor outputs : Metabolic Equivalent of Task [ METs ] ( SenseWear , MiniMod ) , activity counts ( Actiwatch ) , vector magnitude units ( Actigraph , RT3 ) and arbitrary units ( Kenz ) over the whole protocol and slow versus fast walking . Minute-by-minute correlations were highest for the MiniMod ( r = 0.82 ) , Actigraph ( r = 0.79 ) , SenseWear ( r = 0.73 ) and RT3 ( r = 0.73 ) . Over the whole protocol , the mean correlations were best for the SenseWear ( r = 0.76 ) , Kenz ( r = 0.52 ) , Actigraph ( r = 0.49 ) and MiniMod ( r = 0.45 ) . The MiniMod ( r = 0.94 ) and Actigraph ( r = 0.88 ) performed better in detecting different walking speeds . The Dynaport MiniMod , Actigraph GT3X and SenseWear Armb and ( all triaxial monitors ) are the most valid monitors during st and ardized physical activities . The Dynaport MiniMod and Actigraph GT3X discriminate best between different walking speeds RATIONALE Low physical activity is highly prevalent among COPD patients and is associated with increased healthcare utilization and mortality and reduced HRQL . The addition of a website to pedometer use is effective at increasing physical activity ; however , the timeline of change and impact of environmental factors on efficacy is unknown . METHODS U.S. Veterans with COPD were r and omized ( 1:1 ) to receive either ( 1 ) a pedometer and website which provided goal - setting , feedback , disease-specific education , and an online community forum or ( 2 ) pedometer alone for 3 months . Primary outcome was change in daily step count . Secondary outcomes included 6MWT distance , HRQL , dyspnea , depression , COPD knowledge , exercise self-efficacy , social support , motivation , and confidence to exercise . Generalized linear mixed-effects models evaluated the effect of the pedometer plus website compared to pedometer alone . RESULTS Data from 109 subjects ( 98.5 % male , mean age 68.6 ± 8.3 years ) were analyzed . At 13 weeks , subjects in the pedometer plus website group had significant increases daily step count from baseline relative to the pedometer alone group ( 804 ± 356.5 steps per day , p = 0.02 ) . The pedometer plus website group had significant improvements in daily step count from baseline beginning in week 3 which were sustained until week 13 . In subgroup analyses , the pedometer plus website attenuated declines in daily step count during the transition from summer to fall . No significant differences in secondary outcomes were noted between groups . CONCLUSIONS A website added to pedometer use improves daily step counts , sustains walking over 3 months , and attenuates declines in physical activity due to season Rationale Reduced physical activity ( PA )  in patients with COPD is associated with a poor prognosis . Increasing PA is a key therapeutic target , but thus far few strategies have been found effective in this patient group . Objectives To investigate the effectiveness of a 12-week semiautomated telecoaching intervention on PA  in patients with COPD in a multicentre European r and omised controlled trial . Methods 343 patients from six centres , encompassing a wide spectrum of disease severity , were r and omly allocated to either a usual care group ( UCG ) or a telecoaching intervention group ( IG ) between June and December 2014 . This 12-week intervention included an exercise booklet and a step counter providing feedback both directly and via a dedicated smartphone application . The latter provided an individualised daily activity goal ( steps ) revised weekly and text messages as well as allowing occasional telephone contacts with investigators .  