Is physical activity a gateway behavior for diet? Findings from a physical activity trial. What are the most effective behaviour change techniques to promote physical activity and/or reduce sedentary behaviour in inactive adults? A systematic review protocol Physical activity is increased by a 12-week semiautomated telecoaching programme in patients with COPD: a multicentre randomised controlled trial The Effects of Physical Activity on Health and Quality of Life in Adolescent Cancer Survivors: A Systematic Review Movement as Medicine for Type 2 Diabetes: protocol for an open pilot study and external pilot clustered randomised controlled trial to assess acceptability, feasibility and fidelity of a multifaceted behavioural intervention targeting physical activity in primary care A web-based physical activity intervention benefits persons with low self-efficacy in COPD: results from a randomized controlled trial A systematic review of school-based interventions targeting physical activity and sedentary behaviour among older adolescents Effect of a Web-Based Intervention to Promote Physical Activity and Improve Health Among Physically Inactive Adults: A Population-Based Randomized Controlled Trial Impact of feedback on physical activity levels of individuals with chronic obstructive pulmonary disease during pulmonary rehabilitation Benefits and costs of home pedometer assisted physical activity in patients with COPD. A preliminary randomized controlled trial. Physical inactivity is a risk factor for physical activity-related injuries in children One-year Mortality in COPD After an Exacerbation: The Effect of Physical Activity Changes During the Event Intervening to Reduce Sedentary Behaviors and Childhood Obesity among School-Age Youth: A Systematic Review of Randomized Trials Effectiveness of a combined exercise training and home-based walking programme on physical activity compared with standard medical care in moderate COPD: a randomised controlled trial. Chronic obstructive pulmonary disease self-management activation research trial (COPD-SMART): design and methods. Physical activity and adolescents: an exploratory randomized controlled trial investigating the influence of affective and instrumental text messages. Walk2Bactive: A randomised controlled trial of a physical activity-focused behavioural intervention beyond pulmonary rehabilitation in chronic obstructive pulmonary disease. Influence of changes in physical activity on frequency of hospitalization in chronic obstructive pulmonary disease. Perceptions of Patients With Chronic Obstructive Pulmonary Disease and Their Physiotherapists Regarding the Use of an eHealth Intervention Examining the theory‐effectiveness hypothesis: A systematic review of systematic reviews An Internet-Mediated Pedometer-Based Program Improves Health-Related Quality-of-Life Domains and Daily Step Counts in COPD: A Randomized Controlled Trial. The likelihood of improving physical activity after pulmonary rehabilitation is increased in patients with COPD who have better exercise tolerance Female University Students’ Physical Activity Levels and Associated Factors—A Cross-Sectional Study in Southwestern Saudi Arabia
OBJECTIVE While cross-sectional research indicates physical inactivity and poor diet tend to co-occur , there are limited longitudinal data on how interventions targeting one behavior affect other behaviors . The current investigation examined cross-sectional and longitudinal relationships between health behaviors within the context of a physical activity ( PA ) intervention . METHODS Sedentary women ( n=280 ; mean age=47.1 ; 94.6 % Caucasian ) were enrolled in a r and omized controlled PA trial comparing the effects of print-based , individually-tailored and gender-targeted PA interventions to a wellness/control condition . Women completed baseline , month 3 , and month 12 assessment s that included measures of PA and dietary behaviors . RESULTS Participants in more advanced PA stages of change reported significantly greater fruits/vegetables consumption than participants in less advanced stages , although the relationships between diet and minutes of weekly activity were less pronounced . The tailored and targeted print-based PA interventions had no effect on fruit/vegetable intake , although significant reductions in fat intake were observed from baseline ( M=31.24 % ) to month 3 ( M=30.41 % ) , p<0.03 ; and baseline to month 12 ( M=30.36 % ) , p<0.01 . Changes in PA  were not predictive of improvements in eating behaviors . CONCLUSIONS Although fat intake decreased in the context of this PA intervention , fruit/vegetable intake remained unchanged . Also , PA did not serve as a gateway behavior for dietary improvements . In fact , improvements in activity were associated with increases rather than decreases in fat intake Introduction Large proportions of the population are not meeting recommended levels of physical activity and have increasingly sedentary lifestyles . Low levels of physical activity are predictive of poor health outcomes and time spent sedentary is related to a host of risk factors independently of physical activity levels . Building an evidence base of the best approaches to intervene in the lifestyles of inactive individuals is crucial in preventing long-term disease , disability and higher mortality rates . Methods and analysis Systematic search es will be conducted on all relevant data bases ( eg , PubMed , Scopus , CINAHL , PsycINFO ) . Studies will be included if they assess interventions aim ed at changing physical activity or sedentary behaviour levels in adults ( over 18 ) who are inactive and do not suffer from chronic conditions . Studies must also be r and omised controlled trials ( RCTs ) , have a primary outcome of physical activity or sedentary behaviour , and measure outcomes at least 6 months after intervention completion . Studies will be coded using the Behaviour Change Technique ( BCT ) taxonomy v1 and Template for Intervention Description and Replication ( TIDieR ) guidelines . 