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: PURPOSE Acute exacerbations of chronic obstructive pulmonary disease ( AE COPD ) impair health-related quality of life ( HRQL ) . We evaluated the effect of an abbreviated repeat pulmonary rehabilitation ( PR ) program on HRQL after an AE COPD . METHODS Patients who had completed PR were followed for up to 12 months to identify an AE COPD and then placed in r and omized groups to receive a 3-week repeat-PR intervention or usual care .  Measures of HRQL ( Chronic Respiratory Disease Question naire , CRQ ) and functional exercise capacity ( 6-minute walk distance , 6MWD ) were collected at 2 ( T1 ) , 5 ( T2 ) , and 12 weeks ( T3 ) post-AE COPD . The repeat-PR program was undertaken between T1 and T2 . Between-group differences were examined using repeated- measures analysis of variance or covariance . RESULTS Of the 60 patients ( 30 men , age 69±8 years , forced expiratory volume in 1 second 0.86±0.40 L , 6MWD 367±99 m ) followed , 41 experienced an AE COPD 14 ± 11 weeks after completion of the initial PR program and 33 completed the study . Of these , 16 and 17 were r and omized to the intervention and control groups , respectively . No between-group differences were demonstrated at T2 or T3 . With the exclusion of 5 subjects who experienced a second AE COPD between T1 and T3 , the participants in the intervention group demonstrated greater reduction in dyspnea when compared to those in the control group at T3 ( 0.8±1.6 vs −0.4±1.3 points per item , P = .04 ) . CONCLUSIONS The reduction in dyspnea in those who did not experience a second AE COPD provides preliminary evidence for the role of repeat programs . The application of repeat PR should be refined in larger trials Abstract The evaluation of a 13-month maintenance program ( MP ) for 39 severe COPD patients with FEV1%pred 44(7)% who , as result of two different 8-week leg exercise training ( LET ) programs , one supervised at the hospital ( group S ; n = 20 ) and the other self-monitored ( SM ; n = 19 ) , had achieved different levels of exercise tolerance . After LET , patients in group S had a higher maximal oxygen uptake and endurance time than patients in the SM group [ O2max 1.43(0.30 ) l · min−1 ] vs l.25(0.27 ) l · min−1 and endurance-time 16(4 ) min vs 12 ( 5 ) min , respectively ) . During the MP patients were advised to walk vigorously at least 4 km/day , 4 times/wk . After the MP , while endurance time remained higher than at baseline , it had decreased ( p < 0.01 ) immediately after LET in both groups and no differences were evident between groups ( 11(4 ) min and 10(4 ) , respectively ) . In contrast , Chronic Respiratory Diseases Question naire scores , which had improved significantly after LET in both groups , remained high . Long-term effects of MP were independent of the training strategy or whether physiological improvements had been obtained with the initial LET . SM exercise programs do not seem capable of maintaining physiological improvements in exercise tolerance , though “ quality of life ” can be maintained BACKGROUND Pulmonary rehabilitation programmes improve the health of patients disabled by lung disease but their cost effectiveness is unproved . We undertook a cost/utility analysis in conjunction with a r and omised controlled clinical trial of pulmonary rehabilitation versus st and ard care . METHODS Two hundred patients , mainly with chronic obstructive pulmonary disease , were r and omly assigned to either an 18 visit , 6 week rehabilitation programme or st and ard medical management . The difference between the mean cost of 12 months of care for patients in the rehabilitation and control groups ( incremental cost ) and the difference between the two groups in quality adjusted life years ( QALYs ) gained ( incremental utility ) were determined . The ratio between incremental cost and utility ( incremental cost/utility ratio ) was calculated . RESULTS Each rehabilitation programme for up to 20 patients cost £ 12 120 . The mean incremental cost of adding rehabilitation to st and ard care was £ –152 ( 95 % CI –881 to 577 ) per patient , p = NS . The incremental utility of adding rehabilitation was 0.030 ( 95 % CI 0.002 to 0.058 ) QALYs per patient , p=0.03 . The point estimate of the incremental cost/utility ratio was therefore negative . The bootstrapping technique was used to model the distribution of cost/utility estimates possible from the data . A high likelihood of generating QALYs at negative