The fact that the increase in LPA was not sustained is disappointing, but not surprising as long-term maintenance is always challenging. We speculate that a single focused program of behavioral change may not be sufficient to change strongly entrenched habits such as low PA. This may be especially true for people with COPD because of symptoms that interrupt day-to-day PA patterns, including the experience of good days and bad days and acute exacerbations of COPD. To accomplish a sustained change in behavior may require the accumulation of multiple experiences with a variety of behavioral interventions over time, with the experience of each intervention the individual gains new knowledge and experience that will eventually be used to make a lasting change. This would be similar to the pattern observed in people who are trying to lose weight.