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. 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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 Development of a computer-tailored physical activity intervention for prostate and colorectal cancer patients and survivors: OncoActive Randomized controlled trial testing an internet physical activity intervention for sedentary adults. Improving the recruitment activity of clinicians in randomised controlled trials: a systematic review Physical activity for the prevention and treatment of major chronic disease: an overview of systematic reviews Short- and long-term effects of a physical activity counselling programme in COPD: a randomized controlled trial. Using the Internet to promote physical activity: a randomized trial of intervention delivery modes. Correlates of preschool children’s objectively measured physical activity and sedentary behavior: a cross-sectional analysis of the SPLASHY study Intervention-mediated effects for adult physical activity: A latent growth curve analysis. Active Living: development and quasi-experimental evaluation of a school-centered physical activity intervention for primary school children Effects of a Web-Based Personalized Intervention on Physical Activity in European Adults: A Randomized Controlled Trial Impact of an educational intervention on internal medicine residents' physical activity counselling: the Pressure System Model. Effectiveness of chronic obstructive pulmonary disease self-management interventions in primary care settings: a systematic review. Effects of ground-based walking training on daily physical activity in people with COPD: A randomised controlled trial. Efficacy of an mHealth intervention to stimulate physical activity in COPD patients after pulmonary rehabilitation Is intensive counseling in maternity care feasible and effective in promoting physical activity among women at risk for gestational diabetes? Secondary analysis of a cluster randomized NELLI study in Finland Targeting motivation and self-regulation to increase physical activity among patients with rheumatoid arthritis: a randomised controlled trial Effects of workplace-based dietary and/or physical activity interventions for weight management targeting healthcare professionals: a systematic review of randomised controlled trials A written self-help intervention for depressed adults comparing behavioural activation combined with physical activity promotion with a self-help intervention based upon behavioural activation alone: study protocol for a parallel group pilot randomised controlled trial (BAcPAc) The physical activity counselling (PAC) randomized controlled trial: rationale, methods, and interventions. Effect of a prenatal lifestyle intervention on physical activity level in late pregnancy and the first year postpartum Enhancing exercise tolerance and physical activity in COPD with combined pharmacological and non-pharmacological interventions: PHYSACTO randomised, placebo-controlled study design Feasibility of a telephone and web-based physical activity intervention for women shift workers Poor Reliability between Cochrane Reviewers and Blinded External Reviewers When Applying the Cochrane Risk of Bias Tool in Physical Therapy Trials
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 Background Cancer and cancer treatment coincide with substantial negative physical , psychological and psychosocial problems .  Physical activity ( PA ) can positively affect the negative effects of cancer and cancer treatment and thereby increase quality of life in CPS . Nevertheless , only a minority of CPS meet PA guidelines . We developed the OncoActive ( OncoActief in Dutch ) intervention : a computer-tailored PA program to stimulate PA  in prostate and colorectal CPS , because to our knowledge there are only a few PA interventions for these specific cancer types in the Netherl and s Methods The OncoActive intervention was developed through systematic adaptation of a proven effective , evidence -based , computer-tailored PA  intervention for adults over fifty , called Active Plus . The Intervention Mapping ( IM ) protocol was used to guide the systematic adaptation . A literature study and interviews with prostate and colorectal CPS and health care professionals revealed that both general and cancer-specific PA determinants are important and should be addressed . Change objectives , theoretical methods and applications and the actual program content were adapted to address the specific needs , beliefs and cancer-related issues of prostate and colorectal CPS . Intervention participants  received tailored PA advice three times , on internet and with printed material s , and a pedometer to set goals to improve PA .  Pre- and pilot tests showed that the intervention was highly appreciated ( target group ) and regarded safe and feasible ( healthcare professionals ) . The effectiveness of the intervention is being evaluated in a r and omized controlled trial ( RCT ) ( n = 428 ) , consisting of an intervention group and a usual care waiting-list control group , with follow-up measurements at three , six and twelve months . Participants are recruited from seventeen hospitals and with posters , flyers and calls in several media . Discussion Using the Intervention Mapping protocol result ed in a systematic ally adapted , theory and evidence -based intervention providing tailored PA advice to prostate and colorectal CPS . If the intervention turns out to be effective in increasing PA , as evaluated in a RCT , possibilities for nationwide implementation and extension to other cancer types will be explored . Trial registration The study is registered in the Dutch Trial Register ( NTR4296 ) on November 23rd 2013 and can be accessed at http://www.trialregister.nl/trialreg/admin/ rct view.asp?TC=4296 OBJECTIVE Internet-based physical activity ( PA ) interventions have shown promise , although findings remain equivocal . We used formative research to enhance a previously demonstrated program ( Step into Motion ) with the goal of developing an Internet program poised for dissemination . METHODS We conducted focus groups to identify Internet features targeted to theoretical constructs ( social cognitive theory ) predictive of PA behavior and rated as " useful for increasing PA . " We identified 5 theory-targeted Internet features as useful for increasing PA : ( 1 ) a PA tracking/logging