PA  was measured using accelerometry during 1 week preceding r and omisation and during week 12 . Secondary outcomes included exercise capacity and health status . Analyses were based on modified intention to treat . Main results Both groups were comparable at baseline in terms of factors influencing PA . At 12 weeks , the intervention yielded a between-group difference of mean , 95 % CI ( lower limit – upper limit ; ll-ul ) + 1469 , 95 % CI ( 971 to 1965 ) steps/day and + 10.4 , 95 % CI ( 6.1 to 14.7 ) min/day moderate PA ; favouring the IG ( all p≤0.001 ) . The change in 6-min walk distance was significantly different ( 13.4 , 95 % CI ( 3.40 to 23.5 ) m , p<0.01 ) , favouring the IG . In IG patients , an improvement could be observed in the functional state domain of the clinical COPD question naire ( p=0.03 ) compared with UCG . Other health status outcomes did not differ . Conclusions The amount and intensity of PA  can be significantly increased in patients with COPD using a 12-week semiautomated telecoaching intervention including a step counter and an application installed on a smartphone . Trial registration number : NCT02158065 Physical inactivity is a cardinal feature of chronic obstructive pulmonary disease ( COPD ) , and is associated with increased morbidity and mortality . Pedometers , which have been used in healthy population s , might also increase physical activity in patients with COPD . COPD patients taking part in a 3-month individualised programme to promote an increase in their daily physical activity were r and omised to either a st and ard programme of physical activity encouragement alone , or a pedometer-based programme . Assessment s were performed by investigators blinded to treatment allocation . Change in average 1-week daily step count , 6-min walking distance ( 6MWD ) , modified Medical Research Council scale , St George ’s respiratory question naire ( SGRQ ) and COPD assessment test ( CAT ) were compared between groups . 102 patients were recruited , of whom 97 completed the programme ( pedometer group : n=50 ; control group : n=47 ) ; 60.8 % were male with a mean±sd age of 68.7±8.5 years , and forced expiratory volume in 1 s ( FEV1 ) 66.1±19.4 % and FEV1/forced vital capacity 55.2±9.5 % . Both groups had comparable characteristics at baseline . The pedometer group had significantly greater improvements in : physical activity 3080±3254 steps·day−1 versus 138.3±1950 steps·day−1 ( p<0.001 ) ; SGRQ −8.8±12.2 versus −3.8±10.9 ( p=0.01 ) ; CAT score −3.5±5.5 versus −0.6±6.6 ( p=0.001 ) ; and 6MWD 12.4±34.6 versus −0.7±24.4 m ( p=0.02 ) than patients receiving activity encouragement only . A simple physical activity enhancement programme using pedometers can effectively improve physical activity level and quality of life in COPD patients  . Pedometer-based programme produced clinical ly important improvements in physical activity and health status in COPD PURPOSE We evaluated the effects of low-intensity and home-based pulmonary rehabilitation ( PR ) on physical activity ( PA ) and the feedback provided by a pedometer in stable elderly patients with chronic obstructive pulmonary disease ( COPD ) . METHODS We assessed PA using a newly developed triaxial accelerometer ( A-MES ™ , Kumamoto , Japan ) , which measures the time spent walking , st and ing , sitting and lying down .  Twenty-seven elderly patients with COPD ( age 74 ± 8 yrs ; % FEV1 56.6 ± 18.7 % ) participated . They were r and omly selected to undergo PR ( pulmonary rehabilitation only ) or PR + P ( PR plus the feedback from using a pedometer ) . Their PA and pulmonary function , exercise capacity ( 6-min walking distance ; 6MWD ) , quadriceps femoris muscle force ( QF ) were evaluated before the PR began ( baseline ) and at 1 year later . We compared the patients ' changes in PA and other factors between the baseline values and those obtained 1 year later and analyzed the relationships between the changes in PA and other factors in the both groups . RESULTS The increase in the time spent walking in the PR + P group ( 51.3 ± 63.7 min/day ) was significantly greater than that of PR group ( 12.3 ± 25.5 min/day ) after the PR . The improvement rate of daily walking time after PR was significantly correlated with that of the 6MWD and QF in all subjects . CONCLUSIONS These data suggest that low-intensity and home-based 
    Output:
    
agent
A subgroup analysis reported significant differences in the promotion of physical activity based on baseline physical activity levels and the type of instrument used to assess levels of physical activity .