or relatively low cost was indicated . The probability of the cost per QALY generated being below £ 0 was 0.64 . CONCLUSIONS This outpatient pulmonary rehabilitation programme produces cost per QALY ratios within bounds considered to be cost effective and is likely to result in financial benefits to the health service Follow-up evaluation was conducted of 101 older men and women ( mean age = 67 + /- 5 years ) who had participated in a r and omized study of physiological and psychological effects of aerobic exercise . Eighty-five subjects completed the follow-up evaluation , and almost all of them ( 94 % ) reported continuing with physical activity , as assessed by a self-report measure . Total energy expenditure was calculated as an indicator of exercise maintenance , and energy expenditure at follow-up was predicted from measures of physiological functioning , psychological well-being , and cognitive functioning obtained at the conclusion of the structured exercise program . Greater cardiorespiratory endurance , faster psychomotor speed , and lower anxiety predicted exercise behavior at follow-up , accounting for 13 % of the variance in exercise behavior . Gender was not a significant predictor of exercise behavior 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 ) We examined the feasibility of home-based walking training to maintain the benefits of a short-term exercise training in patients with severe chronic obstructive pulmonary disease ( COPD ) . After initial recovery from an exacerbation , 46 patients were r and omized into a training and a control group , and 30 patients completed the programme ( mean + /- SD FEV1 , 36 + /- 7 % predicted ) . The training group performed a 10-day walking training programme in the hospital , followed by a 6-month programme of supervised walking training at home , integrated into daily activities . The control group did not have exercise training in the hospital or at home . Until 6 months after discharge , lung function , exercise performance and symptom scores were assessed . Six-minute walking distance in the training group improved from day 1 to day 10 ( P<0.001 ) and this effect was maintained over 6 months ( P<0.001 ) . On average , daily walking distance at home was 2308 m and walking was reported on 157 days . Quality of life ( QoL ) scores changed significantly over 6 months ( P<0.001 ) . The control group showed no significant changes in exercise performance or QoL scores throughout the whole study period . Therefore , ( i ) significant improvements in exercise performance and Chronic Respiratory Disease Question naire ( CRQ ) scores could be achieved after recovery from an exacerbation and ( ii ) these improvements were maintained after discharge , when supported by a home-based walking training To date , no international surveys estimating the burden of chronic obstructive pulmonary disease ( COPD ) in the general population have been published . The Confronting COPD International Survey aim ed to quantify morbidity and burden in COPD subjects in 2000 . From a total of 201,921 households screened by r and om-digit dialling in the USA , Canada , France , Italy , Germany , the Netherl and s , Spain and the UK , 3,265 subjects with a diagnosis of COPD , chronic bronchitis or emphysema , or with symptoms of chronic bronchitis , were identified . The mean age of the subjects was 63.3 yrs and 44.2 % were female . Subjects with COPD in North America and Europe appear to underestimate their morbidity , as shown by the high proportion of subjects with limitations to their basic daily life activities , frequent work loss ( 45.3 % of COPD subjects of < 65 yrs reported work loss in the past year ) and frequent use of health services ( 13.8 % of subjects required emergency care in the last year ) , and may be undertreated . There was a significant disparity between subjects ' perception of disease severity and the degree of severity indicated by an objective breathlessness scale . Of those with the most severe breathlessness ( too breathless to leave the house ) , 35.8 % described their condition as mild or moderate , as did 60.3 % of those with the next most severe degree of breathlessness ( breathless after walking a few minutes on level ground ) . This international survey confirmed the great burden to society and high individual morbidity associated with chronic obstructive pulmonary disease in subjects in North America and Europe STUDY OBJECTIVE To determine if distractive auditory