421
Views
11
CrossRef citations to date
0
Altmetric
Clinical Features

Exercise and COPD: Therapeutic Responses, Disease-Related Outcomes, and Activity-Promotion Strategies

, MD
Pages 66-80 | Published online: 13 Mar 2015

References

  • . World Health Organization. World Health Statistics 2008. http://www.who.int/whosis/whostat/EN_WHS08_Full.pdf. Accessed March 16, 2011
  • . Jemal A, Ward E, Hao Y, Thun M. Trends in the leading causes of death in the United States, 1970-2002. JAMA. 2005;294(10):1255–1259
  • . Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management and Prevention of COPD. Revised 2011. http://www.goldcopd.org/uploads/users/files/GOLD_Report_2011Dec30.pdf. Updated December 30, 2011. Accessed January 2, 2012
  • . Decramer M, Rennard S, Troosters T, . COPD as a lung disease with systemic consequences—clinical impact, mechanisms, and potential for early intervention. COPD. 2008;5(4):235–256
  • . Finkelstein J, Cha E, Scharf SM. Chronic obstructive pulmonary disease as an independent risk factor for cardiovascular morbidity. Int J Chron Obstruct Pulmon Dis. 2009;4:337–349
  • . Mannino DM, Braman S. The epidemiology and economics of chronic obstructive pulmonary disease. Proc Am Thorac Soc. 2007;4(7):502–506
  • . Troosters T, Sciurba F, Battaglia S, . Physical inactivity in patients with COPD, a controlled multi-center pilot-study. Respir Med. 2010;104(7):1005–1011
  • . ZuWallack R. How are you doing? What are you doing? Differing perspectives in the assessment of individuals with COPD. COPD. 2007;4(3):293–297
  • . McDonough JE, Yuan R, Suzuki M, . Small-airway obstruction and emphysema in chronic obstructive pulmonary disease. N Engl J Med. 2011;365(17):1567–1575
  • . Hogg JC, Timens W. The pathology of chronic obstructive pulmonary disease. Annu Rev Pathol. 2009;4:435–459
  • . Molfino NA. Genetics of COPD. Chest. 2004;125(5):1929–1940
  • . Pepin V, Laviolette L, Saey D, Maltais F. Synergetic interactions between rehabilitation and pharmacotherapy in COPD. Clin Invest Med. 2006;29(3):170–177
  • . Aliverti A, Macklem PT. The major limitation to exercise performance in COPD is inadequate energy supply to the respiratory and locomotor muscles. J Appl Physiol. 2008;105(2):749–751
  • . Debigaré R, Maltais F. Last Word on Point: Counterpoint: The major limitation to exercise performance in COPD is 1) inadequate energy supply to the respiratory and locomotor muscles, 2) lower limb muscle dysfunction, 3) dynamic hyperinflation. J Appl Physiol. 2008;105(2):764
  • . Aliverti A, Macklem PT. Last Word on Point: Counterpoint: The major limitation to exercise performance in COPD is 1) inadequate energy supply to the respiratory and locomotor muscles, 2) lower limb muscle dysfunction, 3) dynamic hyperinflation. J Appl Physiol. 2008;105(2):763
  • . Debigaré R, Maltais F. The major limitation to exercise performance in COPD is lower limb muscle dysfunction. J Appl Physiol. 2008;105(2):751–753
  • . O'Donnell D, Webb K. Last Word on Point: Counterpoint: The major limitation to exercise performance in COPD is 1) inadequate energy supply to the respiratory and locomotor muscles, 2) lower limb muscle dysfunction, 3) dynamic hyperinflation. J Appl Physiol. 2008;105(2):765
  • . Pepin V, Saey D, Laviolette L, Maltais F. Exercise capacity in chronic obstructive pulmonary disease: mechanisms of limitation. COPD. 2007;4(3):195–204
  • . Katz PP, Gregorich S, Eisner M, . Disability in valued life activities among individuals with COPD and other respiratory conditions. J Cardiopulm Rehabil Prev. 2010;30(2):126–136
  • . Cooper CB. Airflow obstruction and exercise. Respir Med. 2009;103(3):325–334
  • . National Guideline Clearinghouse (NGC-7228). Coronary artery disease (CAD) clinical practice guidelines. Kaiser Permanente Care Management Institute. http://guideline.gov/content.aspx?id=14438. Accessed March 2, 2011
