Behavioural modification interventions alongside pulmonary rehabilitation improve COPD patients’ experiences of physical activity

May combine two claims. The quote only partly states this claim.

Adding PA behavioural techniques to pulmonary rehabilitation is superior to PA behavioural interventions alone for improving C-PPAC total score, based on between-group differences of 4.5 units in Arbillaga et al., 4.5 units in Demeyer et al., and 8 units in the current study.

“Considering the magnitude of change in the C-PPAC total scores between the intervention and control groups in the studies of Arbillaga-Extarri [41] (4.5 units) and Demeyer [29] (4.5 units) and that of the current study (8 units), it is clear that PA behavioural techniques added to PR are superior to PA behavioural interventions alone in improving the total score of the C-PPAC instrument.”

• cites [41] Arbillaga-Etxarri, 2018, Long-term efficacy and effectiveness of a behavioural and community-based exercise intervention (Urban Training) to increase physical activity in patients with COPD: a randomised controlled trial, Eur. Respir. J. sourceDisputed

  Split into 2 atoms — 0 confirmed, 1 partially supported, 1 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Checked by a reasoning model — may be wrong.

  Experimental — accuracy not yet measured
• cites [29] Demeyer, 2017, Physical activity is increased by a 12-week semiautomated telecoaching programme in patients with COPD: a multicentre randomised controlled trial, Thorax sourcePartly supported

  Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured

May combine two claims.

Reduced physical activity in COPD is associated with faster disease progression, greater risk of exacerbation, increased hospital admissions, and mortality.

“It is recognised that reduced levels of PA in patients with COPD are associated with a faster rate of disease progression, greater risk for exacerbation of COPD (ECOPD), leading to increased rates of hospital admissions and mortality [5].”

• cites [5] Garcia-Aymerich, 2006, Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study, Thorax sourcePartly supported

  The Results (page not provided) associate very low physical activity with more COPD hospital admissions and higher mortality. The paper discusses admissions due to exacerbations, but it does not establish a higher risk of exacerbations apart from admissions or a faster rate of disease progression. The citing sentence therefore extends beyond the outcomes reported. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim.

A valid assessment of physical activity was defined as more than 8 hours of wear time on at least 4 weekdays within the 7-day period.

“A valid assessment of patient's PA was considered if patients recorded more than 8 h of wear time on at least 4 weekdays within the 7-day period [21].”

• cites [21] Gimeno-Santos, 2015, The PROactive instruments to measure physical activity in patients with chronic obstructive pulmonary disease, Eur. Respir. J. sourceCould not verify

  The Methods (‘Assessments and measures’; page unavailable) say patients wore accelerometers during the study periods, and describe a questionnaire with a 7-day recall. Neither that passage nor the retrieved Results passages define a valid assessment as more than 8 hours of wear on at least 4 weekdays. Searches for wear time, valid days, and the four-weekday threshold found no such criterion in our copy. (LLM, conf=0.73)

  Experimental — accuracy not yet measured

May combine two claims.

Sample size was based on Louvaris et al. comparing PR to usual care, with a mean C-PPAC total score difference of 7.4 units and SD 8.5, alpha 0.05, 80% power, requiring 24 patients per group; this was increased to 58 patients to allow for 20% attrition.

“Based on previous studies on similar PR programmes in the UK [15], considering an attrition rate of 20% the total sample size was increased to 58 patients.”

• cites [40] Louvaris, 2016, Interval training induces clinically meaningful effects in daily activity levels in COPD, Eur. Respir. J. sourceNot checked — no full text of the source
• cites [15] Nolan, 2017, Pedometer step count targets during pulmonary rehabilitation in chronic obstructive pulmonary disease. A randomized controlled trial, Am. J. Respir. Crit. Care Med. sourcePartly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured

May combine two claims.

Physical activity behavioural modification interventions have been employed to address physical activity behaviour, with the majority of previous studies demonstrating promising results in patients with COPD.

“PA behavioural modification interventions have been employed to address the complex behaviour of PA, with the majority of previous studies demonstrating promising results in patients with COPD [10][11][12][13][14][15][16].”

