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The main outcome variables were respiratory symptoms evaluated by the Dyspnoea-12 questionnaire (a validated 12-item breathlessness assessment tool with scores ranging from 0 to 36, where higher scores indicate greater dyspnea severity), pulmonary function parameters measured by spirometry (forced expiratory volume in one second [FEV 1 ], forced vital capacity [FVC]) and impulse oscillometry, and physical activity evaluated by both the International Physical Activity Questionnaire-Short Form (IPAQ-SF) 18 and objective step count assessed by accelerometry