Commercially available accelerometers (Fitbits) will be used to monitor physical activity levels and behavioral coaching will be used to develop strategies of how to increase non-exercise physical activity levels.
In order to monitor physical activity levels, the adolescents in both groups will be required to complete the Adolescent Physical Activity Recall Questionnaire (APARQ), which has been validated in an Australian population [ 25]; and complete a 4-day activity diary (Children's Nutrition Centre, University of Queensland, Australia).
Bearing in mind that people over 60 years of age are mostly bound to their place of residence and that attending testing premises may be an issue, the authors believe that the IPAQ and its methods and protocol are extremely valuable and practical, and meet the need for each country to monitor physical activity levels in the population.
On study completion, they will be offered individual feedback on their activity levels from their accelerometer recordings by post along with a pedometer to keep, with instructions on how to use it to monitor their physical activity levels.
Additionally, participants will complete monthly log-books at home (mailed back to the researchers), will monitor daily physical activity levels for one week during months 2 and 5, and will complete primary outcome measures at home (mailed back to researchers) at 3 months (secondary time-point).
We have identified the need for: better screening of participants, refined inclusion/exclusion criteria, closer tailored support, more flexible physical activity options, broader monitoring of physical activity levels and the use of incentives to encourage participation at postintervention testing.
Measures to improve the intervention and its evaluation include: better screening, refined inclusion/exclusion criteria, broader monitoring of physical activity levels, closer tailored support, more flexible exercise options and the use of incentives.
Pedometers can provide feedback to patients about their daily activity, and have been promoted as effective tools to monitor and increase physical activity levels in healthy populations [ 12], but it is not known if they are effective tools to improve physical activity levels in COPD patients.
Discussion of participants' experiences in the trial appeared to arouse curiosity and encouraged others to become aware of, and monitor, their own physical activity levels: 'I told my family, I told the people that I was sharing a house with, and there was generally a lot of curiosity about it.
Nevertheless, available research on some Arab countries using objective monitoring of daily physical activity levels has indicated that a high proportion of Saudi Arabian school children were not active enough to meet the minimal weekly requirement of moderate to vigorous health-enhancing physical activity.
To monitor the physical activity level, participants of the intervention group will also be asked to keep an exercise log during the 18-week exercise programme.