• cites [10] Altenburg, 2015, Short-and long-term effects of a physical activity counselling programme in COPD: a randomized controlled trial, Respir. Med. sourcePartly supported

  The Introduction (page unavailable) describes two earlier pilot studies in COPD that suggested increased physical activity after counselling. The Results (page unavailable) also report a short-term increase in this trial. The paper does not establish that a majority of previous COPD studies had promising results. (LLM, conf=0.85)

  Experimental — accuracy not yet measured
• cites [11] Cruz, 2016, Walk2Bactive: a randomised controlled trial of a physical activity-focused behavioural intervention beyond pulmonary rehabilitation in chronic obstructive pulmonary disease, Chron. Respir. Dis. sourceNot checked — no full text of the source
• cites [12] de Blok, 2006, The effects of a lifestyle physical activity counseling program with feedback of a pedometer during pulmonary rehabilitation in patients with COPD: a pilot study, Patient Educ. Counsel. sourceNot checked — no full text of the source

May combine two claims.

Qualitative research indicates that patients with COPD engage in daily physical activities but experience symptoms that adversely impact their lifestyle.

“Qualitative research has indicated that while patients engage in daily physical activities, they experience symptoms which adversely impact on their lifestyle [22].”

• cites [22] Dobbels, 2014, The PROactive innovative conceptual framework on physical activity, Eur. Respir. J. sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

Prior research has reported how the C-PPAC instrument responds in two behavioural modification interventions.

“Previous literature has documented the response of the C-PPAC instrument in two behavioural modification interventions [29,41].”

• cites [29] Demeyer, 2017, Physical activity is increased by a 12-week semiautomated telecoaching programme in patients with COPD: a multicentre randomised controlled trial, Thorax sourceCould not verify

  The Methods > Assessments section describes physical activity measured with Actigraph and Dynaport monitors, and the Results > Physical activity section reports changes in those measures. Searches for “C-PPAC instrument response” and “PPAC” found no passage documenting a C-PPAC response to the intervention. Page numbers are not available in our copy. (LLM, conf=0.72)

  Experimental — accuracy not yet measured
• cites [41] Arbillaga-Etxarri, 2018, Long-term efficacy and effectiveness of a behavioural and community-based exercise intervention (Urban Training) to increase physical activity in patients with COPD: a randomised controlled trial, Eur. Respir. J. sourceSupported

Classified as probably not a substantial claim.

The C-PPAC instrument provides a comprehensive measure of patients' experiences of physical activity by merging subjective questions on amount and difficulty with objective measures of steps per day and vector magnitude units.

“The instrument provides a comprehensive measure of patients' experiences of PA, merging subjective questions regarding the amount and difficulty of PA alongside objective measures of PA, encompassing average steps per day and vector magnitude units (VMU), which refers to intensity rather than quantity of PA [21].”

• cites [21] Gimeno-Santos, 2015, The PROactive instruments to measure physical activity in patients with chronic obstructive pulmonary disease, Eur. Respir. J. sourcePartly supported

  The Discussion describes C-PPAC as a hybrid of patient-reported items and activity-monitor measures; Results > Item reduction identifies its amount and difficulty domains and lists steps and VMU among the selected monitor variables (page not provided). These passages support the instrument description, but do not establish the citing sentence’s additional interpretation that VMU measures intensity rather than quantity. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Arbillaga et al. blinded patients by not revealing the existence of an alternative group.

“Meanwhile, Arbillaga and colleagues [41] took a different approach by refraining the existence of an alternative group to patients.”

• cites [41] Arbillaga-Etxarri, 2018, Long-term efficacy and effectiveness of a behavioural and community-based exercise intervention (Urban Training) to increase physical activity in patients with COPD: a randomised controlled trial, Eur. Respir. J. sourcePartly supported

  Methods > Study patients (page unavailable) says the ethics committees approved an exemption from providing patients with complete information and refers readers to supplementary table S1 for blinding details. The passage does not specify that patients were kept unaware of the alternative group, so the particular blinding approach attributed to the study is not established by our copy. (LLM, conf=0.73)

  Experimental — accuracy not yet measured

May combine two claims.