calendar targeting self-monitoring and goal setting ; ( 2 ) geographic mapping tools targeting perceived environment ; ( 3 ) a discussion forum targeting social support ; ( 4 ) exercise videos targeting observational learning ; and ( 5 ) regular up date s of peer PA progress targeting situation . We then tested the efficacy of the enhanced program ( enhanced Internet , EI ; N = 25 ) in relation to publicly available PA Websites ( st and ard Internet , SI ; N = 28 ) among 53 participants in a r and omized controlled trial . RESULTS The EI arm increased PA in relation to the SI arm at 3 months ( 18.4 to 186.0 min/wk vs. 20.9 to 57.3 min/wk ; p = .03 ) but between-groups differences were not observed at 6 months ( 176.8 vs. 133.5 min/wk ; p = .44 ) . EI participants maintained PA from 3 to 6 months ( 186.0 to 176.8 min/wk ) , and the SI group increased PA ( 57.3 to 133.5 min/wk ) . CONCLUSION The EI program was efficacious at improving PA levels in relation to publicly available Websites initially , but differences in PA levels were not maintained at 6 months . Future research should identify Internet features that promote long-term maintenance Background Poor recruitment to r and omised controlled trials ( RCTs ) is a widespread problem . Provision of interventions aim ed at supporting or incentivising clinicians may improve recruitment to RCTs . Objectives To quantify the effects of strategies aim ed at improving the recruitment activity of clinicians in RCTs , complemented with a synthesis of qualitative evidence related to clinicians ' attitudes towards recruiting to RCTs . Data sources A systematic review of English and non-English articles identified from : The Cochrane Library , Ovid MEDLINE , Ovid EMBASE , Ovid PsycINFO , Ebsco CINAHL , Index to Theses and Open SIGLE from 2001 to March 2011 . Additional reports were identified through citation search es of included articles . Study eligibility criteria Quantitative studies were included if they evaluated interventions aim ed at improving the recruitment activity of clinicians or compared recruitment by different groups of clinicians . Information about host trial , study design , participants , interventions , outcomes and host RCT was extracted by one research er and checked by another . Studies that met the inclusion criteria were assessed for quality using a st and ardised tool , the Effective Public Health Practice Project tool . Qualitative studies were included if they investigated clinicians ' attitudes to recruiting patients to RCTs . All results / findings were extracted , and content analysis was carried out . Overarching themes were abstract ed , followed by a meta summary analysis . Studies that met the inclusion criteria were assessed for quality using the Critical Appraisal Skills Programme qualitative checklist . Data extraction Data extraction was carried out by one research er using predefined data fields , including study quality indicators , and verified by another . Results Eight quantitative studies were included describing four interventions and a comparison of recruiting clinicians . One study was rated as strong , one as moderate and the remaining six as weak when assessed for quality using the Effective Public Health Practice Project tool . Effective interventions included the use of qualitative research to identify and overcome barriers to recruitment , reduction of the clinical workload associated with participation in RCTs and the provision of extra training and protected research time . Eleven qualitative studies were identified , and eight themes were abstract ed from the data : underst and ing of research , communication , perceived patient barriers , patient – clinician relationship , effect on patients , effect on clinical practice , individual benefits for clinicians and methods associated with successful recruitment . Meta summary analysis identified the most frequently reported subthemes to be : difficulty communicating trial methods , poor underst and ing of research and priority given to patient well-being . Overall , the qualitative studies were found to be of good quality when assessed using the Critical Appraisal Skills Programme checklist . Conclusions There were few high- quality trials that tested interventions to improve  clinicians ' recruitment activity in RCTs . The most promising intervention was the use of qualitative methods to identify and overcome barriers to  clinician recruitment activity . More good quality studies of interventions are needed to add to the evidence base . The meta summary of qualitative findings identified underst and ing and communicating RCT methods as a key target for future interventions to improve recruitment . Reinforcement of the potential benefits , both for clinicians and for their patients , could also be a successful factor in improving recruitment . A bias was found towards investigating barriers to recruitment , so future work should also encompass a focus on successfully recruiting trials Background The evidence that higher levels of physical activity and /or lower levels of physical inactivity are associated with beneficial health-related outcomes stems mainly from observational studies . Findings from these studies often differ from r and omised controlled trials and systematic review s currently demonstrate mixed results , due partly to heterogeneity in physical activity interventions , method ologies used and population s studied . As a result , translation into clinical practice has been difficult . It is therefore essential that an overview is carried out to compare and contrast systematic review s , and to identify those physical activity interventions that are the most effective in preventing and /or treating major chronic disease . This protocol has been registered on PROSPERO 2013 : CRD42013003523 . Methods We will carry out an overview of Cochrane systematic review s. We will search the Cochrane Data base of Systematic Review s for systematic review s of r and omised controlled trials that have a primary focus on disease-related outcomes . We will restrict review s to those in selected major chronic diseases . Two authors will independently screen search outputs , select studies , extract data and assess the quality of included review s using the assessment of multiple systematic review s tool ; all discrepancies will be resolved by discussing and reaching a consensus , or by arbitration