An intervention program that incorporates outdoor walking trails, motivational feedback, and support increased physical activity in COPD patients, according to a study published in the European Respiratory Journal. [maxbutton id="1" url="http://info.rtmagazine.com/regform" text="SUBSCRIBE TO NEWS" ] The Urban Training Program was developed by researchers in Spain to encourage COPD patients to increase and maintain their walking activity -- a well integrated part of daily life for the elderly in Mediterranean cities. The randomized controlled trial included 407 COPD patients and split them into two groups: usual care (205) or Urban Training (202). The goal of the trial was to assess the 12 month change in steps per day for each group, measured by accelerometer. The Urban Training intervention program involved the following components: A respiratory physiotherapist used motivational interviewing techniques focusing on empathy, reflective listening, affirmation, and addressed patients' resistances (personal difficulties, barriers and limitations) to elicit a behavioral change. During the follow-up period, the physiotherapist administered up to four phone calls lasting 5-10 min to maintain motivation, depending on patients’ self-efficacy and stage of change. Participants received maps of Urban Training walking trails (low, moderate or high intensity trails). Each patient was advised to start with a trail of intensity appropriate to his/her baseline dyspnea and 6MWD, at least one trail per day at least 5 days per week. Patients were provided with both a pedometer and a personalized calendar to monitor their physical activity and keep motivation. Patients also received the same ELF’s information brochure as the usual care group and a personal cell phone number where they would receive phone text messages every 2 weeks with educational or motivational messages. Once per month during the follow-up period, patients could join a walking group for walking a trail accompanied by an experienced physical activity trainer. Patients were provided a phone number to contact the physiotherapists for any questions during follow-up. According to results, the intervention group increased their physical activity by an average of 816 steps per day, compared to no physical activity change in the control group. After adjusted analysis for nonadherence factors (FEV1/FVC, smoking, diabetes and HAD-depression score), there was a difference in steps per day of +957 for the intervention group compared to the control group. No differences were reported in any of the secondary outcomes or in cognitive impairment. Between intervention and control groups, mild-to-moderate COPD patients had were +959 steps/day and severe-to-very severe COPD patients were +383. Researchers concluded "the Urban TrainingTM intervention is more efficacious than usual care in increasing physical activity after 12 months in patients with COPD, with few safety concerns." They did point out the need for patients to be willing and adherent to the protocol, however, as the physical activity increases were not observed in unwilling or self-reported nonadherent patients.