The C-PPAC difficulty dimension correlates moderately to strongly with health status, chronic dyspnea, and exercise capacity, which the amount dimension does not capture.

“The difficulty dimension has demonstrated a moderate-strong correlation with health status, chronic dyspnea and exercise capacity [21], which is not captured by the amount dimension.”

• cites [21] Gimeno-Santos, 2015, The PROactive instruments to measure physical activity in patients with chronic obstructive pulmonary disease, Eur. Respir. J. sourcePartly supported

  The Discussion reports moderate-to-strong correlations between difficulty scores and health status, dyspnoea, and exercise capacity. But it also reports moderate correlations between amount scores and dyspnoea and exercise capacity; Table 5 shows that C-PPAC amount correlates more strongly than difficulty with six-minute walking distance. Thus the claim that the amount dimension does not capture these relationships overstates the distinction. (LLM, conf=0.91)

  Experimental — accuracy not yet measured

May combine two claims.

Because Demeyer et al.'s tele-coaching study lacked specific exercise training and did not improve exercise capacity, this may explain why it did not improve the C-PPAC difficulty domain.

“The study by Demeyer et al. [29] did not include any specific exercise training and as a result was unsuccessful in demonstrating improvements in exercise capacity, which may be the reason for not reporting an improvement in the difficulty domain following 12-weeks of tele-coaching [29].”

• cites [29] Demeyer, 2017, Physical activity is increased by a 12-week semiautomated telecoaching programme in patients with COPD: a multicentre randomised controlled trial, Thorax sourcePartly supported

  The Discussion (Comparison with other studies; page unavailable) says the telecoaching intervention had only a minimal impact on exercise capacity and was not an adequate exercise-training stimulus. But the Results (Other outcomes; page unavailable) report a statistically significant 13.4 m between-group improvement in six-minute walk distance, so saying it demonstrated no improvement overstates the finding. The paper does not report a C-PPAC difficulty-domain outcome or link that outcome to exercise capacity. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

May combine two claims.

In Demeyer et al., the usual care group had a large decrease in C-PPAC scores over 12 weeks while tele-coaching yielded only small improvements, indicating marginal effects on C-PPAC.

“It should be noted that the usual care group reported a large decrease in C-PPAC scores following a 12-week period, with only small improvements in C-PPAC scores reported following the tele-coaching intervention, thereby suggesting that the tele-coaching intervention only had marginal effects on the C-PPAC tool [29].”

• cites [29] Demeyer, 2017, Physical activity is increased by a 12-week semiautomated telecoaching programme in patients with COPD: a multicentre randomised controlled trial, Thorax sourcePartly supported

  The Results > Physical activity section reports that measured activity decreased in the usual-care group and increased in the telecoaching group over 12 weeks. But the Methods > Assessments section identifies accelerometers, not C-PPAC, as the physical-activity measures; the paper does not report C-PPAC scores or establish marginal effects on that tool. It also reports a significant between-group improvement in activity, rather than characterising the intervention effect as marginal. (LLM, conf=0.82)

  Experimental — accuracy not yet measured

May combine two claims.

Patients in Louvaris et al. had higher baseline PA and 6MWD than those in the current study, and baseline levels have been documented to affect intervention effectiveness for PA.

“Furthermore, COPD patients in the Louvaris et al. study [40] presented greater baseline levels of PA and 6MWD than the current study, which has previously been documented to influence the effectiveness of interventions to improve PA [18].”

• cites [40] Louvaris, 2016, Interval training induces clinically meaningful effects in daily activity levels in COPD, Eur. Respir. J. sourceNot checked — no full text of the source
• cites [18] Armstrong, 2019, Use of pedometers as a tool to promote daily physical activity levels in patients with COPD: a systematic review and meta-analysis, Eur. Respir. Rev. sourceSupported

May combine two claims.

In Arbillaga et al., C-PPAC amount and difficulty scores improved significantly from baseline to 12 months, but the improvements did not significantly differ between intervention and usual care.

