FIG. 37:  Yet another aspect of pulmonary rehabilitation concerns its effect on physical activity.  It is clear that pulmonary rehabilitation increases exercise capacity, but does it also increase physical activity in the home and community settings?  Is there is a difference between what exercise capacity can do, which has been proven to increase with pulmonary rehabilitation, and what patients actually do in the “real-life” setting?  Does the increase in exercise capacity translate into increased physical activity in the home and community settings?  This is important because physical activity is a strong predictor of subsequent survival and healthcare utilization.  This Figure from Leuven, Belgium, shows that patients with COPD are more physically inactive than age-matched, healthy individuals, spending less time walking or standing, and more time lying and sitting.^[28]