with a third author . The data extraction form will summarise key information from each review , including details of the population ( s ) ( for example , disease condition ) , the context ( for example , prevention , treatment or management ) , the participants , the intervention(s ) , the comparison(s ) and the outcomes . The primary outcomes of interest are the prevention of chronic disease and /or improved outcomes , in the treatment or management of chronic disease . These outcomes will be summarised and presented for individual chronic diseases ( for example , any change in blood pressure in hypertension or glucose control in diabetes ) . Secondary outcomes of interest are to describe the structure and delivery of physical activity interventions  across chronic disease conditions and adverse events associated with physical activity . Discussion We anticipate that our results could inform research ers , guideline groups and policymakers of the most efficacious physical activity interventions in preventing and /or managing major chronic disease BACKGROUND We were interested in the effects of a physical activity ( PA ) counselling programme in three groups of COPD patients from general practice ( primary care ) , outpatient clinic ( secondary care ) and pulmonary rehabilitation ( PR ) . METHODS In this r and omized controlled trial 155 COPD patients , 102 males , median ( IQR ) age 62 ( 54 - 69 ) y , FEV1predicted 60 ( 40 - 75 ) % were assigned to a 12-weeks ' physical activity counselling programme or usual care .  Physical activity ( pedometer ( Yamax SW200 ) and metabolic equivalents ) , exercise capacity ( 6-min walking distance ) and quality of life ( Chronic Respiratory Question naire and Clinical COPD Question naire ) were assessed at baseline , after three and 15 months . RESULTS A significant difference between the counselling and usual care group in daily steps ( 803 steps , p = 0.001 ) and daily physical activity ( 2214 steps + equivalents , p = 0.001 ) ) from 0 to 3 months was found in the total group , as well as in the outpatient ( 1816 steps , 2616 steps + equivalents , both p = 0.007 ) and PR ( 758 steps , 2151 steps + equivalents , both p = 0.03 ) subgroups . From 0 to 15 months no differences were found in physical activity . However , when patients with baseline physical activity>10,000 steps per day ( n = 8) , who are already sufficiently active , were excluded , a significant long-term effect of the counselling programme on daily physical activity existed in the total group ( p = 0.02 ) . Differences in exercise capacity and quality of life were found only from 0 to 3 months , in the outpatient subgroup . CONCLUSION Our PA counselling programme  effectively enhances PA level in COPD patients after three months . Sedentary patients at baseline still benefit after 15 months . Clinical Trials.gov : registration number NCT00614796 BACKGROUND A growing number of the population are using the Internet for health information , such as physical activity ( PA ) . The aim of this study was to examine the effectiveness of delivery modes for a behavior change program targeting PA . METHODS A r and omized trial was conducted with 192 subjects r and omly allocated to either a face-to-face , Internet-mediated , or Internet-only arm of a 12-wk intervention . Subjects included inactive adults with Internet access . The primary outcome variable was self-reported PA , assessed at four time points . RESULTS The results showed no group x time interaction for PA F(6 , 567 ) = 1.64 , p > 0.05 , and no main effect for group F(2 , 189 ) = 1.58 , p > 0.05 . However , a main effect for time F(3 , 567 ) = 75.7 , p < 0.01 was observed for each group . All groups were statistically equivalent immediately post-intervention ( p < 0.05 ) , but not at the follow-up time points ( p > 0.05 ) . The Internet-mediated and Internet-only groups showed similar increases in PA to the face-to-face group immediately post-intervention . CONCLUSIONS This study provides evidence in support of the Internet in the delivery of PA interventions and highlights avenues for future research Background Identifying ways to promote physical activity and decrease sedentary time during childhood is a key public health issue . Research on the putative influences on preschool children ’s  physical activity ( PA ) and  sedentary behavior  ( SB ) is limited and has yielded inconsistent results . Our aim was to identify correlates of PA and SB in preschool children . Methods Cross-sectional data were drawn from the Swiss Preschoolers ’ Health Study ( SPLASHY ) , a Swiss population -based cohort study . Of 476 two to six year old children , 394 ( 54 % boys ) had valid PA data assessed by accelerometry .  Information on exposure data was directly measured or extracted from parental question naires . Multilevel linear regression modeling was used to separately assess associations between 35 potential correlates and  total PA ( TPA ) , moderate-to-vigorous PA ( MVPA ) and SB . Results In total , 12 correlates from different domains were identified . TPA and MVPA were greater in boys than girls , increased with age and were positively associated with gross motor skills . Children from single parent families had a higher level of TPA and spent less time sedentary than those living with two parents . Time spent outdoors was positively associated with TPA and negatively with SB . The child ’s activity temperament was related all three outcomes , whereas parental sports club membership , living area per person and neighborhood safety were associated with SB only . Fixed and r and om factors in the final models accounted for 28 % , 32 % and 22 % of the total variance in TPA , MVPA and SB , respectively . Variance decomposition revealed that age , sex and activity temperament were the most influential correlates of both , TPA and MVPA , whereas the child ’s activity temperament , time outdoors and neighborhood safety were identified as the most important correlates of SB . Conclusions A multidimensional set of correlates of young children ’s  activity behavior has been identified . Personal factors had the greatest influence on PA , whereas environmental-level factors had the greatest influence on SB . Moreover , we identified a number of previously unreported , potentially modifiable correlates of young children ’s PA and SB . These factors could serve to define target groups or become valuable