“The C-PPAC instrument was able to detect a significant improvement from baseline to 12 months in both the amount and difficulty C-PPAC scores, however improvements were not significant between the intervention and the usual care groups [41].”

• cites [41] Arbillaga-Etxarri, 2018, Long-term efficacy and effectiveness of a behavioural and community-based exercise intervention (Urban Training) to increase physical activity in patients with COPD: a randomised controlled trial, Eur. Respir. J. sourcePartly supported

  In the Results (Tables 2 and 3; page unavailable), the per-protocol analysis shows significant baseline-to-12-month improvements in both C-PPAC scores in the Urban Training group, but also significant adjusted differences from usual care for both scores. The intention-to-treat analysis shows no significant between-group differences, but only the difficulty score—not the amount score—improved significantly from baseline. The claim combines findings from the two analyses as though they came from one. (LLM, conf=0.91)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim. May combine two claims.

To remain comparable with previous literature, the current study followed prior studies that provided PA counselling with standard care PR and did not give pedometers to the control group.

“Secondly, in order to remain comparable with previous literature, we followed the procedure of several previous studies that implemented PA counselling alongside standard care PR [10,12,13,15], of which pedometers were not provided to the control group.”

• cites [10] Altenburg, 2015, Short-and long-term effects of a physical activity counselling programme in COPD: a randomized controlled trial, Respir. Med. sourcePartly supported

  The Intervention and Discussion sections support that physical activity counselling was added to usual care, which included pulmonary rehabilitation for the PR subgroup. But the Primary outcome measures section says the usual-care group also wore pedometers for two weeks at each measurement point. Thus the claim that control participants were not given pedometers is inaccurate without the qualification that they did not receive them as part of the counselling intervention. (LLM, conf=0.91)

  Experimental — accuracy not yet measured
• cites [12] de Blok, 2006, The effects of a lifestyle physical activity counseling program with feedback of a pedometer during pulmonary rehabilitation in patients with COPD: a pilot study, Patient Educ. Counsel. sourceNot checked — no full text of the source
• cites [13] Holland, 2017, Home-based rehabilitation for COPD using minimal resources: a randomised, controlled equivalence trial, Thorax sourcePartly supported

  The Interventions section describes exercise counselling through motivational interviewing in the home-based group and says those participants used pedometers to record walking distance. It describes the comparison group as receiving centre-based pulmonary rehabilitation, with no pedometer provision reported. However, counselling was part of the home-based rehabilitation programme, not an addition to standard-care PR as the citing sentence suggests (page unavailable in our copy). (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites [15] Nolan, 2017, Pedometer step count targets during pulmonary rehabilitation in chronic obstructive pulmonary disease. A randomized controlled trial, Am. J. Respir. Crit. Care Med. sourceSupported

May combine two claims.

Behavioural modification components have been shown to improve COPD patients' readiness, motivation, and confidence for PA and are associated with significant improvements in PA behaviour.

“Such behavioural modification components have been shown to benefit COPD patients' readiness, motivation and confidence to engage in PA and were associated with significant improvements in PA behaviour [42].”

• cites [42] Bourbeau, 2021, Mechanisms associated with increased physical activity in patients undergoing self-management behaviour modification in the randomised PHYSACTO® trial, ERJ Open Res. sourceSupported

May combine two claims.

In the same population, 6-minute walk distance improved following both PR+PA and PR alone, with similar within-group changes.

“The 6MWD improved following both PR + PA and PR alone interventions, with similar within group changes (Table 3).”

The quote only partly states this claim.

In the same population, the CAT score showed a clinically important difference in favour of PR+PA, with a between-group difference of -2.1 points (95% CI -3.8 to -0.3; p=0.025).

“the CAT score (mean [95% CI] difference: -2.1 [-3.8 to -0.3] points, p = 0.025)”

• Also stated in: § 3.4. Other outcomes · plain

  “clinically important differences in the CAT score in favour of the PR + PA group (Table 3).”

May combine two claims.

In the PR+PA group, patients rated the step counter, daily step goals, and researcher feedback as useful, with median scores of 9 [8-10], 8 [8,9], and 9 [8-10] respectively.