2 review ers will independently screen full-text articles and extract data on study characteristics , participants , BCTs , intervention features and outcome measures . Study quality will also be assessed independently by 2 review ers using the Cochrane risk of bias tool . A meta- analysis will be considered if there is sufficient homogeneity across outcomes . GRADE criteria will be used to assess quality of evidence . Dissemination This will be the first review to systematic ally appraise interventions aim ed at changing the physical activity or sedentary behaviour of inactive individuals using RCT design s with a 6-month follow-up post-intervention . This review will better inform intervention design ers targeting inactive population s and inform the design of a future complex intervention . Review registration number This protocol was registered with the International Prospect i ve Register of Systematic Review s ( PROSPERO ) on 17 October 2014 ( registration number : CRD42014014321 ) 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 Background There are numerous published controlled trials assessing the safety and the benefits of physical activity ( PA ) for child and adult cancer survivors . However , trials exclusively comprised of adolescent cancer survivors aged 13 - 19 years , who may experience different health and quality of life ( QOL ) effects as a function of their developmental status , are lacking . Rather , some trials have included both adolescent and child cancer survivors together . Objective The aim of this systematic review was to synthesize the findings from r and omized controlled trails ( RCTs ) and controlled clinical trials ( CCTs ) investigating the effects of PA on health and QOL outcomes in sample s comprised of > 50 % adolescent cancer survivors to summarize the current state of evidence , identify knowledge gaps , and highlight areas in need of additional research within this population . Methods Using a search strategy developed for this review , 10 electronic data bases were search ed for RCTs and CCTs that reported on the effects of PA on at least 1 health and /or QOL outcome in sample s comprised of > 50 % adolescent cancer survivors . Results From the 2249 articles identified , 2 CCTs met the predetermined eligibility criteria and were included in this review . Combined , 28 adolescents ( of 41 participants ) who were receiving active treatment participated in the 2 studies review ed . A total of 4 health and QOL outcomes ( ie , bone mass , fatigue , grip strength , QOL ) were assessed pre- and post-PA intervention . Conclusions On the basis of the 2 studies review ed , PA appears to be safe and feasible .  PA also shows promise to mitigate reductions in bone mass and might be a viable strategy to improve fatigue , grip strength , and QOL . High- quality controlled trials with larger sample s exclusively comprised of adolescent cancer survivors that assess a wide range of outcomes are needed to determine the effects of PA on health and QOL outcomes in this population Background Physical activity ( PA ) and nutrition are the cornerstones of diabetes management . Several review s and meta-analyses report that PA independently produces clinical ly important improvements in glucose control in people with Type 2 diabetes . However , it remains unclear what the optimal strategies are to increase PA behaviour in people with Type 2 diabetes in routine primary care . Methods This study will determine whether an evidence -informed multifaceted behaviour change intervention ( Movement as Medicine for Type 2 Diabetes ) targeting both consultation behaviour of primary healthcare professionals and PA behaviour in adults with Type 2 diabetes is both acceptable and feasible in the primary care setting . An open pilot study conducted in two primary care practice s ( phase one ) will assess acceptability , feasibility and fidelity . Ongoing feedback from participating primary healthcare professionals and patients will provide opportunities for systematic adaptation and refinement of the intervention and study procedures . A two-arm parallel group clustered pilot r and omised controlled trial with patients from participating primary care practice s in North East Engl and will assess acceptability , feasibility , and fidelity of the intervention ( versus usual clinical care ) and trial processes over a 12-month period . Consultation behaviour involving fidelity of intervention delivery , diabetes and PA related knowledge , attitudes/beliefs , intentions and self-efficacy for delivering a