Introduction
Pulmonary rehabilitation (PR) improves impairment and disability in patients with chronic obstructive pulmonary disease (COPD).1 Physical training contributes greatly to these effects of PR,2, 3 and training alone generates significant gains both in physiologic measures and in health-related quality of life (HRQOL).4 The improvements achieved by training will, however, fade in the absence of physical activity. PR for COPD patients is therefore aimed at creating permanent changes in behaviour towards increased physical activity also when patients have left the rehabilitation centre.3 However, some form of supervision after PR seems necessary if the improvements in body functions are to be sustained. Ries et al. found that weekly telephone calls and monthly reinforcement sessions at the hospital were not enough to prevent exercise tolerance and HRQOL from declining during the year after PR, even though the situation was even worse for the patients without such follow-up.5 Self-monitored endurance training (ET) with weekly visits to the rehabilitation centre also failed to produce physiological changes, although submaximal endurance time and HRQOL improved.6 Cambach et al. found that training supervised by community physiotherapists resulted in increased exercise tolerance and HRQOL.7