General introduction 15 score representative of adherence. This study developed a valid and reliable measurement instrument which will be used in the other studies to objectively measure exercise adherence. Chapter 4 sets the basis for the development of an exercise adherence prediction model. This chapter includes a systematic review and meta-analysis of prognostic factors of adherence to home-based exercise therapy in patients with chronic diseases. Variables are identified, classified and graded. Chapter 5 describes exercise adherence over a 12-month period in patients with COPD following prolonged pulmonary rehabilitation, including clinical implications on health service utilization and possibly more affordable health care. Chapter 6 presents a study on the development of a prediction model for the probability of exercise adherence in patients with COPD already following pulmonary rehabilitation. The study provides an online calculator for practical use of the prediction model. Chapter 7 presents a supplement on the prediction model described in chapter 6. To not only predict adherence, but also to better understand the relationship between determinants and adherence, this supplement was written. It describes the predictors that could potentially had a causal relationship with exercise adherence to complement the prediction model and provides examples of interventions that might be used to possibly enhance exercise adherence. Chapter 8 provides a protocol for a study that will evaluate 1. The safety and effectiveness of self-management within pulmonary rehabilitation (PR) on health outcomes in patients with COPD, 2. the predictive validity of the PATCH tool, and 3. the feasibility and acceptability of self-management and the PATCH tool by patients and physiotherapists. In chapter 9, the general discussion, the results of all chapters are discussed and taken into a broader theoretical and practical perspective. This chapter also includes conclusions and recommendations for further research. References 1. Jakab, M., J. Farrington, S. Borgermans, and F. Mantingh, Health systems respond to noncommunicable diseases: time for ambition. 2018, Denmark: WHO Regional Office for Europe. 2. Zeilstra, A., A. den Ouden, and W. Vermeulen, Middellangetermijn- verkenning zorg 2022-2025 [Medium-term care exploration 2022-2025]. 2019. Available at:
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