  • . O'Donnell DE, Revill SM, Webb KA. Dynamic hyperinflation and exercise intolerance in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001;164(5):770–777
  • . Deesomchok A, Webb KA, Forkert L, . Lung hyperinflation and its reversibility in patients with airway obstruction of varying severity. COPD. 2010;7(6):428–437
  • . Hannink J, Lahaije A, Bischoff E, . Dynamic hyperinflation after metronome-paced hyperventilation in COPD—a 2 year follow-up. Respir Med. 2010;104(11):1700–1705
  • . Ofir D, Laveneziana P, Webb KA, Lam YM, O'Donnell DE. Mechanisms of dyspnea during cycle exercise in symptomatic patients with GOLD stage I chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2008;177(6):622–629
  • . Saey D, Debigare R, LeBlanc P, . Contractile leg fatigue after cycle exercise: a factor limiting exercise in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2003;168(4):425–430
  • . Jones PW. Health status and the spiral of decline. COPD. 2009;6(1):59–63
  • . Couillard A, Muir JF, Veale D. COPD recent findings: impact on clinical practice. COPD. 2010;7(3):204–213
  • . Lewis R, Cramp F. Facilitators and barriers to exercise maintenance in chronic obstructive pulmonary disease: patient views. Physiotherapy Ireland. 2010;31(2)19–24
  • . Janssens T, De Peuter S, Stans L, . Dyspnea perception in COPD: association between anxiety, dyspnea-related fear and dyspnea in a pulmonary rehabilitation program. Chest. 2011;140(3):618–625
  • . Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med. 2002;346(11):793–801
  • . Oga T, Nishimura K, Tsukino M, Sato S, Hajiro T. Analysis of the factors related to mortality in chronic obstructive pulmonary disease: role of exercise capacity and health status. Am J Respir Crit Care Med. 2003;167(4):544–549
  • . Garcia-Aymerich J, Lange P, Benet M, Schnohr P, Antó JM. Regular physical activity reduces hospital admission and mortality in chronic obstructive pulmonary disease: a population based cohort study. Thorax. 2006;61(9):772–778
  • . Garcia-Aymerich J, Lange P, Benet M, Schnohr P, Antó JM. Regular physical activity modifies smoking-related lung function decline and reduces risk of chronic obstructive pulmonary disease: a population-based cohort study. Am J Respir Crit Care Med. 2007;175(5):458–463
  • . Pelkonen M, Notkola IL, Lakka T, Tukiainen HO, Kivinen P, Nissinen A. Delaying decline in pulmonary function with physical activity: a 25-year follow-up. Am J Respir Crit Care Med. 2003;168(4):494–499
  • . Pitta F, Troosters T, Probst VS, Spruit MA, Decramer M, Gosselink R. Physical activity and hospitalization for exacerbation of COPD. Chest. 2006;129(3):536–544
  • . Celli BR, Cote CG, Marin JM, . The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med. 2004;350(10):1005–1012
  • . Nishimura K, Izumi T, Tsukino M, Oga T. Dyspnea is a better predictor of 5-year survival than airway obstruction in patients with COPD. Chest. 2002;121(5):1434–1440
  • . Waschki B, Kirsten A, Holz O, . Physical activity is the strongest predictor of all-cause mortality in patients with COPD: a prospective cohort study. Chest. 2011;140(2):331–342
  • . Wisløff U, Najjar SM, Ellingsen O, . Cardiovascular risk factors emerge after artificial selection for low aerobic capacity. Science. 2005;307(5708):418–420
  • . Haskell WL. The influence of exercise on the concentrations of triglyceride and cholesterol in human plasma. Exerc Sport Sci Rev. 1984;12:205–244
  • . Fagard RH. Effects of exercise, diet and their combination on blood pressure. J Hum Hypertens. 2005;19( suppl 3):S20–S24
  • . Ren JM, Semenkovich CF, Gulve EA, Gao J, Holloszy JO. Exercise induces rapid increases in GLUT4 expression, glucose transport capacity, and insulin-stimulated glycogen storage in muscle. J Biol Chem. 1994;269(20):14396–14401