targets for change in future interventions .Trial registration Current Controlled Trials IS RCT N41045021 ( date of registration : 21.03.14 ) Data from two r and omized clinical trials ( RCT ) were used to examine the extent to which a health promotion intervention affected changes in growth trajectories of psychosocial constructs and if so , whether these constructs in turn explained changes in  physical activity ( PA ) . PA and psychosocial measures on 842 overweight adults in the United States were collected in two RCTs evaluating Internet-based behavior change interventions with assessment s at baseline , 6 and 12 months . A physical activity latent variable at 12 months was created using indicators of self-reported walking and leisure time activities . Intervention-mediated effects on  PA  at 12 months were found via latent growth curves representing self-efficacy and behavioral strategies , where increasing growth curves across time were associated with higher  PA values at 12 months . These findings provide some evidence that web-based self-help intervention programs worked through targeted behavior change constructs to influence physical activity levels in overweight adults Background The worldwide increase in the rates of childhood overweight and physical inactivity requires successful prevention and intervention programs for children . The aim of the Active Living project is to increase physical activity and decrease sedentary behavior of Dutch primary school children by developing and implementing tailored , multicomponent interventions at and around schools . Methods / design In this project , school-centered interventions have been developed at 10 schools in the south of the Netherl and s , using a combined top-down and bottom-up approach in which a research unit and a practice unit continuously interact . The interventions consist of a combination of physical and social interventions tailored to local needs of intervention schools . The process and short- and long-term effectiveness of the interventions will be evaluated using a quasi-experimental study design in which 10 intervention schools are matched with 10 control schools . Baseline and follow-up measurements ( after 12 and 24 months ) have been conducted in grade s 6 and 7 and included accelerometry , GPS , and question naires . Primary outcome of the Active Living study is the change in physical activity levels , i.e. sedentary behavior ( SB ) , light physical activity ( LPA ) , moderate-to-vigorous physical activity ( MVPA ) , and counts-per-minute ( CPM ) . Multilevel regression analyses will be used to assess the effectiveness of isolated and combined physical and social interventions on children ’s PA levels . Discussion The current intervention study is unique in its combined approach of physical and social environmental PA interventions both at school(yard)s as well as in the local neighborhood around the schools . The strength of the study lies in the quasi-experimental design including objective measurement techniques , i.e. accelerometry and GPS , combined with more subjective techniques , i.e. question naires , implementation logbooks , and neighborhood observations . Trial registration Current Controlled Trials IS RCT N25497687 ( registration date 21/10/2015 ) , METC 12 - 4 - 077 , Project number Background The high prevalence of physical inactivity worldwide calls for innovative and more effective ways to promote physical activity ( PA ) . There are limited objective data on the effectiveness of Web-based personalized feedback on increasing PA in adults . Objective It is hypothesized that providing personalized advice based on PA measured objective ly alongside diet , phenotype , or genotype information would lead to larger and more sustained changes in PA , compared with nonpersonalized advice . Methods A total of 1607 adults in seven European countries were r and omized to either a control group ( nonpersonalized advice , Level 0 , L0 ) or to one of three personalized groups receiving personalized advice via the Internet based on current PA plus diet ( Level 1 , L1 ) , PA plus diet and phenotype ( Level 2 , L2 ) , or PA plus diet , phenotype , and genotype ( Level 3 , L3 ) .  PA  was measured for 6 months using triaxial accelerometers , and self-reported using the  Baecke question naire . Outcomes were objective and self-reported PA after 3 and 6 months . Results While 1270 participants ( 85.81 % of 1480 actual starters ) completed the 6-month trial , 1233 ( 83.31 % ) self-reported PA at both baseline and month 6 , but only 730 ( 49.32 % ) had sufficient objective PA data at both time points . For the total cohort after 6 months , a greater improvement in self-reported total PA ( P=.02 ) and PA during leisure ( nonsport ) ( P=.03 ) was observed in personalized groups compared with the control group . For individuals advised to increase PA , we also observed greater improvements in those two self-reported indices ( P=.006 and P=.008 , respectively ) with increased personalization of the advice ( L2 and L3 vs L1 ) . However , there were no significant differences in accelerometer results between personalized and control groups , and no significant effect of adding phenotypic or genotypic information to the tailored feedback at month 3 or 6 . After 6 months , there were small but significant improvements in the objective ly measured physical activity level ( P<.05 ) , moderate PA ( P<.01 ) , and sedentary time ( P<.001 ) for individuals advised to increase PA , but these changes were similar across all groups . Conclusions Different levels of personalization produced similar small changes in objective PA . We found no evidence that personalized advice is more effective than conventional “ one size fits all ” guidelines to promote changes in PA in our Web-based intervention when PA was measured objective ly . Based on self-reports , PA increased to a greater extent with more personalized advice . Thus , it is crucial to measure PA objective ly in any PA intervention study . Trial Registration Clinical Trials.gov NCT01530139 ; http:// clinical trials.gov/show/NCT01530139 ( Archived by WebCite at : http://www.webcitation.org/6XII1QwHz RATIONALE , AIMS AND OBJECTIVES Systematic review s point to inconclusive evidence that counselling patients in a primary care setting is effective in increasing  adults ' physical activity ( PA ) levels .  