behaviour change intervention targeting PA behaviour will be assessed in primary healthcare professionals . We will rehearse the collection of outcome data ( with the focus on data yield and quality ) for a future definitive trial , through outcome assessment at baseline , one , six and twelve months . An embedded qualitative process evaluation and treatment fidelity assessment will explore issues around intervention implementation and assess whether intervention components can be reliably and faithfully delivered in routine primary care . Discussion Movement as Medicine for Type 2 Diabetes will address an important gap in the evidence -base , that is , the need for interventions to increase free-living PA behaviour in adults with Type 2 diabetes . The multifaceted intervention incorporates an online accredited training programme for primary healthcare professionals and represents , to the best of our knowledge , the first of its kind in the United Kingdom . This study will establish whether the multifaceted behavioural intervention is acceptable and feasible in routine primary care . Trial registration Movement as Medicine for Type 2 Diabetes ( MaMT2D ) was registered with Current Controlled Trials on the 14th January 2012 : IS RCT N67997502 . The first primary care practice was r and omised on the 5th October 2012 Promoting  physical activity ( PA ) is of top priority in chronic obstructive pulmonary disease ( COPD ) . This study examines the influence of an internet-delivered intervention on the relationship between exercise self-efficacy and changes in PA , physical health , and exercise capacity in COPD . 112 U.S. Veterans with COPD were r and omized to either a comparison ( pedometer alone ) or an intervention group ( pedometer plus access to an internet-mediated PA intervention ) . There was a significant interaction between baseline exercise self-efficacy and r and omization group on change in PA . In the comparison group , there was a significant relationship between higher baseline exercise self-efficacy and greater change in PA , whereas in the intervention group , improvements in PA were independent of level of baseline self-efficacy . Similar patterns were found with physical health and exercise capacity as outcomes . The use of an internet-mediated intervention significantly benefited persons with COPD who had low baseline self-efficacy to increase PA  and  physical health . Clinical trial registration The r and omized clinical trial was registered on Clinical Trials.gov ( NCT01772082 ) ABSTRACT Lack of  physical activity  (  PA  ) and high levels of sedentary behaviour ( SB ) have been associated with health problems . This systematic review evaluates the effectiveness of school-based interventions to increase PA  and decrease SB  among 15–19-year-old adolescents , and examines whether intervention characteristics ( intervention length , delivery mode and intervention provider ) and intervention content ( i.e. behaviour change techniques , BCTs ) are related to intervention effectiveness . A systematic search of r and omised or cluster r and omised controlled trials with outcome measures of PA and /or SB rendered 10 results . Risk of bias was assessed using the Cochrane risk of bias tool . Intervention content was coded using Behaviour Change Technique Taxonomy v1 . Seven out of 10 studies reported significant increases in PA . Effects were generally small and short-term ( Cohen 's d ranged from 0.132 to 0.659 ) . Two out of four studies that measured SB reported significant reductions in SB . Interventions that increased PA  included a higher number of BCTs , specific BCTs ( e.g. , goal setting , action planning and self-monitoring ) , and were delivered by research staff . Intervention length and mode of delivery were unrelated to effectiveness . More studies are needed that evaluate long-term intervention effectiveness and target SBs among older adolescents Background Many people in Western countries do not follow public health physical activity ( PA ) recommendations . Web-based interventions provide cost- and time-efficient means of delivering individually targeted lifestyle modification at a population level . Objective To examine whether access to a website with individually tailored feedback and suggestions on how to increase PA led to improved PA , anthropometrics , and health measurements . Methods Physically inactive adults ( n = 12,287 ) participating in a nationwide eHealth survey and health examination in Denmark were r and omly assigned to either an intervention ( website ) ( n = 6055 ) or a no-intervention control group ( n = 6232 ) in 2008 . The intervention website was founded on the theories of stages of change and of planned behavior and , apart from a forum page where a physiotherapist answered questions about PA and training , was fully automated . After 3 and again after 6 months we emailed participants invitations to answer a Web-based follow-up question naire , which included the long version of the International Physical Activity Question naire . A subgroup of participants ( n = 1190 ) were invited to a follow-up health examination at 3 months . Results Less than 22.0 % ( 694/3156 ) of the participants logged on to the website once and only 7.0 % ( 222/3159 ) logged on frequently . We found no