stimuli ( DAS ) in the form of music would promote adherence to a walking regimen following completion of a pulmonary rehabilitation program ( PRP ) and , thereby , maintenance of gains achieved during the program . DESIGN Experimental , r and omized , two-group design with testing at baseline , 4 weeks , and 8 weeks . SETTING Outpatient . PATIENTS Twenty-four patients ( 4 men and 20 women ) with moderate-to-severe COPD ( FEV(1 ) 41.3 + /- 13 % predicted [ mean + /- SD ] ) . INTERVENTION Experimental group subjects ( n = 12 ) were instructed to walk at their own pace for 20 to 45 min , two to five times a week , using DAS with a portable audiocassette player . The control group ( n = 12 ) received the same instructions , but no DAS . MEASUREMENTS AND RESULTS Primary outcome measures were perceived dyspnea during activities of daily living ( ADL ) and 6-min walk ( 6MW ) distance . Secondary outcome measures were anxiety , depressive symptoms , health-related quality of life ( QoL ) , global QoL , and breathlessness and fatigue at completion of the 6MW . In addition , all subjects recorded the distance and time walked using self-report ( pedometers and daily logs ) . There was a significant decrease in perceived dyspnea during ADL ( p = 0.0004 ) and a significant increase in 6MW distance ( p = 0.0004 ) over time in the DAS group compared to the control group . DAS subjects increased 6MW distance 445 + /- 264 feet ( mean + /- SD ) from baseline to 8 weeks , whereas control subjects decreased 6MW distance to 169 + /- 154 feet . No significant differences were noted for the remaining variables . The cumulative distance walked by the DAS group was 19.1 + /- 16.7 miles compared to 15.4 + /- 8.0 miles for the control group , a 24 % difference ( p = 0.49 ) . Despite this difference , self-report exercise log data were similar for the two groups . CONCLUSION Subjects who used DAS while walking had improved functional performance and decreased perceptions of dyspnea , whereas control subjects could not maintain post-PRP gains . DAS is a simple , cost-effective strategy that may have the potential to augment the effectiveness of post-PRP maintenance training 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 
    Output:
    
agent
***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: PURPOSE Acute exacerbations of chronic obstructive pulmonary disease ( AE COPD ) impair health-related quality of life ( HRQL ) . We evaluated the effect of an abbreviated repeat pulmonary rehabilitation ( PR ) program on HRQL after an AE COPD . METHODS Patients who had completed PR were followed for up to 12 months to identify an AE COPD and then placed in r and omized groups to receive a 3-week repeat-PR intervention or usual care .  Measures of HRQL ( Chronic Respiratory Disease Question naire , CRQ ) and functional exercise capacity ( 6-minute walk distance , 6MWD ) were collected at 2 ( T1 ) , 5 ( T2 ) , and 12 weeks ( T3 ) post-AE COPD . The repeat-PR program was undertaken between T1 and T2 . Between-group differences were examined using repeated- measures analysis of variance or covariance . RESULTS Of the 60 patients ( 30 men , age 69±8 years , forced expiratory volume in 1 second 0.86±0.40 L , 6MWD 367±99 m ) followed , 41 experienced an AE COPD 14 ± 11 weeks after completion of the initial PR program and 33 completed the study . Of these , 16 and 17 were r and omized to the intervention and control groups , respectively . No between-group differences were demonstrated at T2 or T3 . With the exclusion of 5 subjects who experienced a second AE COPD between T1 and T3 , the participants in the intervention group demonstrated greater reduction in dyspnea when compared to those in the control group at T3 ( 0.8±1.6 vs −0.4±1.3 points per item , P = .04 ) . CONCLUSIONS The reduction in dyspnea in those who did not experience a second AE COPD provides preliminary evidence for the role of repeat programs . The application of repeat PR should be refined in larger trials Abstract The evaluation of a 13-month maintenance program ( MP ) for 39 severe COPD patients with FEV1%pred 44(7)% who , as result of two different 8-week leg exercise training ( LET ) programs , one supervised at the hospital ( group S ; n = 20 ) and the other self-monitored ( SM ; n = 19 ) , had achieved different levels of exercise tolerance . After LET , patients in group S had a higher maximal oxygen uptake and endurance time than patients in the SM group [ O2max 1.43(0.30 ) l · min−1 ] vs