“Patients rated the usefulness of components of the PR + PA intervention with scores based on a satisfaction scale (0 terrible to 10 perfect) with the step counter (median [P25-P75]; 9 [8][9][10]), daily step goals (8 [8,9]) and feedback from researcher (9 [8-10]) all deemed useful parts of the intervention.”

The quote only partly states this claim.

In the PR+PA group, 58% of patients claimed the intervention helped them a lot regarding completing more physical activity outside of PR.

“Furthermore, 58% of patients claimed the intervention”

May combine two claims.

In the PR+PA group, compliance with the PA diary for self-reported daily step counts was 91 ± 18%, with a median of 55 [49-56] recorded days over 8 weeks.

“Compliance with the PA diary to self-reported daily step counts was also high (91 ± 18%), with a median number of 55 [49-56] recorded days over the 8 weeks.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

In the current study, HADS depression improved within the PR+PA group by -1 (95% CI -2 to 0, p=0.004) and within PR alone by -1 (95% CI -2 to -1, p=0.036), but the between-group difference was not significant (0, 95% CI -2 to 1, p=0.527).

“HADS (D) | PR + PA | 6 ± 6 | 5 ± 4 | -1 (-2 to 0) | 0.004 | 0 (-2 to 1) | 0.527 |”

• Also stated in: § Additional information · plain

  “| | PR alone | 7 ± 4 | 6 ± 3 | -1 (-2 to -1) | 0.036 | | |”

May combine two claims.

In the current study, hand grip strength improved within the PR+PA group by 3.3 kg (95% CI 2.1-4.5, p=0.001), and the between-group difference was 2.1 kg (95% CI 0.3-3.9, p=0.022).

“HG (kg) | PR + PA | 22.7 ± 8.9 | 26.0 ± 9.2 | 3.3 (2.1-4.5) | 0.001 | 2.1 (0.3-3.9) | 0.022 |”

May combine two claims.

In the current study, the PR+PA group improved C-PPAC amount score by 11 units (95% CI 7-16) within group, and the between-group difference was 8 units (95% CI 3-16), p=0.005.

“C-PPAC Amount score PR + PA 58 ± 20 69 ± 20 11 (7-16) 0.001 8 (3-16) 0.005 PR alone 56 ± 19 59 ± 21 3 (-2 to 7) 0.315”

May combine two claims.

In the current study, the PR+PA group increased steps/day by 976 (95% CI 651-1300) within group, and the between-group difference was 1016 (95% CI 556-1474), p=0.001.

“Steps/day PR + PA 3450 ± 2168 4426 ± 2577 976 (651-1300) 0.001 1016 (556-1474) 0.001 PR alone 3446 ± 2342 3406 ± 2095 -40 (-365 to 284) 0.805”

May combine two claims.

In the current study, the PR+PA group improved C-PPAC difficulty score by 7 units (95% CI 3-10) within group, and the between-group difference was 8 units (95% CI 3-13), p=0.002.

“C-PPAC Difficulty score PR + PA 62 ± 15 69 ± 15 7 (3-10) 0.001 8 (3-13) 0.002 PR alone 62 ± 16 61 ± 15 -1 (-4 to 2) 0.525”

May combine two claims.

In the current study, the behavioural modification interventions alongside PR were well received by the vast majority of patients, who showed high compliance.

“Finally, the present behavioral modification interventions alongside PR were well received by the vast majority of patients showing high compliance”

May combine two claims.

In the current study, 6MWD improved within the PR+PA group by 54 m (95% CI 36-72) and within PR alone by 38 m (95% CI 20-57), both p=0.001, but the between-group difference was not significant (16 m, 95% CI -10 to 41, p=0.236).

“6MWD (m) | PR + PA | 285 ± 92 | 339 ± 90 | 54 (36-72) | 0.001 | 16 (-10 to 41) | 0.236 |”

• Also stated in: § Additional information · plain

  “| | PR alone | 276 ± 92 | 314 ± 99 | 38 (20-57) | 0.001 | | |”

May combine two claims.