  • . Thorp AA, Owen N, Neuhaus M, Dunstan DW. Sedentary behaviors and subsequent health outcomes in adults: a systematic review of longitudinal studies, 1996-2011. Am J Prev Med. 2011;41(2):207–215
  • . Marquis K, Debigaré R, Lacasse Y, . Midthigh muscle cross-sectional area is a better predictor of mortality than body mass index in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2002;166(6):809–813
  • . Schols AM, Broekhuizen R, Weling-Scheepers CA, Wouters EF. Body composition and mortality in chronic obstructive pulmonary disease. Am J Clin Nutr. 2005;82(1):53–59
  • . Garcia-Aymerich J, Serra I, Gómez FP, . Physical activity and clinical and functional status in COPD. Chest. 2009;136(1):62–70
  • . Seymour JM, Moore L, Jolley CJ, . Outpatient pulmonary rehabilitation following acute exacerbations of COPD. Thorax. 2010;65(5):423–428
  • . Spruit MA, Gosselink R, Troosters T, . Muscle force during an acute exacerbation in hospitalised patients with COPD and its relationship with CXCL8 and IGF-I. Thorax. 2003;58(9):752–756
  • . Troosters T, Probst VS, Crul T, . Resistance training prevents deterioration in quadriceps muscle function during acute exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2010;181(10):1072–1077
  • . McNicholas WT. Impact of sleep in COPD. Chest. 2000;117( 2 suppl): S48–S53
  • . Loprinzi PD, Cardinal BJ. Association between objectively-measured physical activity and sleep, NHANES 2005-2006. Mental Health and Physical Activity. 2011;4(2):65–69
  • . Myers J, Bader D, Madhavan R, Froelicher V. Validation of a specific activity questionnaire to estimate exercise tolerance in patients referred for exercise testing. Am Heart J. 2001;142(6):1041–1046
  • . Ståhl E, Jansson SA, Jonsson AC, Svensson K, Lundbäck B, Andersson F. Health-related quality of life, utility, and productivity outcomes instruments: ease of completion by subjects with COPD. Health Qual Life Outcomes. 2003;1:18
  • . Cella D. Functional Assessment of Chronic Illness Therapy (FACIT)-Dyspnea Short Form. http://www.facit.org/FACITOrg/Questionnaires. Accessed January 15, 2013
  • . Langer D, Gosselink R, Sena R, Burtin C, Decramer M, Troosters T. Validation of two activity monitors in patients with COPD. Thorax. 2009;64(7):641–642
  • . Langer D, Pitta F, Troosters T, Burtin C, Decramer M, Gosselink R. Quantifying physical activity in COPD: different measures for different purposes. Thorax. 2009;64(5):458
  • . Pitta F, Troosters T, Spruit MA, Decramer M, Gosselink R. Activity monitoring for assessment of physical activities in daily life in patients with chronic obstructive pulmonary disease. Arch Phys Med Rehabil. 2005;86(10):1979–1985
  • . Pitta F, Troosters T, Spruit MA, Probst VS, Decramer M, Gosselink R. Characteristics of physical activities in daily life in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2005;171(9):972–977
  • . Cavalheri V, Donária L, Ferreira T, . Energy expenditure during daily activities as measured by two motion sensors in patients with COPD. Respir Med. 2011;105(6):922–929
  • . Bornstein DB, Beets MW, Byun W, . Equating accelerometer estimates of moderate-to-vigorous physical activity: in search of the Rosetta Stone. J Sci Med Sport. 2011;14(5):404–410
  • . Hsia D, Casaburi R, Pradhan A, Torres E, Porszasz J. Physiological responses to linear treadmill and cycle ergometer exercise in COPD. Eur Respir J. 2009;34(3):605–615
  • . O'Donnell DE, Travers J, Webb KA, . Reliability of ventilatory parameters during cycle ergometry in multicentre trials in COPD. Eur Respir J. 2009;34(4):866–874
  • . Oga T, Nishimura K, Tsukino M, Hajiro T, Ikeda A, Izumi T. The effects of oxitropium bromide on exercise performance in patients with stable chronic obstructive pulmonary disease. A comparison of three different exercise tests. Am J Respir Crit Care Med. 2000;161(6):1897–1901
