title: Exercise training alone or with the addition of activity counseling improves physical activity levels in COPD: a systematic review and meta-analysis of randomized controlled trials.
abstract: 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 randomized controlled trials (RCTs) targeting PA in COPD.
  
  
  METHODS
  Databases (Physiotherapy Evidence Database [PEDro], Embase, MEDLINE, CINAHL and the Cochrane Central Register for Controlled Trials) were searched using the following keywords: "COPD", "intervention" and "physical activity" from inception to May 20, 2016; published RCTs that aimed to increase PA in individuals with COPD were included. The PEDro scale was used to rate study quality. Standardized mean differences (effect sizes, ESs) with 95% confidence intervals (CIs) were determined. Effects of included interventions were also measured according to the minimal important difference (MID) in daily steps for COPD (599 daily steps).
  
  
  RESULTS
  A total of 37 RCTs with 4,314 participants (mean forced expiratory volume in one second (FEV1) % predicted 50.5 [SD=10.4]) were identified. Interventions including exercise training (ET; n=3 studies, 103 participants) significantly increased PA levels in COPD compared to standard care (ES [95% CI]; 0.84 [0.44-1.25]). The addition of activity counseling to pulmonary rehabilitation (PR; n=4 studies, 140 participants) showed important effects on PA levels compared to PR alone (0.47 [0.02-0.92]), achieving significant increases that exceeded the MID for daily steps in COPD (mean difference [95% CI], 1,452 daily steps [549-2,356]). Reporting of methodological quality was poor in most included RCTs.
  
  
  CONCLUSIONS
  Interventions that included ET and PA counseling during PR were effective strategies to improve PA in COPD.
authors.affiliation: Discipline of Physiotherapy, La Trobe University; Institute for Breathing and Sleep.
authors.forename: Aroub
authors.initials: A
authors.lastname: Lahham
authors.affiliation: Institute for Breathing and Sleep; Department of Respiratory and Sleep Medicine, Austin Health; Department of Medicine, The University of Melbourne.
authors.forename: Christine F
authors.initials: CF
authors.lastname: McDonald
authors.affiliation: Discipline of Physiotherapy, La Trobe University; Institute for Breathing and Sleep; Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia.
authors.forename: Anne E
authors.initials: AE
authors.lastname: Holland
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003376:Counseling / Q000379:methods*; D015444:Exercise; D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance; D005260:Female; D005541:Forced Expiratory Volume; D006304:Health Status; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
keywords: chronic obstructive; interventions; physical activity; pulmonary disease