Home-based pulmonary rehabilitation might improve patient-centred outcomes, including health-related quality of life and exercise capacity, to an extent comparable to hospital-based programmes [185]. A randomised trial supports the effectiveness of home-based pulmonary rehabilitation. The trial compared cycle ergometer exercise training in the home with the same training in a pulmonary rehabilitation centre [186]. All patients had participated in a 4-week educational programme before randomisation to an exercise training site. Dyspnoea and exercise tolerance improved to an equivalent degree in both groups, and there were no significant safety issues in either group. However, critics have argued that the magnitude of benefit in the hospital-based pulmonary rehabilitation group was smaller than usual, potentially biasing the results toward no difference. This highlights the need for confirmatory studies before concluding that home-based pulmonary rehabilitation programmes provide outcomes similar to hospital-based programmes.