difference in PA level between the website and control groups at 3- and 6-month follow-ups . By dividing participants into three groups according to use of the intervention website , we found a significant difference in total and leisure-time PA in the website group . The follow-up health examination showed no significant reductions in body mass index , waist circumference , body fat percentage , and blood pressure , or improvements in arm strength and aerobic fitness in the website group . Conclusions Based on our findings , we suggest that active users of a Web-based PA intervention can improve their level of PA . However , for unmotivated users , single-tailored feedback may be too brief . Future research should focus on developing more sophisticated interventions with the potential to reach both motivated and unmotivated sedentary individuals . Trial Registration Clinical trials.gov NCT01295203 ; http:// clinical trials.gov/ct2/show/NCT01295203 ( Archived by WebCite at http://www.webcitation.org/6B7HDMqiQ This study aim ed at investigating whether providing feedback on physical activity ( PA ) levels to patients with chronic obstructive pulmonary disease ( COPD ) is feasible and enhances daily PA during pulmonary rehabilitation ( PR ) . Patients with COPD participated in a 12-week PR program  . Daily PA was measured using activity monitors on weeks 1 , 7 , and 12 , and feedback was given in the following weeks on the number of steps , time spent in sedentary , light , and moderate-to-vigorous intensity activities , and time spent st and ing , sitting , and lying . Compliance with PA monitoring was collected . Two focus groups were conducted to obtain patients ’ perspectives on the use of activity monitors and on the feedback given . Differences in PA data were also assessed . Sixteen patients ( 65.63 ± 10.57 years ; forced expiratory volume in one second ( FEV1 ) 70.31 ± 22.74 % predicted ) completed the study . From those , only eleven participants used the activity monitors during all monitoring days . Participants identified several problems regarding the use of activity monitors and monitoring duration . Daily steps ( p = 0.026 ) and st and ing time ( p = 0.030 ) were improved from week 1 to week 7 ; however , the former declined from week 7 to week 12 . Findings suggest that using feedback to improve PA during PR is feasible and results in improved daily steps and st and ing time on week 7 . The subsequent decline suggests that additional strategies may be needed to stimulate/maintain PA improvements . Further research with more robust design s is needed to investigate the impact of feedback on patients ’ daily PA BACKGROUND AND OBJECTIVE There are barriers to providing pulmonary rehabilitation for chronic obstructive pulmonary disease ( COPD ) such as the high number of patients , difficult access to health facilities and high costs of programs . Pedometers can monitor and improve  physical activity ( PA ) . The aim of this study was to evaluate benefits and costs of home pedometer assisted PA , as compared to a st and ard outpatient supervised exercise training program in patients with COPD . METHODS Patients were r and omly assigned either to home pedometer assisted PA ( Group 1 ) , or to a six-week outpatient st and ard supervised exercise training program ( Group 2 ) . Patients of Group 1 had to walk at home for 6 weeks , at least 30min daily at the fastest step pace as possible , to achieve a weekly 10 % increase in their average daily steps up to more than 6500 . Pre and post programs we assessed : the six minute walking distance ( 6MWT : primary outcome ) , daily steps count , the Medical Research Council scale ( MRC ) , the COPD assessment test score , and the BODE index ( body-mass index , airflow obstruction , dyspnea , exercise capacity ) . Costs of programs were also evaluated . RESULTS Out of 40 patients , 18 in both groups ( mean ( st and ard deviation ) ) age : 68.3 ( 6.7 ) and 61.2 ( 6.7 ) years ; FEV1 : 1.1 ( 0.5 ) and 0.9 ( 0.4 ) liters in Group 1 and 2 respectively completed the study . At the end of the program 44.5 % patients of Group 1 had reached the target daily steps , in 26.6 ( 9.5 ) days . Following the programs , both groups showed significant improvements in all outcome measures , except BODE . The home program was cheaper ( p=0.0001 ) , with a mean 76.3 euros saving per patient . CONCLUSION Home pedometer assisted PA may be a useful and cheaper alternative to outpatient supervised exercise training programs in patients with COPD Objectives To describe the risk factors associated with injuries result ing from physical education ( PE ) , leisure time physical activity ( leisure time PA ) and sports in 9–12-year-old children . Design Prospect i ve cohort study . Setting Primary schools . Participants Nine hundred and ninety-five children aged 9–12 years . Main outcome measures Injuries occurring during either PE class  , leisure time PA or sports , and caused the child to at least stop the current activity were recorded prospect ively . Individual weekly exposure was estimated from baseline and follow-up question naires . Potential risk factors were gender , age , socioeconomic status , ethnicity , habitual level of PA , body mass index and a motor fitness . A multivariate Cox proportional hazard