The Effect of a Technology-Mediated Integrated Walking and Tai Chi Intervention on Physical Function in Veterans With COPD and Chronic Musculoskeletal Pain

Inclusion Criteria:

* Male and female participants, aged 40 and older
* Clinical diagnosis of COPD defined as history of cigarette consumption of \> 10 pack-years, and either a ratio of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) \< 0.70 or chest computerized tomography (CT) evidence of emphysema\*
* Numeric Rating Scale pain score \> 3 for \> 3 months
* Self-reported ability to walk a minimum of one block, bend at the hip, and transfer weight from one leg to another
* Ability to complete 800 feet walk with Fitbit Inspire-2 recording \> 90% accuracy to detect steps compared to manual counts\*
* Have access to a computer or smartphone with Internet connection or willing to come to study site to use study computers
* Have access to videoconferencing audio and video capabilities
* Competent to provide informed consent and willingness to make return study visits

  * Different criteria are used if baseline study visit is a virtual one.

Exclusion Criteria:

* COPD exacerbation in the previous 1 month
* Clinical signs of unstable cardiovascular disease (active coronary artery disease, congestive heart failure, uncontrolled atrial fibrillation, or uncontrolled hypertension)
* Oxygen saturation \< 85% recorded on baseline 4-meter walk\*
* High fall risk (unable to perform 5 chair stand tests)
* Inability to ambulate
* Inability to complete questionnaires
* Inability to collect at least 7 of 10 days of baseline step counts
* Active substance abuse
* Participation in a regular exercise (i.e., MOVE! or Gerofit) or Tai Chi program in the previous 3 months
* Concurrent participation in another interventional research study
* Receipt of hospice or end-of-life palliative care
* Active medical intervention that would cause a meaningful increase in pain such as surgery, chemotherapy, or radiation therapy

  * Different criteria are used if baseline study visit is a virtual one.