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In patients with pulmonary disease, disease severity and prognosis are determined not only by lung function impairment (1, 2). In patients with mild, moderate, or severe disease, exercise capacity, health-related quality of life, and participation in activities of daily living are often impaired out of proportion to lung function impairment (3–5). Hence, therapies that improve the patient's lung function may have relatively limited impact on the above-mentioned outcomes (6, 7). Optimal bronchodilatation can be seen as a first step in the treatment of patients with chronic obstructive pulmonary disease (COPD); greater treatment effects (eg, improvements in exercise performance, symptoms, and health-related quality of life) are often achieved only after the addition of pulmonary rehabilitation (8). Comprehensive pulmonary rehabilitation programs aim at tackling the systemic consequences of COPD, as well as the behavioral …