  • . Pepin V, Saey D, Whittom F, LeBlanc P, Maltais F. Walking versus cycling: sensitivity to bronchodilation in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2005;172(12):1517–1522
  • . American Thoracic Society; American College of Chest Physicians. ATS/ACCP Statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med. 2003;167(2):211–277
  • . Kocks JW, Asijee GM, Tsiligianni IG, Kerstjens HA, van der Molen T. Functional status measurement in COPD: a review of available methods and their feasibility in primary care. Prim Care Respir J. 2011;20(3):269–275
  • . Pepin V, Brodeur J, Lacasse Y, . Six-minute walking versus shuttle walking: responsiveness to bronchodilation in chronic obstructive pulmonary disease. Thorax. 2007;62(4):291–298
  • . Singh SJ, Morgan MD, Scott S, Walters D, Hardman AE. Development of a shuttle walking test of disability in patients with chronic airways obstruction. Thorax. 1992;47(12):1019–1024
  • . Revill SM, Morgan MD, Singh SJ, Williams J, Hardman AE. The endurance shuttle walk: a new field test for the assessment of endurance capacity in chronic obstructive pulmonary disease. Thorax. 1999;54(3):213–222
  • . Cooper CB, Abrazado M, Legg D, Kesten S. Development and implementation of treadmill exercise testing protocols in COPD. Int J Chron Obstruct Pulmon Dis. 2010;5:375–385
  • . Poulain M, Durand F, Palomba B, . 6-minute walk testing is more sensitive than maximal incremental cycle testing for detecting oxygen desaturation in patients with COPD. Chest. 2003;123(5):1401–1407
  • . O'Donnell DE, Flüge T, Gerken F, . Effects of tiotropium on lung hyperinflation, dyspnoea and exercise tolerance in COPD. Eur Respir J. 2004;23(6):832–840
  • . O'Donnell DE, Voduc N, Fitzpatrick M, Webb KA. Effect of salmeterol on the ventilatory response to exercise in chronic obstructive pulmonary disease. Eur Respir J. 2004;24(1):86–94
  • . Man WD, Soliman MG, Gearing J, . Symptoms and quadriceps fatigability after walking and cycling in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2003;168(5):562–567
  • . Neder JA, Fuld JP, Overend T, . Effects of formoterol on exercise tolerance in severely disabled patients with COPD. Respir Med. 2007;101(10):2056–2064
  • . Worth H, Förster K, Eriksson G, Nihlén U, Peterson S, Magnussen H. Budesonide added to formoterol contributes to improved exercise tolerance in patients with COPD. Respir Med. 2010;104(10):1450–1459
  • . Okudan N, Gök M, Gökbel H, Süerdem M. Single dose of tiotropium improves the 6-minute walk distance in chronic obstructive pulmonary disease. Lung. 2006;184(4):201–204
  • . Grove A, Lipworth BJ, Reid P, . Effects of regular salmeterol on lung function and exercise capacity in patients with chronic obstructive airways disease. Thorax. 1996;51(7):689–693
  • . Puhan MA, Mador MJ, Held U, Goldstein R, Guyatt GH, Schünemann HJ. Interpretation of treatment changes in 6-minute walk distance in patients with COPD. Eur Respir J. 2008;32(3):637–643
  • . Verkindre C, Bart F, Aguilaniu B, . The effect of tiotropium on hyperinflation and exercise capacity in chronic obstructive pulmonary disease. Respiration. 2006;73(4):420–427
  • . Bédard ME, Brouillard C, Pepin V, . Tiotropium improves walking endurance in COPD. Eur Respir J. 2012;39(2):265–271
  • . Brouillard C, Pepin V, Milot J, Lacasse Y, Maltais F. Endurance shuttle walking test: responsiveness to salmeterol in COPD. Eur Respir J. 2008;31(3):579–584
  • . Pepin V, Laviolette L, Brouillard C, . Significance of changes in endurance shuttle walking performance. Thorax. 2011;66(2):115–120
  • . Casaburi R, Kukafka D, Cooper CB, Witek TJ Jr, Kesten S. Improvement in exercise tolerance with the combination of tiotropium and pulmonary rehabilitation in patients with COPD. Chest. 2005;127(3):809–817