regression model was developed , accounting for clustering within schools . Results Gender , age and level of PA were independent significant risk factors for injury . Different modalities of PA had different injury risk factors . Most importantly , the low levels of habitual PA  significantly increased injury risk . Conclusions The children at highest injury risk are the target audience of the contemporary PA promotion efforts . PA promotion should also focus on injury prevention ABSTRACT Mortality is one of the most important outcomes in patients with chronic obstructive pulmonary disease ( COPD ) . Different predictors have been associated with mortality , including the patient 's level of physical activity ( PA ) . The objective of this work was to establish the relationship between changes in PA during a moderate-to-severe COPD exacerbation ( e COPD ) and 1-year mortality after the index event . This was a prospect i ve observational cohort study with recruitment of 2,484 patients with an e COPD attending the emergency department ( ED ) of 16 participating hospitals . Variables recorded included clinical and sociodemographic data from medical records , dyspnea , health-related quality of life , and PA  before the index e COPD and 2 months after the hospital or ED discharge , as reported by the patient . In the multivariate analysis worsening changes in PA from baseline to 2 months after the ED index visit [ odds ratio ( ORs ) from 2.78 to 6.31 ] was related to 1-year mortality , using the age-adjusted Charlson comorbidity index ( OR : 1.22 ) , and previous use of long-term domiciliary oxygen therapy or non-invasive mechanical ventilation at home ( OR : 1.68 ) . The same variables were also predictive in the validation sample . Areas under the receiver operating characteristic curve in the derivation and validation sample were 0.79 and 0.78 , respectively . In conclusion , PA is the strongest predictor of dying in the following year , i.e. , those with worsened PA from baseline to 2 months after an e COPD or with very low PA levels have a higher risk Objective . To assess the effectiveness of interventions that focus on reducing  sedentary behavior ( SB ) among school-age youth and to identify elements associated with interventions ' potential for translation into practice setting s. Methods . A comprehensive literature search was conducted using 4 data bases for peer- review ed studies published between 1980 and April 2011 . R and omized trials , which lasted at least 12 weeks , aim ed at decreasing  SB among children aged 6 to 19 years were identified . Results . Twelve studies were included ; 3 focused only on SB , 1 focused on  physical activity ( PA )  , 6 were combined SB and PA interventions , and 2 studies targeted SB , PA , and diet .  The majority of the studies were conducted in a school setting , while others were conducted in such setting s as clinics , community centers , and libraries . Conclusions . Overall , interventions that focused on decreasing SB were associated with reduction in time spent on SB and /or improvements in anthropometric measurements related to childhood obesity . Several of the studies did consider elements related to the intervention 's potential for translation into practice setting OBJECTIVE To estimate the effectiveness of a 10-week combined exercise training and home-based walking programme on daily physical activity ( PA ) compared with st and ard medical care in patients with moderate chronic obstructive pulmonary disease ( COPD ) . DESIGN R and omised controlled trial . SETTING Primary care physiotherapy . PARTICIPANTS Consecutive patients with stable COPD at Gold Stage II with a score of two or more on the Medical Research Council Dyspnoea Scale . INTERVENTION Ten-week combined exercise training and home-based walking programme compared with st and ard medical care . MAIN OUTCOMES At baseline and after 10 weeks , daily PA was evaluated by accelerometry using three levels of intensity and expressed as metabolic equivalent of task . In addition , daily activities ( Physical Activity Scale for the Elderly ) , functional exercise capacity ( 6-minute Walk Test ) , health-related quality of life ( Chronic Respiratory Question naire ) and exercise self-efficacy ( Exercise Self-Regulatory Efficacy Scale ) were measured . RESULTS Fifty-two patients { 34 females ; mean age 70.2 [ st and ard deviation ( SD ) 9.5 ] years ; mean forced expiratory volume in 1second 67 % ( SD 9.2 ) of predicted } were r and omised .  