Evaluation of a walking training program on quality of life and exercise capacity in patients with chronic obstructive pulmonary disease.

1A- Subjects that are randomised to the Walk Group (WG) or Walk Feedback Group (WFG) will attend a Pulmonary Rehabiltation program, 3 times a week for 8 weeks. They will complete overground walking training only, supervised by a physiotherapist. This will start at 30 minutes and will be progressed by 5 minutes every 6th session until a maximum of 45 minutes is reached. Trial 1B -Following the completion of the supervised walking training, both the WG and the WFG subjects will be asked to complete a further 12 months of home-based training. Subjects will receive a package comprising written instructions to walk for 45 minutes, with rests as necceasry on at least 3 days each week, a scoring system for self assessment of breathlessness and effort, and a weekly diary card to record the number of days of walking trianing each week and the total number of minutes walked each week. In addition the WFG will be given a pedometer to use during the home based training with further instrcutions to walk a minimum number of steps on at least 3 days each week whilst still achieving the duration of 45 minutes. The WFG will be contacted by telephone every 2 weeks for the first 3 months and their exercise training will be adjusted according to the number of steps achieved in the immediate past two training sessions. In the 3 to 12 month period, telephone contact will be made every month and training adjusted as above