FIG. 12:  The two pillars of pulmonary rehabilitation are exercise training and education aimed at self-management.  Exercise training probably works through several mechanisms, shown in this Figure.^[10]  These include central desensitization to dyspnea, decreased anxiety and depression, indirect reduction in dynamic hyperinflation, and improved skeletal muscle function. 

Education has evolved from purely didactic (e.g., that there are “X”-million alveoli in the lungs) toward promoting self-management and efficacy in patients with COPD.^[11,12]  This might include education about smoking cessation (when indicated) and adherence to the prescribed medical treatment regimen, and certainly to promotion of a healthy lifestyle, including regular exercise and physical activity, proper nutrition, early recognition and treatment of the exacerbation, and even forms of palliative care.  The “Row Your Own Boat” logo (on the right-hand side of the Figure), devised by the Calgary Health Region (now Alberta Health Services) in Canada,^[13] is appropriate for pulmonary rehabilitation.  Patients with advanced chronic respiratory disease are often very passive and reliant on the healthcare provider for support.  Pulmonary rehabilitation makes patients better consumers who are more efficient in their care in collaborating with the health care professional.