PA , adjusted for baseline differences , increased significantly in the intervention group compared with the control group , by 26.1minutes/day [ 95 % confidence interval ( CI ) 7.3 to 44.9 ] . The increase in functional capacity between groups was clinical ly relevant ( 34.0 m , 95 % CI 2.3 to 65.6 ) in favour of the intervention group . CONCLUSIONS A combined exercise training and home-based walking programme in primary care physiotherapy improved PA in patients with moderate COPD . Clinical trial registration number NL24766.018.08 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 OBJECTIVE The present study attempts to develop and pilot the feasibility and efficacy of a novel intervention using affective messages as a strategy to increase  physical activity ( PA ) levels in adolescents . Design An exploratory pilot r and omized control trial was used to compare behaviour change over 2 weeks . A modified form of the International Physical Activity Question naire was used to assess PA behaviour . A total of 120 adolescents ( 16 - 19 years ) from 4 sixth forms in West Yorkshire completed the field-based study . METHOD Participants were r and omly assigned to one of three experimental conditions , or the control condition ( N=28 ) . Participants in experimental conditions received 1 short messaging service ( SMS ) text message per day over the 2 weeks , which included manipulations of either affective beliefs ( enjoyable/unenjoyable ; N=31 ) , instrumental beliefs ( beneficial/harmful ; N=30 ) , or a combination of these ( N=31 ) . Control participants received one SMS text message per week . Outcomes were measured at baseline and at the end of the 2 week intervention . RESULTS PA levels increased by the equivalent of 31.5 minutes of moderate ( four metabolic equivalent ) activity per week during the study . Main effects of condition ( p=.049 ) , and current physical activity level ( p=.002 ) were identified , along with a significant interaction between condition and current activity level ( p=.006 ) . However , when the sample was split at baseline into active and inactive participants , a main effect of condition remained for inactive participants only ( p=.001 ) . Post hoc analysis revealed that inactive participants who received messages targeting affective beliefs increased their activity levels significantly more than the instrumental ( p=.012 ) , combined ( p=.002 ) , and control groups ( p=.018 ) . CONCLUSION Strategies based on affective associations may be more effective for increasing PA levels in inactive individuals The aim of this study was to investigate the impact of a physical activity (PA)-focused behavioural intervention during and after  pulmonary rehabilitation ( PR ) on PA levels ( primary aim ) , health-related outcomes and self-efficacy ( secondary aims ) of patients with COPD . Thirty-two patients were r and omly assigned to an experimental group ( EG ) or control group ( CG ) . The EG received a PA-focused behavioural intervention during PR ( 3 months ) and follow-up support ( 3 months ) . The CG received PR ( 3 months ) . Daily PA was collected : number of steps ; time spent in moderate-to-vigorous PA ( MVPA ) , total PA and sedentary activities ( SA ) . Secondary outcomes comprised exercise capacity , muscle strength , health-related quality of life ( HRQOL ) and self-efficacy . Measures were collected at baseline , 3 and 6 months . Compared with the CG , the EG improved the number of steps ( p = 0.006 ) and time spent in MVPA ( p = 0.007 ) , total PA ( p = 0.014 ) and SA ( p = 0.018 ) at 3 months . Differences were maintained after follow-up support ( 0.025 ≤ p ≤ 0.040 ) , except for SA ( p = 0.781 ) . Exercise capacity , muscle strength and HRQOL were increased at 3 and 6 months ( p ≤ 0.002 ) with no between-group differences ( 0.148 ≤ p ≤ 0.987 ) . No changes were observed in self-efficacy ( p = 0.899 ) . A PA-focused behavioural intervention during and after PR may improve patients ' PA levels . Further research is warranted to assess the sustainability of the findings BACKGROUND AND OBJECTIVE To evaluate whether changes in regular physical activity ( PA ) in patients with chronic obstructive pulmonary disease ( COPD ) affect the rate of hospitalizations for COPD exacerbation ( e COPD ) . METHODS Five hundred forty-three ambulatory clinic patients being treated for COPD were prospect ively identified . PA was self-reported by patients , and the level was established by the distance they walked ( km/day ) at least 3 days per week . Hospitalizations were recorded from hospital data bases . All patients with at least a 2-year follow-up after enrollment were included in the analysis . The response variable was the number of hospitalizations for e COPD within the 3-year period from 2 to 5 years after study enrollment . RESULTS Three hundred ninety-one survivors were studied . Mean forced expiratory volume in 1 s was 52 % ( ±14 % ) of the predicted value . Patients who maintained a lower level of PA had an increased rate of hospitalization ( odds ratio 1.901 ; 95 % confidence interval 1.090 - 3.317 ) . After having had the highest level of PA , those patients who decreased their PA in the follow-up showed an increasing rate of hospitalizations ( odds ratio 2.134 ; 95 % confidence interval 1.146 - 3.977 ) . CONCLUSIONS Patients with COPD with a low level of PA or who reduced their PA over time were more likely to experience a significant increase in the rate of hospitalization for e COPD . Changes to a higher level of PA or maintaining a moderate or high level of PA over time , with a low intensity activity such as walking for at least 3 - 6 km/day , could reduce the rate of hospitalizations for e COPD Background If eHealth interventions are not used ( properly ) , their potential benefits can not be fulfilled . User perceptions of eHealth are an important determinant of its successful implementation . This study examined how patients with chronic obstructive pulmonary disease ( COPD ) and their physiotherapists ( PHTs ) value an eHealth self-management intervention following a period of