In the current study, the PR+PA group increased movement intensity by 73 VMU (95% CI 37-109) within group, and the between-group difference was 93 (95% CI 41-145), p=0.001.

“Movement intensity (VMU) PR + PA 337 ± 154 410 ± 231 73 (37-109) 0.001 93 (41-145) 0.001 PR alone 307 ± 170 287 ± 133 -20 (-57 to 17) 0.281”

May combine two claims.

In the current study, CAT score improved within the PR+PA group by -4.2 (95% CI -5.4 to -2.9, p=0.001), and the between-group difference was -2.1 (95% CI -3.8 to -0.3, p=0.025).

“CAT | PR + PA | 25.9 ± 6.4 | 21.7 ± 6.1 | -4.2 (-5.4 to -2.9) | 0.001 | -2.1 (-3.8 to -0.3) | 0.025 |”

May combine two claims.

In the current study, the PR+PA group reduced sedentary time by 37 min (95% CI 12-62) within group, p=0.005, but the between-group difference was not significant (-15 min, 95% CI -51 to 21, p=0.406).

“Sedentary time (min) PR + PA 495 ± 84 458 ± 111 -37 (12-62) 0.005 -15 (-51 to 21) 0.406 PR alone 541 ± 90 519 ± 103 -22 (-48 to 3) 0.088”

May combine two claims.

In the current study, the PR+PA group increased MVPA by 3 min (95% CI 0-6) within group, p=0.041, but the between-group difference was not significant (3 min, 95% CI -1 to 7, p=0.185).

“MVPA (min) PR + PA 7 ± 8 10 ± 14 3 (0-6) 0.041 3 (-1 to 7) 0.185 PR alone 7 ± 10 7 ± 8 0 (-3 to 3) 0.791”

May combine two claims.

In the current study, quadriceps muscle voluntary capacity improved within the PR+PA group by 5.0 kg (95% CI 3.4-6.8, p=0.001), and the between-group difference was 2.5 kg (95% CI 0.2-4.9, p=0.033).

“QMVC (kg) | PR + PA | 24.6 ± 8.7 | 29.6 ± 9.7 | 5.0 (3.4-6.8) | 0.001 | 2.5 (0.2-4.9) | 0.033 |”

May combine two claims.

In the current study, the PR+PA group increased light time by 20 min (95% CI 6-35) within group, and the between-group difference was 22 min (95% CI 2-43), p=0.030.

“Light time (min) PR + PA 167 ± 56 187 ± 73 20 (6-35) 0.006 22 (2-43) 0.030 PR alone 135 ± 57 133 ± 48 -2 (-17 to 12) 0.741”

Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based). May combine two claims.

The C-PPAC instrument is responsive to pharmacological and non-pharmacological interventions and to changes in clinically relevant variables.

“The C-PPAC instrument is responsive to pharmacological and non-pharmacological interventions and to changes in clinically relevant variables.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Twelve patients were lost during the study due to COPD exacerbation (n=6), non-respiratory illness (n=5), and inability to attend PR (n=1).

“Throughout the study, 12 patients were lost due to: ECOPD (n = 6), non-respiratory illness' (n = 5) and inability to attend the PR programme (n = 1).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Randomisation was stratified by 6-minute walk distance (<350 m or ≥350 m) and average HADS score (<8 or ≥8) using a block size of 4 at the onset of PR.

“Randomisation was stratified by the 6MWD (<350 m or ≥ 350 m), and the average HADS score for anxiety and depression (<8 points or ≥8 points) using a block size of 4 at the onset of the PR programme.”

Classified as probably not a substantial claim. May combine two claims.

Forty-eight patients completed the post-PR assessment, with 24 in PR+PA and 24 in PR alone.

“Therefore, 48 patients completed the post-PR assessment visit, with 24 patients completing PR + PA and 24 completing PR alone.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The study was prospectively registered at clinicaltrials.gov (NCT03749655).

“This study complies with NIHR HRA requirements (Ref: 18/YH/0376) and was prospectively registered at clinicaltrials.govonline database (NCT03749655).”

May combine two claims.

