Objectives. This study investigated the activity behavior of patients with COPD in detail compared to asymptomatic controls, and the relationship between subjective and objective activities (awareness), and readiness to change activity behavior. Methods. Thirty-nine patients with COPD (66.0 years; FEV1% predicted: 44.9%) and 21 healthy controls (57.0 years) participated. Objective daily activity was assessed by accelerometry and expressed as amount of activity in counts per minute (cpm). Patients' baseline subjective activity and stage of change were assessed prior to measurements. Results. Mean daily activity in COPD patients was significantly lower compared to the healthy controls ( ？cpm versus ？cpm, ). COPD patients showed a temporary decrease in objective activities in the early afternoon. Objective and subjective activities were significantly moderately related and most patients (55.3%) were in the maintenance phase of the stages of change. Conclusions. COPD patients show a distinctive activity decrease in the early afternoon. COPD patients are moderately aware of their daily activity but regard themselves as physically active. Therefore, future telemedicine interventions might consider creating awareness of an active lifestyle and provide feedback that aims to increase and balance activity levels. 1. Introduction Chronic Obstructive Pulmonary Disease (COPD) is a respiratory disease characterized by the progressive development of airflow limitation in the lungs, causing primarily shortness of breath (dyspnea) and diminishing physical exertion capabilities [1, 2]. Symptomatic patients with COPD are dyspnoeic even when they perform normal daily activities, which leads to inactivity and, subsequently, to physical deconditioning . A vicious cycle develops that greatly affects quality of life [1, 2]. Regular physical activity in COPD has been associated with a reduction of the risk of hospital (re)admission [3–5], increase of life expectancy , and slowing the rate of decline in lung function . The importance of an active lifestyle is underlined by several studies that showed the inactivity of COPD patients compared to healthy individuals, for example, [8–15]. This decrease in activity levels is not caused solely by airflow limitation, and other factors like dynamic hyperinflation and systemic inflammation seem to play an important role as well [16–18]. In addition to increasing activity levels, a more equally distributed daily activity pattern is assumed to improve patients’ well-being. In daily care healthcare professionals therefore advise
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