use . Objective The study aim ed to evaluate the perceptions of COPD patients and their PHTs as eHealth users . Methods In this study , an eHealth self-management intervention ( website and mobile phone app ) aim ed at stimulating physical activity ( PA ) in COPD patients was evaluated by its users ( patients and PHTs ) . As participants in a r and omized controlled trial ( RCT ) , they were asked how they valued the eHealth intervention after 6 months ’ use . Interview requests were made to 33 PHTs from 26 participating practice s , and a question naire was sent to 76 patients . The question naire was analyzed in Excel ( Microsoft ) . The interviews with the PHTs and text messages ( short message service , SMS ) sent between patients and PHTs were transcribed and independently coded in MAXQDA 10 for Windows ( VERBI GmbH ) . Results A total of 60 patients with COPD filled out the question naire , and 24 PHTs were interviewed . The mobile phone app was used 89.0 % ( 160.2/180 days ) ( st and ard deviation [ SD ] 18.5 ) of the time by patients ; 53 % ( 13/24 ) of PHTs reported low or no use . Patients scored the ease of use of the app 5.09 ( SD 1.14 ) ( on a 7-point scale ) . They found the presentation of the PA information in the app to be clear , insightful , and stimulating . All PHTs judged the website as explicit and user-friendly but had trouble devising a new PA goal for their patients . Patients mostly sent informative , neutral messages concerning the PA goal , and PHTs sent mostly motivating , positive messages concerning the PA goal . Messages were not perceived as supportive in reaching the PA goal according to the patients . Perceived usefulness of the intervention for the PHTs was the objective measurement of PA , the ability to see PA patterns over time , and the ability to use the intervention as a tool to give their patients insight into their PA . For patients , it was that the intervention supported them in increasing their PA and that it made them feel fitter . Barriers to use of the intervention according to the PHTs were time constraints and financial reasons . Seventy-nine percent ( 19/24 ) of the PHTs and 58 % ( 35/60 ) of the patients mentioned they would be interested in using the intervention in the future . Conclusions PHTs and COPD patients had positive feelings regarding the functionality and potential of the eHealth self-management intervention . This paper addresses a number of topics that may aid in the successful development and implementation of these types of eHealth interventions in the future PURPOSE Health interventions based on theory may be more effective than those that are not . This review of review s synthesizes all published r and omized controlled trial ( RCT ) meta-analytic evidence from the last decade to examine whether theory-based interventions were found to be associated with more effective  adult health behaviour change interventions . METHODS Systematic review s including meta-analyses were identified by search ing Medline , CINAHL , PsycINFO , and CDSR . A narrative synthesis was used to summarize and analyse the evidence . Only review s including RCTs of health behaviour change interventions with adults aged 18 + published from 2007 to 2017 were included . RESULTS Of 8,659 articles , nine systematic review s met inclusion criteria . The majority of review s ( n = 8) suggested no increased effectiveness for theory-based compared to non-theory-based interventions for effectiveness of outcomes relating to health behaviour . Less than half of the RCTs included in the review s reported the use of theory ( 85/183 ) . Two review s suggested interventions based on control theory , motivational interviewing , or self-determination theory were associated with greater effectiveness for physical activity and /or dietary interventions and outcomes . Method ological and reporting issues limit the conclusions . CONCLUSIONS Theory-based interventions as currently operationalized in systematic review s were not found to be more effective than non-theory-based interventions . Method ological and reporting issues at study and review level may not reflect the true utility of theory use within health behaviour interventions . The promotion of theory use may benefit from using a multifaceted argument , rather than a narrow focus of increased effectiveness . Statement of contribution What is already known on this subject ? Theory use is regularly promoted by cl aim ing that it will lead to more effective behaviour change interventions . Theory use has been frequently linked to effectiveness within systematic review s of behaviour change interventions . The theory-effectiveness hypothesis has not been systematic ally examined at the systematic review level . What does this study add ? Theory use as operationalized by systematic review authors was not associated with increased effectiveness within systematic review s examining r and omized controlled trials of behaviour change interventions in adults . Interventions based on control theory , motivational interviewing , or self-determination theory were associated with greater effectiveness for physical activity and /or dietary interventions and outcomes . Theory use should be promoted using a multifaceted argument , and assertions for increased effectiveness of theory-based interventions should only be used in domains where specific evidence exists to support this cl aim BACKGROUND Low levels of physical activity ( PA ) are associated with poor outcomes in people with COPD . Interventions to increase PA could improve outcomes . METHODS We tested the efficacy of a novel Internet-mediated , pedometer-based exercise intervention .  