Setting
This multicenter trial is coordinated by the CAPHRI School for Public Health and Primary Care of Maastricht University and conducted in several general practices and physiotherapy practices in the southern part of the Netherlands.
Study population
Participants for the trial will be recruited from general practices in Limburg, in the southern part of the Netherlands. There are 614 general practices in this region covering a population of over 1.000.000 [30]. Statistics suggest that 1,7% of the Dutch population is likely to have COPD [31]. The population in Limburg is the least physically active population of the Netherlands [32].
Inclusion will be based on patients with a clinical diagnosis of mild to moderate COPD (post-bronchodilator FEV1/FVC ratio < 0,7 and FEV1 ≥ 50% of predicted); who not have a minimum of 30 minutes of physical activity at moderate
intensity, on at least 5 days per week, according to the ACSM-recommendation [33]; having a stable situation
(no exacerbations in the last 8 weeks) and adequate and optimal inhalation technique, are competent enough to
understand and speak the Dutch language and having provided written informed consent. According to the Practice
Guidelines of the Dutch College of General Practitioners, a maximal cardiopulmonary exercise test prior to exercise
training will be conducted by a pulmonologist, cardiologist or a sports medicine physician in COPD patients who suffer
from cardiopulmonary co morbidities [5,34]. Patients will be excluded from the trial, when they: already receive or have received a physical exercise training programme or rehabilitation therapy in the past year; have had respiratory tract infections within the last 8 weeks; are suffering from serious co morbid conditions, which would interfere with regular exercise training (including severe orthopaedic, muscular, neurological disorders or cardiovascular
conditions) and patients who are expected to be lost for follow-up (e.g. because of a planned change of residency
or a long holiday break).