l.25(0.27 ) l · min−1 and endurance-time 16(4 ) min vs 12 ( 5 ) min , respectively ) . During the MP patients were advised to walk vigorously at least 4 km/day , 4 times/wk . After the MP , while endurance time remained higher than at baseline , it had decreased ( p < 0.01 ) immediately after LET in both groups and no differences were evident between groups ( 11(4 ) min and 10(4 ) , respectively ) . In contrast , Chronic Respiratory Diseases Question naire scores , which had improved significantly after LET in both groups , remained high . Long-term effects of MP were independent of the training strategy or whether physiological improvements had been obtained with the initial LET . SM exercise programs do not seem capable of maintaining physiological improvements in exercise tolerance , though “ quality of life ” can be maintained BACKGROUND Pulmonary rehabilitation programmes improve the health of patients disabled by lung disease but their cost effectiveness is unproved . We undertook a cost/utility analysis in conjunction with a r and omised controlled clinical trial of pulmonary rehabilitation versus st and ard care . METHODS Two hundred patients , mainly with chronic obstructive pulmonary disease , were r and omly assigned to either an 18 visit , 6 week rehabilitation programme or st and ard medical management . The difference between the mean cost of 12 months of care for patients in the rehabilitation and control groups ( incremental cost ) and the difference between the two groups in quality adjusted life years ( QALYs ) gained ( incremental utility ) were determined . The ratio between incremental cost and utility ( incremental cost/utility ratio ) was calculated . RESULTS Each rehabilitation programme for up to 20 patients cost £ 12 120 . The mean incremental cost of adding rehabilitation to st and ard care was £ –152 ( 95 % CI –881 to 577 ) per patient , p = NS . The incremental utility of adding rehabilitation was 0.030 ( 95 % CI 0.002 to 0.058 ) QALYs per patient , p=0.03 . The point estimate of the incremental cost/utility ratio was therefore negative . The bootstrapping technique was used to model the distribution of cost/utility estimates possible from the data . A high likelihood of generating QALYs at negative or relatively low cost was indicated . The probability of the cost per QALY generated being below £ 0 was 0.64 . CONCLUSIONS This outpatient pulmonary rehabilitation programme produces cost per QALY ratios within bounds considered to be cost effective and is likely to result in financial benefits to the health service Follow-up evaluation was conducted of 101 older men and women ( mean age = 67 + /- 5 years ) who had participated in a r and omized study of physiological and psychological effects of aerobic exercise . Eighty-five subjects completed the follow-up evaluation , and almost all of them ( 94 % ) reported continuing with physical activity , as assessed by a self-report measure . Total energy expenditure was calculated as an indicator of exercise maintenance , and energy expenditure at follow-up was predicted from measures of physiological functioning , psychological well-being , and cognitive functioning obtained at the conclusion of the structured exercise program . Greater cardiorespiratory endurance , faster psychomotor speed , and lower anxiety predicted exercise behavior at follow-up , accounting for 13 % of the variance in exercise behavior . Gender was not a significant predictor of exercise behavior 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 ) We examined the feasibility of home-based walking training to maintain the benefits of a short-term exercise training in patients with severe chronic obstructive pulmonary disease ( COPD ) . After initial recovery from an exacerbation , 46 patients were r and omized into a training and a control group , and 30 patients completed the programme ( mean + /- SD FEV1 , 36 + /- 7 % predicted ) . The training group performed a 10-day walking training programme in the hospital , followed by a 6-month programme of supervised walking training at home , integrated into daily activities . The control group did not have exercise training in the hospital or at home . Until 6 months after discharge , lung function , exercise performance and symptom scores were assessed . Six-minute walking distance in the training group improved from day 1 to day 10 ( P<0.001 ) and this effect was maintained over 6 months ( P<0.001 ) . On average , daily walking distance at home