Supplementary Material for: Physical Activity Recommendations in Patients with Chronic Obstructive Pulmonary Disease

<b><i>Background:</i></b> Physical activity recommendations are hardly studied in patients with chronic obstructive pulmonary disease (COPD), and specifically recommendations that are individualized to a patient's aerobic fitness level are not studied. <b><i>Objectives:</i></b> To compare individualized (relative) and nonindividualized (absolute) physical activity recommendations in patients with COPD and to assess whether there are differences between patients with mild to moderate and (very) severe COPD. <b><i>Methods:</i></b> We compared 7 different physical activity recommendations that were described in the literature. Four recommendations were individualized based on the patient's aerobic fitness level measured by a maximal cycle ergometer test. Three recommendations were nonindividualized. The recommendations were measured with an accelerometer, pedometer or questionnaire in 115 patients with mild to very severe COPD (68% male, mean age 65 years, mean FEV<sub>1</sub> 58% predicted). <b><i>Results:</i></b> The percentage of patients that met the different recommendations ranged from 22 to 86% and only 8 patients met all 7 recommendations. The agreement between the different recommendations was poor (intraclass correlation coefficient, 0.28). Individualizing the recommendations resulted in a higher number of patients with severe or very severe COPD meeting the individualized recommendations compared to the nonindividualized recommendations. In contrast, patients with mild to moderate COPD less frequently met the individualized recommendations. <b><i>Conclusions:</i></b> Our study showed that applying various physical activity recommendations with small differences in frequency, intensity or time led to large differences in the classification of patients with COPD into being sufficiently physically active or not. Consequently, the used recommendation will highly affect the proposed physical activity advice to the patient.