Although insufficient to lead to significant or clinically
relevant between-group differences on the SGRQ-domain
physical activity (_2.8; 95% CI (_13 to 7 units)), the
benefits seen at 12 month in the energy and tension
dimensions are associated with lower perceived symptoms
measured by the SGRQ (_14.0; 95% CI (_23 to _5 units)).
These results concerning SGRQ-symptom scores are original,
compared to the pooled summary estimate for mean
change calculated in the review of Effing et al. (_1.4; 95%
CI (_4 to 1 units)).2 However, they are consistent with the
results reported by Boxal et al., who also provided supervised
exercise sessions within the self-management education program.6 This emphasizes the importance of exercise to act on the determinants of mood, such as energy and tension; mood that may bias symptom reporting. This change in perception of respiratory symptoms may explain the reduction observed in mean cost of COPD medication in favor of the intervention group (_481; 95% CI (_891 to _70 V) per patient and per year). Mood is strongly associated with investment beliefs, which have been shown as the primary predictor of physically active behavior ; thus the encouraging changes in two important elements of mood that we observed one year after a short self-management education intervention should be verified with a longer follow-up period.