This study evaluates the impact of an innovative physician counselling programme on physicians ' PA counselling behaviour and their patients ' PA levels . METHODS A controlled educational study conducted at six Yale School of Medicine hospitals . Sixty-five internal medicine residents and 316 primary care patients were r and omized to intervention or control groups . Intervention physicians participated in five interactive sessions outlining details of the Pressure System Model , while control physicians received usual residency training . Intervention and control patients '  PA levels and residents counselling behaviour  were assessed using a vali date d question naire and compared pre- and post intervention . Data analysis was performed using paired t-tests and repeated measures anova . RESULTS At 6-month follow-up intervention , patients ' PA levels increased significantly from baseline ( 1.77 + /- 0.84 ; P = 0.0376 ) . A similar pattern was observed after 12 months ( 1.94 + /- 0.98 ; P = 0.0486 ) . Control patients ' PA did not change significantly from baseline at 6 or 12 months ( 0.35 + /- 1.00 ; P = 0.7224 and 0.99 + /- 1.52 ; P = 0.5160 , respectively ) . At 12 months , intervention residents provided PA counselling 1.5 times more than they did at baseline ( P < 0.05 ) compared with no significant changes in the control group . CONCLUSIONS The present study has shown that providing residents with a practical tool , enabling them to deal with patients ' barriers and previous failure in behavioural change , is efficacious in increasing PA levels of adult patients Chronic obstructive pulmonary disease ( COPD ) is one of the more disabling diseases and the third cause of mortality worldwide . Self-management is considered an effective strategy for controlling and managing COPD . This review aims to summarise the available evidence on the effectiveness of COPD self-management in primary care setting s. Social Sciences , Citation Index , MEDLINE , CINAHL , Academic Search Complete and Scopus were search ed for r and omised controlled trials of COPD self-management in general practice between 2001 and 2018 . Ten r and omised controlled trials of COPD self-management trials conducted in primary care setting s were included in this review . The identified trials have recruited stable patients ; a majority having mild to moderate COPD . The trials implemented different types of interventions and measured improvements in knowledge , skills and behaviours of self-management , mental health , self-efficacy and endpoint outcomes such as hospitalisation and quality of life . The findings showed that COPD self-management trials had positive effects on COPD knowledge and improved self-management behaviours such as adherence to medication , physical activities and smoking cessation in some cases ; however , the effect of trials on hospitalisation rate , quality of life and healthcare utilisation were not conclusive . There was also not enough evidence to suggest that the trials were efficient in improving self-efficacy , a major driver of self-management behaviours . Primary care COPD self-management trials are efficient in improving surrogate outcomes such as knowledge of and adherence to self-management behaviours ; however , such improvements are less likely to be sustainable in the absence of self-efficacy . Future studies should also focus on improving endpoint self-management outcomes like hospitalisation rate and quality of life to benefit both patient and healthcare system This study explored the effects of ground-based walking training on physical activity ( PA ) and sedentary time ( ST ) in people with chronic obstructive pulmonary disease ( COPD ) . Participants were r and omised to a walk group ( WG ) [ supervised , ground-based walking training , two or three times per week for 8 - 10 weeks ] or a control group ( CG ) [ usual medical care ] . Before and after the intervention period , PA and ST were measured using the SenseWear ® Pro3 Armb and . Of the 143 participants r and omised , 101 ( 71 % ) had sufficient data for the primary analysis ; 62 were from the WG ( mean [ SD ] age 69 [ 8 ] years , FEV1 42 [ 15 ] % predicted ) and 39 were from the CG ( age 68 [ 9 ] years , FEV1 43 [ 15 ] % predicted ) . No between-group differences were demonstrated in any measure of PA or ST ( all p > 0.05 ) . Secondary analyses ( n = 44 ) revealed that , compared to the CG , the proportion of waking hours spent in moderate intensity PA accumulated in uninterrupted bouts of between 30 and 60 min , increased in the WG by 0.8 % ( 95 % CI = 0.4 to 1.3 ) . This study demonstrated that , in people with COPD  , ground-based walking training alone had little , if any clinical ly important effect on daily PA and no effect on ST Physical inactivity in patients with chronic obstructive pulmonary disease ( COPD ) is associated with poor health status and increased disease burden . The present study aims to test the efficacy of a previously developed mobile (m)Health intervention to improve or maintain physical activity in patients with COPD after pulmonary rehabilitation . A r and omised controlled trial was performed in 32 physiotherapy practice s in the Netherl and s. COPD patients were r and omised into intervention or usual care groups . The intervention consisted of a smartphone application for the patients and a monitoring website for the physiotherapists . Measurements were performed at 0 , 3 , 6 and 12 months . Physical activity , functional exercise capacity , lung function , health-related quality of life and body mass index were assessed . 