title: Designing trials of behavioral interventions to increase physical activity in patients with COPD: insights from the chronic disease literature.
abstract: OBJECTIVE
  There is increasing evidence that physical activity (PA) can affect health outcomes, particularly in chronic disease. While pharmacologic therapy and exercise training can improve exercise capacity, increasing PA requires behavior change. This review examined clinical trials testing the effectiveness of behavioral interventions to increase PA in adults with chronic disease to inform future research in COPD.
  
  
  METHODS
  Embase and PubMed searches of studies published in English, 1995-2011.
  
  
  METHODS
  Adults ≥ 45 years; COPD, diabetes, heart failure, obesity; exercise or PA endpoint; behavioral intervention described in sufficient detail to permit interpretation.
  
  
  RESULTS
  932 abstracts screened; 169 articles retrieved; 36 reviewed. Most were randomized trials (n = 32, 89%); 2 arms (n = 26, 72%), sample sizes 40-100 (n = 15, 42%); recruitment through clinical settings (n = 28, 78%); disease severity as primary eligibility criterion (n = 23, 64%); mean duration: 10 months (range: 1-84). Exercise intervention: aerobic activity, 30-60 min (n = 20, 56%), 3-5 times/week (n = 20, 56%). Behavioral intervention: Counseling (n = 19, 53%) with personal follow-up (n = 12, 33%).
  
  
  METHODS
  Exercise without behavioral intervention (n = 14, 39%) or usual care (n = 15, 42%). Significant effects were reported in 15 of 25 (60%) studies testing exercise capacity (6-minute walk, cycle, treadmill), 19 of 26 (73%) testing PA (pedometer, activity log, questionnaire), 11 of 22 (50%) measuring quality of life, and 8 of 13 (62%) capturing behavioral endpoints.
  
  
  CONCLUSIONS
  This review provides insight into the range of designs, interventions, and outcome measures used in studies testing methods to improve PA in chronic disease with implications for designing trials in COPD.
authors: Evidera, 7101 Wisconsin Ave, Suite 600, Bethesda, MD 20814, USA. Electronic address: nancy.leidy@evidera.com.
authors: Nancy Kline
authors: NK
authors: Leidy
authors: Evidera, 7101 Wisconsin Ave, Suite 600, Bethesda, MD 20814, USA.
authors: Miriam
authors: M
authors: Kimel
authors: Evidera, 7101 Wisconsin Ave, Suite 600, Bethesda, MD 20814, USA.
authors: Loni
authors: L
authors: Ajagbe
authors: Evidera, 7101 Wisconsin Ave, Suite 600, Bethesda, MD 20814, USA.
authors: Katherine
authors: K
authors: Kim
authors: Boehringer Ingelheim (Canada) Ltd., 5180 S Service Rd, Burlington, ON L7L 5H4, Canada.
authors: Alan
authors: A
authors: Hamilton
authors: Boehringer Ingelheim GmbH, Binger Str. 173, Ingelheim D-55216, Germany.
authors: Karin
authors: K
authors: Becker
mesh_terms: D002908:Chronic Disease; D015444:Exercise; D005081:Exercise Therapy / Q000379:methods*; D015438:Health Behavior; D006801:Humans; D009043:Motor Activity; D029424:Pulmonary Disease, Chronic Obstructive / Q000534:rehabilitation*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
keywords: Activity outcomes; Behavioral interventions; COPD; Literature review; Physical activity; Trial design