Referring staff were aware that our rehabilitation service was intending to trial the addition of formal exercise to the CDSMP. Inclusion criteria included being over age 18 years, agreeable to attend supervised exercise as well as the CDSMP as randomized, a firm diagnosis of COPD, and there being at least 2 months since an acute exacerbation. Exclusion criteria were cognitive impairment, inability to provide informed consent or complete a self-administered questionnaire, previous CDSMP or PR attendance within the past 2 years, and standard contraindications to exercise. 33