***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: 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 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 Reduced physical activity is an important feature of Chronic Obstructive Pulmonary Disease ( COPD ) . Various activity monitors are available but their validity is poorly established . The aim was to evaluate the validity of six monitors in patients with COPD . We hypothesized triaxial monitors to be more valid compared to uniaxial monitors . Thirty-nine patients ( age 68±7years , FEV1 54±18%predicted ) performed a one-hour st and ardized activity protocol . Patients wore 6 monitors ( Kenz Lifecorder ( Kenz ) , Actiwatch , RT3 , Actigraph GT3X ( Actigraph ) , Dynaport MiniMod ( MiniMod ) , and SenseWear Armb and ( SenseWear ) ) as well as a portable metabolic system ( Oxycon Mobile ) . Validity was evaluated by correlation analysis between indirect calorimetry ( VO2 ) and the monitor outputs : Metabolic Equivalent of Task [ METs ] ( SenseWear , MiniMod ) , activity counts ( Actiwatch ) , vector magnitude units ( Actigraph , RT3 ) and arbitrary units ( Kenz ) over the whole protocol and slow versus fast walking . Minute-by-minute correlations were highest for the MiniMod ( r = 0.82 ) , Actigraph ( r = 0.79 ) , SenseWear ( r = 0.73 ) and RT3 ( r = 0.73 ) . Over the whole protocol , the mean correlations were best for the SenseWear ( r = 0.76 ) , Kenz ( r = 0.52 ) , Actigraph ( r = 0.49 ) and MiniMod ( r = 0.45 ) . The MiniMod ( r = 0.94 ) and Actigraph ( r = 0.88 ) performed better in detecting different walking speeds . The Dynaport MiniMod , Actigraph GT3X and SenseWear Armb and ( all triaxial monitors ) are the most valid monitors during st and ardized physical activities . The Dynaport MiniMod and Actigraph GT3X discriminate best between different walking speeds RATIONALE Low physical activity is highly prevalent among COPD patients and is associated with increased healthcare utilization and mortality and reduced HRQL . The addition of a website to pedometer use is effective at increasing physical activity ; however , the timeline of change and impact of environmental factors on efficacy is unknown . METHODS U.S. Veterans with COPD were r and omized ( 1:1 ) to receive either ( 1 ) a pedometer and website which provided goal - setting , feedback , disease-specific education , and an online community forum or ( 2 ) pedometer alone for 3 months . Primary outcome was change in daily step count . Secondary outcomes included 6MWT distance , HRQL , dyspnea , depression , COPD knowledge , exercise self-efficacy , social support , motivation , and confidence to exercise . Generalized linear mixed-effects models evaluated the effect of the pedometer plus website compared to pedometer alone . RESULTS Data from 109 subjects ( 98.5 % male , mean age 68.6 ± 8.3 years ) were analyzed . At 13 weeks , subjects in the pedometer plus website group had significant increases daily step count from baseline relative to the pedometer alone group ( 804 ± 356.5 steps per day , p = 0.02 ) . The pedometer plus website group had significant improvements in daily step count from baseline beginning in week 3 which were sustained until week 13 . In subgroup analyses , the pedometer plus website attenuated declines in daily step count during the transition from summer to fall . No significant differences in secondary outcomes were noted between groups . CONCLUSIONS A website added to pedometer use improves daily step counts , sustains walking over 3 months , and attenuates declines in physical activity due to season Rationale Reduced physical activity ( PA )  in patients with COPD is associated with a poor prognosis . Increasing PA is a key therapeutic target , but thus far few strategies have been found effective in this patient group . Objectives To investigate the effectiveness of a 12-week semiautomated telecoaching intervention on PA  in patients with COPD in a multicentre European r and omised controlled trial . Methods 343 patients from six centres , encompassing a wide spectrum of disease severity , were r and omly allocated to either a usual care group ( UCG ) or a telecoaching intervention group ( IG ) between June and December 2014 . This 12-week intervention included an exercise booklet and a step counter providing feedback both directly and via a dedicated smartphone application . The latter provided an individualised daily activity goal ( steps ) revised weekly and text messages as well as allowing occasional telephone contacts with investigators .  