  • . Berton DC, Reis M, Siqueira AC, . Effects of tiotropium and formoterol on dynamic hyperinflation and exercise endurance in COPD. Respir Med. 2010;104(9):1288–1296
  • . Saey D, Pepin V, Brodeur J, . Use of facemask and mouthpiece to assess constant-workrate exercise capacity in COPD. Med Sci Sports Exerc. 2006;38(2):223–230
  • . Whipp BJ, Ward SA. Quantifying intervention-related improvements in exercise tolerance. Eur Respir J. 2009;33(6):1254–1260
  • . Maltais F, Hamilton A, Marciniuk D, . Improvements in symptom-limited exercise performance over 8 h with once-daily tiotropium in patients with COPD. Chest. 2005;128(3):1168–1178
  • . O'Donnell DE, Sciurba F, Celli B, . Effect of fluticasone propionate/salmeterol on lung hyperinflation and exercise endurance in COPD. Chest. 2006;130(3):647–656
  • . Maltais F, Celli B, Casaburi R, . Aclidinium bromide improves exercise endurance and lung hyperinflation in patients with moderate to severe COPD. Respir Med. 2011;105(4):580–587
  • . Mador MJ, Bozkanat E, Aggarwal A, Shaffer M, Kufel TJ. Endurance and strength training in patients with COPD. Chest. 2004;125(6):2036–2045
  • . Porszasz J, Casaburi R, Somfay A, Woodhouse LJ, Whipp BJ. A treadmill ramp protocol using simultaneous changes in speed and grade. Med Sci Sports Exerc. 2003;35(9):1596–1603
  • . O'Donnell DE, Casaburi R, Vincken W, . Effect of indacaterol on exercise endurance and lung hyperinflation in COPD. Respir Med. 2011;105(7):1030–1036
  • . Casaburi R. Factors determining constant work rate exercise tolerance in COPD and their role in dictating the minimal clinically important difference in response to interventions. COPD. 2005;2(1):131–136
  • . Laviolette L, Bourbeau J, Bernard S, . Assessing the impact of pulmonary rehabilitation on functional status in COPD. Thorax. 2008;63(2):115–121
  • . Zhang X, Waterman LA, Ward J, Baird JC, Mahler DA. Advantages of endurance treadmill walking compared with cycling to assess bronchodilator therapy. Chest. 2010;137(6):1354–1361
  • . Deschênes D, Pepin V, Saey D, LeBlanc P, Maltais F. Locus of symptom limitation and exercise response to bronchodilation in chronic obstructive pulmonary disease. J Cardiopulm Rehabil Prev. 2008;28(3):208–214
  • . Hay JG, Stone P, Carter J, . Bronchodilator reversibility, exercise performance and breathlessness in stable chronic obstructive pulmonary disease. Eur Respir J. 1992;5(6):659–664
  • . Spence DP, Hay JG, Carter J, Pearson MG, Calverley PM. Oxygen desaturation and breathlessness during corridor walking in chronic obstructive pulmonary disease: effect of oxitropium bromide. Thorax. 1993;48(11):1145–1150
  • . Boyd G, Morice AH, Pounsford JC, Siebert M, Peslis N, Crawford C. An evaluation of salmeterol in the treatment of chronic obstructive pulmonary disease (COPD). Eur Respir J. 1997;10(4):815–821
  • . Mahler DA, Donohue JF, Barbee RA, . Efficacy of salmeterol xinafoate in the treatment of COPD. Chest. 1999;115(4):957–965
  • . O'Donnell D, Maltais F, Porszasz J, . Lung function and exercise impairment in patients with GOLD stage I and II COPD. Poster presented at: American Thoracic Society 108th International Conference; May 18-23, 2012; San Francisco, CA
  • . Blonshine S, Cao R, Casaburi R, Paden H, Porszasz J. Results from a multi-center cardiopulmonary exercise physiological quality control protocol. Poster presented at: American Thoracic Society 108th International Conference; May 18-23, 2012; San Francisco, CA
  • . Lacasse Y, Goldstein R, Lasserson TJ, Martin S. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2006;(4):CD003793
  • . Ortega F, Toral J, Cejudo P, . Comparison of effects of strength and endurance training in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2002;166(5):669–674
  • . Porszasz J, Emtner M, Goto S, Somfay A, Whipp BJ, Casaburi R. Exercise training decreases ventilatory requirements and exercise-induced hyperinflation at submaximal intensities in patients with COPD. Chest. 2005;128(4):2025–2034