was 2308 m and walking was reported on 157 days . Quality of life ( QoL ) scores changed significantly over 6 months ( P<0.001 ) . The control group showed no significant changes in exercise performance or QoL scores throughout the whole study period . Therefore , ( i ) significant improvements in exercise performance and Chronic Respiratory Disease Question naire ( CRQ ) scores could be achieved after recovery from an exacerbation and ( ii ) these improvements were maintained after discharge , when supported by a home-based walking training To date , no international surveys estimating the burden of chronic obstructive pulmonary disease ( COPD ) in the general population have been published . The Confronting COPD International Survey aim ed to quantify morbidity and burden in COPD subjects in 2000 . From a total of 201,921 households screened by r and om-digit dialling in the USA , Canada , France , Italy , Germany , the Netherl and s , Spain and the UK , 3,265 subjects with a diagnosis of COPD , chronic bronchitis or emphysema , or with symptoms of chronic bronchitis , were identified . The mean age of the subjects was 63.3 yrs and 44.2 % were female . Subjects with COPD in North America and Europe appear to underestimate their morbidity , as shown by the high proportion of subjects with limitations to their basic daily life activities , frequent work loss ( 45.3 % of COPD subjects of < 65 yrs reported work loss in the past year ) and frequent use of health services ( 13.8 % of subjects required emergency care in the last year ) , and may be undertreated . There was a significant disparity between subjects ' perception of disease severity and the degree of severity indicated by an objective breathlessness scale . Of those with the most severe breathlessness ( too breathless to leave the house ) , 35.8 % described their condition as mild or moderate , as did 60.3 % of those with the next most severe degree of breathlessness ( breathless after walking a few minutes on level ground ) . This international survey confirmed the great burden to society and high individual morbidity associated with chronic obstructive pulmonary disease in subjects in North America and Europe STUDY OBJECTIVE To determine if distractive auditory stimuli ( DAS ) in the form of music would promote adherence to a walking regimen following completion of a pulmonary rehabilitation program ( PRP ) and , thereby , maintenance of gains achieved during the program . DESIGN Experimental , r and omized , two-group design with testing at baseline , 4 weeks , and 8 weeks . SETTING Outpatient . PATIENTS Twenty-four patients ( 4 men and 20 women ) with moderate-to-severe COPD ( FEV(1 ) 41.3 + /- 13 % predicted [ mean + /- SD ] ) . INTERVENTION Experimental group subjects ( n = 12 ) were instructed to walk at their own pace for 20 to 45 min , two to five times a week , using DAS with a portable audiocassette player . The control group ( n = 12 ) received the same instructions , but no DAS . MEASUREMENTS AND RESULTS Primary outcome measures were perceived dyspnea during activities of daily living ( ADL ) and 6-min walk ( 6MW ) distance . Secondary outcome measures were anxiety , depressive symptoms , health-related quality of life ( QoL ) , global QoL , and breathlessness and fatigue at completion of the 6MW . In addition , all subjects recorded the distance and time walked using self-report ( pedometers and daily logs ) . There was a significant decrease in perceived dyspnea during ADL ( p = 0.0004 ) and a significant increase in 6MW distance ( p = 0.0004 ) over time in the DAS group compared to the control group . DAS subjects increased 6MW distance 445 + /- 264 feet ( mean + /- SD ) from baseline to 8 weeks , whereas control subjects decreased 6MW distance to 169 + /- 154 feet . No significant differences were noted for the remaining variables . The cumulative distance walked by the DAS group was 19.1 + /- 16.7 miles compared to 15.4 + /- 8.0 miles for the control group , a 24 % difference ( p = 0.49 ) . Despite this difference , self-report exercise log data were similar for the two groups . CONCLUSION Subjects who used DAS while walking had improved functional performance and decreased perceptions of dyspnea , whereas control subjects could not maintain post-PRP gains . DAS is a simple , cost-effective strategy that may have the potential to augment the effectiveness of post-PRP maintenance training 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 
    Output:
    