157 patients started the study and 121 completed it . There were no significant positive effects of the intervention on physical activity ( at 0 months : intervention 5824±3418 steps per weekday , usual care 5717±2870 steps per weekday ; at 12 months : intervention 4819±2526 steps per weekday , usual care 4950±2634 steps per weekday ; p=0.811 ) or on the secondary end-points . There was a significant decrease over time in physical activity ( p<0.001 ) , lung function ( p<0.001 ) and mastery ( p=0.017 ) , but not in functional exercise capacity ( p=0.585 ) . Although functional exercise capacity did not deteriorate , our mHealth intervention did not improve or maintain physical activity in patients with COPD after a period of pulmonary rehabilitation . mHealth intervention does not improve or maintain physical activity in COPD patients after pulmonary rehabilitation Abstract Background Women who are physically active during early pregnancy have notably lower odds of developing gestational diabetes than do inactive women . The purpose of the intervention was to examine whether intensified physical activity ( PA ) counseling in Finnish maternity care is feasible and effective in promoting leisure-time PA ( LTPA ) among pregnant women at risk of gestational diabetes . Methods Fourteen municipalities were r and omized to intervention ( INT ) and usual care group ( UC ) . Nurses in INT integrated five PA counseling sessions into routine maternity visits and offered monthly group meetings on PA instructed by physiotherapists . In UC conventional practice s were continued . Feasibility evaluation included safety ( incidence of PA-related adverse events ; question naire ) , realization ( timing and duration of sessions , number of sessions missed , attendance at group meetings ; systematic record-keeping of the nurses and physiotherapists ) and applicability ( nurses ’ views ; telephone interview ) . Effectiveness outcomes were weekly frequency and duration of total and intensity-specific LTPA and meeting PA recommendation for health self-reported at 8 - 12 ( baseline ) , 26 - 28 and 36 - 37 weeks ’ gestation . Multilevel analysis with adjustments was used in testing for between-group differences in PA changes . Results The decrease in the weekly days of total and moderate-to-vigorous-intensity LTPA was smaller in INT ( N = 219 ) than in UC ( N = 180 ) from baseline to the first follow-up ( 0.1 vs. -1.2 , p = 0.040 and −0.2 vs. -1.3 , p = 0.016 ) . A similar trend was seen in meeting the PA recommendation ( −11%-points vs. -28%-points , p = 0.06 ) . INT did not experience more adverse events classified as warning signs to terminate exercise than UC , counseling was implemented as planned and viewed positively by the nurses . Conclusions Intensified counseling had no effects on the duration of total or intensity-specific weekly LTPA . However , it was able to reduce the decrease in the weekly frequency of total and moderate-to-vigorous-intensity LTPA from baseline to the end of second trimester and was feasibly embedded into routine practice s . Trial registration IS RCT N 33885819 ( http://www.is rct n.org The purpose of this study is to evaluate the effects of targeting both the motivation and action phases of behaviour change in a 5-week intervention to increase physical activity ( PA )  among patients with rheumatoid arthritis ( RA ) not meeting current PA recommendations . In a r and omised controlled trial , a control group — which received a group-based patient education session led by a physical therapist — was compared to a treatment group which received the education session plus a motivational interview from a physical therapist and two self-regulation coaching sessions from a rheumatology nurse . Outcomes included  leisure-time PA , days per week with at least 30 min of moderate-intensity PA , self-efficacy and autonomous motivation ( cognitions which predict PA initiation and maintenance ) , disease activity , functional status , depressive symptoms and fatigue . Effects were assessed using mixed models repeated measures . Of the 78 patients r and omised , 76 and 67 completed the post-treatment and follow-up assessment s , respectively . Significant treatment effects were found for leisure-time PA  ( p = 0.022 ) , active days/week ( p = 0.016 ) , self-efficacy ( p = 0.008 ) and autonomous motivation ( p = 0.001 ) . At post-treatment and 6-months follow-up , significantly more treated patients than controls met current PA recommendations . No significant effects were found for disease activity , functional status , depressive symptoms or fatigue . Combining motivation- and action-focused intervention approaches improved PA-related cognitions and led to improved uptake and maintenance of leisure-time PA . However , further research is necessary to identify ways of helping patients with RA transition to— and maintain — more intensive forms of PA which are more likely to improve disease activity and functional status Background The prevalence of overweight and obesity is high amongst healthcare professionals and there is growing interest in delivering weight loss interventions in the workplace . We conducted a systematic review to ( i ) examine the effectiveness of workplace-based diet and /or physical activity interventions aim ed at healthcare professionals and to ( ii ) identify and describe key components of effective interventions . Seven electronic data bases were systematic ally search ed . Results Thirteen r and omised controlled trials met the inclusion criteria , of which seven had data available for meta- analysis . Where meta- analysis was possible , studies were grouped according to length of follow-up ( < 12 months and ≥12 months ) and behavioural target ( diet only , physical activity only or diet and physical activity ) , with outcome data pooled using a weighted r and om effects model . Nine studies reported statistically significant ( between-group ) differences . Four studies reported being informed by a behaviour change theory . Meta- analysis of all trials reporting weight data demonstrated healthcare professionals allocated to dietary and physical activity interventions lost significantly more body weight ( −3.95 Kg , [ 95 % CI −4.96 to- 2.95 Kg ] ) than controls up to 12 months follow up . Conclusions Workplace diet and /or physical activity interventions targeting healthcare professionals are limited in number and are heterogeneous . To improve the evidence base , we recommend additional evaluations of theory-based interventions and adequate reporting of intervention content Background Challenges remain to find ways to support patients with depression who have low levels of physical activity ( PA )  to overcome perceived barriers and enhance the perceived value of PA for preventing future relapse . There is an evidence -base for behavioural activation ( BA ) for depression , which focuses on supporting patients to restore activities that have been avoided , but practitioners have no specific training in promoting PA . We aim ed to design and evaluate an integrated BA and PA ( BAcPAc ) practitioner-led , written , self-help intervention to enhance both physical and mental health . Methods / design This study is informed by the Medical Research Council Complex