**5.1 The effects of pulmonary rehabilitation on physical activity in COPD**

Exercise training and education, which work to transform behavior by encouraging self-efficacy, are the cornerstones of PR. The increases in exercise capacity shown in the rehabilitation facility would ideally translate into increases in physical activity in the home and community settings for PR to have its best long-term impact [19, 22]. To obtain a large and long-lasting increase in daily physical activity in COPD patients, both improvements in exercise capacity and adaptive behavioral modifications are required. The definition of physical activity (which is a distinct component from exercise capacity), its prevalence in COPD, its objective assessment, risk factors for physical inactivity, and potential methods to maintain or develop the physical strength components are all included in this clinical review. In stable COPD patients, PR has likely the biggest favorable impact on exercise capacity of any contemporary medication [22].

An interdisciplinary strategy including pulmonary medicine, rehabilitation sciences, social sciences, and behavioral sciences is required to alter physical activity behavior in COPD patients. The data in this succinct clinical review show that people with COPD are typically quite sedentary, and that this lack of physical exercise is bad for both the quality and quantity of life [23, 24]. Therefore, a major objective of PR must be to make increasing efforts to better understand the factors that influence physical activity as well as practical ways to enhance this characteristic. The ATS/ERS Official Statement on PR now lists physical activity as one of the primary outcome metrics of PR programs [25].