  • . Pasqua F, Biscione G, Crigna G, Auciello L, Cazzola M. Combining triple therapy and pulmonary rehabilitation in patients with advanced COPD: a pilot study. Respir Med. 2010;104(3):412–417
  • . Crul T, Spruit MA, Gayan-Ramirez G, . Markers of inflammation and disuse in vastus lateralis of chronic obstructive pulmonary disease patients. Eur J Clin Invest. 2007;37(11):897–904
  • . Donaldson GC, Wilkinson TM, Hurst JR, Perera WR, Wedzicha JA. Exacerbations and time spent outdoors in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2005;171(5):446–452
  • . Tashkin DP, Celli B, Senn S, ; UPLIFT Study Investigators.A 4-year trial of tiotropium in chronic obstructive pulmonary disease. N Engl J Med. 2008;359(15):1543–1554
  • . Calverley PM, Anderson JA, Celli B, ; TORCH investigators.Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med. 2007;356(8):775–789
  • . Pitta F, Troosters T, Probst VS, Langer D, Decramer M, Gosselink R. Are patients with COPD more active after pulmonary rehabilitation? Chest. 2008;134(2):273–280
  • . Marciniuk DD, Brooks D, Butcher S, et al; Canadian Thoracic Society COPD Committee Expert Working Group. Optimizing pulmonary rehabilitation in chronic obstructive pulmonary disease—practical issues: a Canadian Thoracic Society Clinical Practice Guideline. Can Respir J. 2010;17(4):159–168
  • . Behnke M, Wewel AR, Kirsten D, Jörres RA, Magnussen H. Exercise training raises daily activity stronger than predicted from exercise capacity in patients with COPD. Respir Med. 2005;99(6):711–717
  • . Kesten S, Casaburi R, Kukafka D, Cooper CB. Improvement in self-reported exercise participation with the combination of tiotropium and rehabilitative exercise training in COPD patients. Int J Chron Obstruct Pulmon Dis. 2008;3(1):127–136
  • . Soicher JE, Mayo NE, Gauvin L, . Trajectories of endurance activity following pulmonary rehabilitation in COPD patients. Eur Respir J. 2012;39(2):272–278
  • . US Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. http://health.gov/paguidelines/pdf/paguide.pdf. Published August 21, 2009. Accessed March 23, 2012
  • . Nelson ME, Rejeski WJ, Blair SN, . Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Circulation. 2007;116(9):1094–1105
  • . McGuire KA, Ross R. Incidental physical activity is positively associated with cardiorespiratory fitness. Med Sci Sports Exerc. 2011;43(11):2189–2194
  • . Gordon NF, Kohl HW, Blair SN. Life Style Exercise: A new strategy to promote physical activity for adults. J Cardiopulm Rehabil. 1993;13(3):161–163
  • . Pinto BM, Goldstein MG, Marcus BH. Activity counseling by primary care physicians. Prev Med. 1998;27(4):506–513
  • . Lewis BS, Lynch WD. The effect of physician advice on exercise behavior. Prev Med. 1993;22(1):110–121
  • . Cardinal BJ, Kosma M. Self-efficacy and the stages and processes of change associated with adopting and maintaining muscular fitness-promoting behaviors. Res Q Exerc Sport. 2004;75(2):186–196
  • . Miller WR, Rollnick S, eds. Motivational Interviewing: Preparing People for Change. 2nd ed. New York, NY: Guilford Press; 2002
  • . Puhan MA, Chandra D, Mosenifar Z, ; and National Emphysema Treatment Trial (NETT) Research Group.The minimal important difference of exercise tests in severe COPD. Eur Respir J. 2011;37(4):784–790

Reprints and Corporate Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

To request a reprint or corporate permissions for this article, please click on the relevant link below:

Academic Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

Obtain permissions instantly via Rightslink by clicking on the button below:

If you are unable to obtain permissions via Rightslink, please complete and submit this Permissions form. For more information, please visit our Permissions help page.