PA  was measured using accelerometry during 1 week preceding r and omisation and during week 12 . Secondary outcomes included exercise capacity and health status . Analyses were based on modified intention to treat . Main results Both groups were comparable at baseline in terms of factors influencing PA . At 12 weeks , the intervention yielded a between-group difference of mean , 95 % CI ( lower limit – upper limit ; ll-ul ) + 1469 , 95 % CI ( 971 to 1965 ) steps/day and + 10.4 , 95 % CI ( 6.1 to 14.7 ) min/day moderate PA ; favouring the IG ( all p≤0.001 ) . The change in 6-min walk distance was significantly different ( 13.4 , 95 % CI ( 3.40 to 23.5 ) m , p<0.01 ) , favouring the IG . In IG patients , an improvement could be observed in the functional state domain of the clinical COPD question naire ( p=0.03 ) compared with UCG . Other health status outcomes did not differ . Conclusions The amount and intensity of PA  can be significantly increased in patients with COPD using a 12-week semiautomated telecoaching intervention including a step counter and an application installed on a smartphone . Trial registration number : NCT02158065 Physical inactivity is a cardinal feature of chronic obstructive pulmonary disease ( COPD ) , and is associated with increased morbidity and mortality . Pedometers , which have been used in healthy population s , might also increase physical activity in patients with COPD . COPD patients taking part in a 3-month individualised programme to promote an increase in their daily physical activity were r and omised to either a st and ard programme of physical activity encouragement alone , or a pedometer-based programme . Assessment s were performed by investigators blinded to treatment allocation . Change in average 1-week daily step count , 6-min walking distance ( 6MWD ) , modified Medical Research Council scale , St George ’s respiratory question naire ( SGRQ ) and COPD assessment test ( CAT ) were compared between groups . 102 patients were recruited , of whom 97 completed the programme ( pedometer group : n=50 ; control group : n=47 ) ; 60.8 % were male with a mean±sd age of 68.7±8.5 years , and forced expiratory volume in 1 s ( FEV1 ) 66.1±19.4 % and FEV1/forced vital capacity 55.2±9.5 % . Both groups had comparable characteristics at baseline . The pedometer group had significantly greater improvements in : physical activity 3080±3254 steps·day−1 versus 138.3±1950 steps·day−1 ( p<0.001 ) ; SGRQ −8.8±12.2 versus −3.8±10.9 ( p=0.01 ) ; CAT score −3.5±5.5 versus −0.6±6.6 ( p=0.001 ) ; and 6MWD 12.4±34.6 versus −0.7±24.4 m ( p=0.02 ) than patients receiving activity encouragement only . A simple physical activity enhancement programme using pedometers can effectively improve physical activity level and quality of life in COPD patients  . Pedometer-based programme produced clinical ly important improvements in physical activity and health status in COPD PURPOSE We evaluated the effects of low-intensity and home-based pulmonary rehabilitation ( PR ) on physical activity ( PA ) and the feedback provided by a pedometer in stable elderly patients with chronic obstructive pulmonary disease ( COPD ) . METHODS We assessed PA using a newly developed triaxial accelerometer ( A-MES ™ , Kumamoto , Japan ) , which measures the time spent walking , st and ing , sitting and lying down .  Twenty-seven elderly patients with COPD ( age 74 ± 8 yrs ; % FEV1 56.6 ± 18.7 % ) participated . They were r and omly selected to undergo PR ( pulmonary rehabilitation only ) or PR + P ( PR plus the feedback from using a pedometer ) . Their PA and pulmonary function , exercise capacity ( 6-min walking distance ; 6MWD ) , quadriceps femoris muscle force ( QF ) were evaluated before the PR began ( baseline ) and at 1 year later . We compared the patients ' changes in PA and other factors between the baseline values and those obtained 1 year later and analyzed the relationships between the changes in PA and other factors in the both groups . RESULTS The increase in the time spent walking in the PR + P group ( 51.3 ± 63.7 min/day ) was significantly greater than that of PR group ( 12.3 ± 25.5 min/day ) after the PR . The improvement rate of daily walking time after PR was significantly correlated with that of the 6MWD and QF in all subjects . CONCLUSIONS These data suggest that low-intensity and home-based 
    Output:
    