Pulmonary rehabilitation improves exercise capacity and health-related quality of life in people with COPD.

“while PR programs improve exercise capacity and health-related quality of life in people with COPD [6]”

• cites [6] Spruit, 2013, An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation, Am. J. Respir. Crit. Care Med. sourceNot checked — no full text of the source

May combine two claims.

The study was a single-centre, two parallel-groups randomised controlled trial with 1:1 individual allocation.

“This is a single centre, two parallel-groups, randomised controlled trial (RCT) with 1:1 individual allocation looking into patient compliance to PA behavioural modification interventions alongside PR (PR + PA) and its efficacy in comparison to PR alone in patients with COPD.”

Classified as probably not a substantial claim. May combine two claims.

Seventy patients provided consent, and 60 were randomised to PR+PA (n=31) or PR alone (n=29).

“In total, 70 patients provided consent for the study at visit 1, while 60 patients were randomised at visit 2 to PR + PA (n = 31) and PR alone (n = 29) (Fig. 1).”

May combine two claims.

Varas et al. blinded patients by giving pedometers to both groups but no pedometer-specific instructions to controls.

“Varas and colleagues [16] blinded patients by allocating a pedometer to both intervention and control groups, but provided no pedometer specific instructions to the control group.”

• cites [16] Varas, 2018, Effectiveness of a community‐based exercise training programme to increase physical activity level in patients with chronic obstructive pulmonary disease: a randomized controlled trial, Physiother. Res. Int. sourceNot checked — no full text of the source

May combine two claims.

Lack of patient blinding to allocation may have reduced the quality of evidence and increased risk of bias favouring the intervention.

“Our inability to blind patients to the study allocation may have impacted on the overall quality of evidence and increased the risk of bias towards the intervention.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The approach of concealing group existence would have been difficult in the current study because resources were insufficient to run two separate PR programmes simultaneously.

“The latter would be difficult to incorporate into the current study due to the lack of resources available to run two separate PR programmes simultaneously, in order to refrain the existence of groups from one another.”

May combine two claims.

The initial motivational interview allowed the researcher to discuss preferred and non-preferred activities with the patient and tailor weekly PA goals to enjoyed activities, encouraging self-motivation.

“Furthermore, the initial motivation interview stimulated a discussion between patient and researcher regarding preferred and non-preferred activities, allowing the researcher to tailor weekly PA goals around activities that the patient enjoyed, encouraging self-motivation within the patient [12].”

• cites [12] de Blok, 2006, The effects of a lifestyle physical activity counseling program with feedback of a pedometer during pulmonary rehabilitation in patients with COPD: a pilot study, Patient Educ. Counsel. sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Having patients bring step count diaries to each PR session and twice-weekly face-to-face consultations allowed the research team to monitor compliance and intervene when patients could not cope with current goals.

“Finally, attending each PR session with a step count diary and twice-weekly face-to-face consultations gave the research team an insight into the compliance of each patient, and enabled researchers to intervene if patients were unable to cope with the present goals.”

May combine two claims.

Because a single researcher administered all measures face-to-face and delivered the PA behavioural intervention, assessor blinding was impossible and related bias could not be avoided.

“Due to all measures being administered in a face-to-face manner by a single researcher, bias related to the researcher providing the PA behavioural modification interventions couldn't be avoided and blinding of assessor was not possible.”

Classified as probably not a substantial claim. May combine two claims.

Giving a pedometer to the PR-alone group, even without PA counselling, might stimulate self-management and increase their steps/day.

“Although the simple addition of a pedometer alongside generic advice on PA provided during PR doesn't necessary provide any form of PA counselling, the stimulus and incentive to self-manage and increase steps/day with the availability of a pedometer may impact upon the steps/day of the PR alone group.”

Probably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.

In the current study, baseline characteristics did not differ significantly between the PR+PA and PR alone groups.

“| Variable | PR alone (n = 24) | PR + PA (n = 24) | p value |”

• Also stated in: § 5. Conclusions · plain

  “| FEV 1 (L) | 1.21 ± 0.5 | 1.27 ± 0.5 | 0.733 |”