Veterans with COPD ( N = 239 ) were r and omized in a 2:1 ratio to the ( 1 ) intervention group ( Omron HJ-720 ITC pedometer and Internet-mediated program ) or ( 2 ) wait-list control group ( pedometer ) . The primary outcome was health-related quality of life ( HRQL ) , assessed by the St. George 's Respiratory Question naire ( SGRQ ) , at 4 months . We examined the SGRQ total score ( SGRQ-TS ) and three domain scores : Symptoms , Activities , and Impact . The secondary outcome was daily step counts . Linear regression models assessed the effect of intervention on outcomes . RESULTS Participants had a mean age of 67 ± 9 years , and 94 % were men . There was no significant between-group difference in mean 4-month SGRQ-TS ( 2.3 units , P = .14 ) . Nevertheless , a significantly greater proportion of intervention participants than control subjects had at least a 4-unit improvement in SGRQ-TS , the minimum clinical ly important difference ( 53 % vs 39 % , respectively , P = .05 ) . For domain scores , the intervention group had a lower ( reflecting better HRQL ) mean than the control group by 4.6 units for Symptoms ( P = .046 ) and by 3.3 units for Impact ( P = .049 ) . There was no significant difference in Activities score between the two groups . Compared with the control subjects , intervention participants walked 779 more steps per day at 4 months ( P = .005 ) . CONCLUSIONS An Internet-mediated , pedometer-based walking program can improve domains of HRQL and daily step counts at 4 months in people with COPD . TRIAL REGISTRY Clinical Trials.gov ; No. : NCT01102777 ; URL : www . clinical trials.gov Purpose Pulmonary rehabilitation ( PR ) enhances exercise tolerance in patients with COPD ; however , improvements in physical activity ( PA ) are not guaranteed . This study explored the relationship between baseline exercise tolerance and changes in PA after PR . Material s and methods Patient data from prospect i ve clinical trials in the PR setting s of Athens and Leuven ( 2008–2016 ) were analyzed . Vali date d PA monitors were worn for 1 week before and after a 12-week program . The proportion of patients who improved PA levels ≥1,000 steps/day ( “ PA responders ” ) after PR was compared between those with initial 6-minute walk distance [ 6MWDi ] < 350 m and ≥350 m. Baseline predictors of PA change were evaluated via univariate and multivariate logistic regression analyses . Results Two hundred thirty-six patients with COPD ( median [ IQR ] FEV1 44 [ 33–59 ] % predicted , age 65±8 years , 6MWDi 416 [ 332–486 ] m ) were included .  The proportion of “ PA responders ” after PR was significantly greater in those with higher vs lower 6MWDi ( 37.9 % vs 16.4 % , respectively ; P<0.001 ) . 6MWDi group classification was the strongest baseline independent predictor of PA improvement ( univariate OR 3.10 , 95 % CI 1.51–6.36 ) . Conclusion The likelihood of improving PA after PR is increased with greater 6MWDi . Baseline exercise tolerance appears as an important stratification metric for future research in this field Background : The high prevalence of physical inactivity in Saudi Arabia is a growing challenge to public health . This study aim ed to examine the prevalence of  physical activity ( PA ) and associated factors among female university students . Methods : This cross-sectional study involved 663 r and omly selected female university students who completed the Arab Teens Life Style question naire . Data included measurements of anthropometric , socioeconomic and environmental factors , as well as  self-reported PA .  Ordinal regression was used to identify associated factors with low , moderate and high PA levels . Results : The mean age of participants was 20.4 years ( SD 1.5 ) .  Mean BMI of the students in relation to PA were 23.0 , 22.9 , 22.1 for high , moderate and low levels of activity , respectively . The analysis revealed significantly higher PA levels among married students , those with high educated mothers , and those who lived far from parks , and lower activity levels among underweight students . Conclusions : This study raises four important determinants for female university students ’  PA levels . These factors could be of great importance in the endeavor to prevent the health-threatening increase in physical inactivity patterns and thus non-communicable diseases and obesity where the focus should be on the specific situation and needs of women in Saudi Arabia
Interventions that included ET and PA counseling during PR were effective strategies to improve PA in COPD
BACKGROUND Physical inactivity is associated with poor outcomes in COPD , and as a result , interventions to improve physical activity ( PA ) are a current research focus .
However , many trials have been small and inconclusive .
OBJECTIVE The aim of this systematic review and meta- analysis was to study the effects of r and omized controlled trials ( RCTs ) targeting PA in COPD .