Intervention Framework and describes a protocol for a pilot phase II r and omised controlled trial ( RCT ) to test the feasibility and acceptability of the trial methods to inform a definitive phase III RCT . Following development of the augmented written self-help intervention ( BAcPAc ) incorporating behavioural activation with physical activity promotion , depressed adults are r and omised to receive up to 12 sessions over a maximum of 4 months of either BAcPAc or behavioural activation alone within a written self-help format , which represents treatment as usual . The study is located within two ‘ Improving Access to Psychological Therapies ’ services in South West Engl and , with both written self-help interventions supported by mental health paraprofessionals . Measures assessed at 4 , 9 , and 12 month follow-up include the following : CIS-R , PHQ-9 , accelerometer recorded ( 4 months only ) and self-reported PA , body mass index , blood pressure , Insomnia Severity Index , quality of life , and health and social care service use . Process evaluation will include analysis of recorded support sessions and patient and practitioner interviews . At the time of writing the study has recruited 60 patients . Discussion The feasibility outcomes will inform a definitive RCT to assess the clinical and cost-effectiveness of the augmented BAcPAc written self-help intervention to reduce depression and depressive relapse , and bring about improvements across a range of physical health outcomes .Trial registration Current Controlled Trials IS RCT N74390532 , 26.03.2013 Primary care is a promising venue to build patient motivation and confidence to increase physical activity ( PA ) . Physician PA counselling has demonstrated some success ; however , maintenance of behaviour change appears to require more intensive interventions . In reality , most physicians do not have the necessary training nor the time for this type of counselling . The purpose of this paper is to outline the rationale , methods , and interventions for the ongoing physical activity counselling ( PAC ) r and omized controlled trial ( RCT ) , which aims to assess the impact of integrating a PA counsellor into a primary care practice . This RCT has 2 arms : ( i ) brief PA counselling ( 2 - 4 min ) from a health care provider and ( ii ) brief PA counselling+intensive PA counselling from a PA counsellor ( 3 months ) . The impact of this intervention is being evaluated using the comprehensive RE- AIM framework . One hundred twenty insufficiently active adult patients , aged 18 to 69 y and recruited during regular primary care visits have been r and omized . Dependent measures include psychological mediators , PA participation , quality of life , and physical and metabolic outcomes . The PAC project represents an innovative , theoretically-based approach to promoting PA in primary care , focusing on psychological mediators of change . We anticipate that key lessons from this study will be useful for shaping future public health interventions , theories , and research Background Despite documented health benefits for mother and baby , physical activity (PA)-level tends to decline in pregnancy . Overweight/obese and physically inactive women are two selected groups at increased risk of pregnancy complications . Thus , efficient strategies to maintain or increase PA-level in pregnancy and the postpartum period , especially among these women , are warranted . This secondary analysis examined the effect of a prenatal lifestyle-intervention on PA-level in late pregnancy and the first year postpartum , with sub analysis on initially physically active versus inactive and normal-weight versus overweight/obese women . Method The Norwegian Fit for Delivery ( NFFD ) r and omized controlled trial included healthy primiparous women with singleton pregnancies and body mass index ( BMI ) ≥19 kg/m2 assigned to an intervention group , n = 303 ( twice weekly group-exercises and dietary counseling ) or a control group , n = 303 ( st and ard prenatal care ) . The International Physical Activity Question naire short-form was used to assess PA-levels at inclusion ( mean gestational week ( GW ) 16 ) , GW 36 , and six and 12 months postpartum . Results At GW 36 , a positive intervention-effect with a significant between-group difference in total PA-level compared to time of inclusion was found for the total group ( 530 MET-min/week , p = 0.001 ) and the subgroups of normal-weight ( 533 MET-min/week , p = 0.003 ) and initially active women ( 717 MET-min/week , p<0.001 ) . Intervention-effect was dependent on exercise-adherence among overweight/obese and inactive women . Compared to time of inclusion , the intervention groups maintained total PA-level at GW 36 , while total PA-level decreased in the control groups . The PA-levels increased postpartum , but with no significant differences between the r and omization groups . Conclusion The NFFD prenatal combined lifestyle intervention had a significant effect on TPA-level in late pregnancy among women entering pregnancy normal-weight or physically active , thereby preventing the downward trend typically seen during pregnancy . Intervention-effect among overweight/obese and physically inactive women was , however , dependent on exercise-adherence . Long-term intervention-effect was not observed in the postpartum period Introduction Chronic obstructive pulmonary disease ( COPD ) is associated with exercise limitation and physical inactivity , which are believed to have significant long-term negative health consequences for patients . While a number of COPD treatments and exercise training programmes increase exercise capacity , there is limited evidence for their effects on physical activity levels , with no clear association between exercise capacity and physical activity in clinical trials . Physical activity depends on a number of behaviour , environmental and physiological factors . We describe the design of the PHYSACTO trial , which is investigating the effects of bronchodilators , either alone or with exercise training , in combination with a st and ardised behaviour-change self-management programme , on exercise capacity and physical activity in patients with COPD . It is hypothesised that bronchodilators in conjunction with a behaviour-change self-management programme will improve physical activity and that this effect will be amplified by the addition of exercise training . Methods and analysis Patients are being recruited from 34 sites in Australia , New Zeal and , the USA , Canada and Europe . Patients receiving a multicomponent intervention design ed to support behaviour change related to physical activity are r and omised to four treatment arms : placebo , tiotropium , tiotropium+olo date rol , and tiotropium+olo date rol+exercise training . The primary outcome is improvement in exercise capacity after 8 weeks , measured by endurance time during a shuttle walk test . The secondary outcome is improvement in physical activity , including objective accelerometer assessment and patient-reported functioning using the Functional Performance Inventory — Short Form and the novel hybrid PROactive instrument . Additionally , the influence of moderating variables ( ie , factors influencing a patient 's choice to be physically active ) on increases in physical activity is also explored . Ethics and dissemination The study has been approved by the relevant Institutional Review Boards , Independent Ethics Committee and Competent Authority according to national and international regulations . The findings of the trial will be disseminated through relevant peer- review ed journals and international conference presentations . Trial registration number NCT02085161 INTRODUCTION Shift work ( an occupation requiring work between 2200 and 0500H ) comprises approximately 20 % of the workforce in Europe and North America [ 1 ] . This is likely to increase , with many shift workers ( SWs ) in emergency services , retail , hospitality , healthcare , transportation and manufacturing [ 2 ] . SWs are at increased risk for negative health outcomes , including cancer and other chronic diseases [ 3 , 4 ] . Biological changes from poor lifestyle habits related to shift work ( e.g. low physical activity ( PA ) , poor nutrition , obesity ) are thought to contribute to this risk ; these factors are also amenable to lifestyle intervention [ 5 ] . PA in particular , reduces cancer risk [ 6 ] , and has many positive physical and psychological benefits [ 7 ] . It is a simple , cost-effective strategy that may be implemented by individual workers or within workplaces to mitigate risk . Unfortunately , SWs are unlikely to engage in regular PA [ 8 ] . In Canada , only 15.9 % of SWsmeet the PA guidelines and have lower levels of aerobic fitness than those of day workers [ 9 ] . Few behavioural interventions improving health outcomes in SWs have been published [ 10 ] . In a targeted PA intervention , nurses r and omised to 4 months of supervised PA  improved aerobic fitness , muscular strength , fatigue and musculoskeletal symptoms . However , authors reported low adherence and large loss to follow-up , perhaps due to the supervised scheduled sessions [ 11 , 12 ] . Sustained behaviour change is a challenge and requires targeted efforts to encourage individuals to reach an adequate dose of PA to change health outcomes [ 13 ] . Due to irregular schedules and time constraints , SWs may be less likely to adhere to a traditional supervised PA intervention with face-to-face behavioural support [ 12 ] . Women SWs cite work schedule interference and lack of time as PA barriers and report scheduling flexibility as the most important in PA [ 14 ] . This highlights the need for a creative and innovative programming to promote PA in SWs . Distance-based interventions , in which individuals exercise independent of study staff or participants , may include telephone counselling and website or smart phone app-based technology . These interventions are highly flexible and may help overcome barriers related to timing and scheduling that are important for SWs . In a review of telephone-based PA interventions , 14 of 17 found evidence for behaviour change [ 15 ] . These may be a way to implement scalable , individuallytailored interventions in SWs . The primary objective of this study was to test the feasibility of a distance-based PA intervention in women SWs . Feasibility studies are important for establishing effective processes and underst and ing re sources required before attempting a r and omised controlled trial ( RCT ) , in order to put forward interventions that are most likely to be efficacious [ 16 ] . As this work was funded by a grant to examine the role of lifestyle in reducing breast cancer risk in SWs , only women were included . A secondary objective was to conduct a preliminary evaluation of intervention efficacy , to estimate effect size for future studies Objectives To test the inter-rater reliability of the RoB tool applied to Physical Therapy ( PT ) trials by comparing ratings from Cochrane review authors with those of blinded external review ers . Methods R and omized controlled trials ( RCTs ) in PT were identified by search ing the Cochrane Data base of Systematic Review s for meta- analysis of PT interventions .  RoB assessment s were conducted independently by 2 review ers blinded to the RoB ratings reported in the Cochrane review s. Data on RoB assessment s from Cochrane review s and other characteristics of review s and trials were extracted . Consensus assessment s between the two review ers were then compared with the RoB ratings from the Cochrane review s. Agreement between Cochrane and blinded external review ers was assessed using weighted kappa ( κ ) . Results In total , 109 trials included in 17 Cochrane review s were assessed . Inter-rater reliability on the overall RoB assessment between Cochrane review authors and blinded external review ers was poor ( κ = 0.02 , 95%CI : −0.06 , 0.06 ] ) . Inter-rater reliability on individual domains of the RoB tool was poor ( median κ = 0.19 ) , ranging from κ = −0.04 ( “ Other bias ” ) to κ = 0.62 ( “ Sequence generation ” ) . There was also no agreement ( κ = −0.29 , 95%CI : −0.81 , 0.35 ] ) in the overall RoB assessment at the meta- analysis level . Conclusions Risk of bias assessment s of RCTs using the RoB tool are not consistent across different research groups . Poor agreement was not only demonstrated at the trial level but also at the meta- analysis level . Results have implication s for decision making since different recommendations can be reached depending on the group analyzing the evidence . Improved guidelines to consistently apply the RoB tool and revisions to the tool for different health areas are needed
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 .