PT - JOURNAL ARTICLE AU - T. Troosters AU - R. Gosselink AU - W. Janssens AU - M. Decramer TI - Exercise training and pulmonary rehabilitation: new insights and remaining challenges AID - 10.1183/09059180.00007809 DP - 2010 Mar 01 TA - European Respiratory Review PG - 24--29 VI - 19 IP - 115 4099 - http://err.ersjournals.com/content/19/115/24.short 4100 - http://err.ersjournals.com/content/19/115/24.full SO - EUROPEAN RESPIRATORY REVIEW2010 Mar 01; 19 AB - Pulmonary rehabilitation is now regarded as an evidence-based treatment for symptomatic patients with chronic obstructive pulmonary disease. It has been shown to enhance exercise tolerance, improve symptoms and health-related quality of life, and reduce exacerbations in patients with recurrent exacerbations. In this article we review the mechanisms through which exercise training results in beneficial effects. We also review three challenges that currently remain: 1) the fine tuning of exercise training and multidisciplinary programmes; 2) the timing of rehabilitation; and 3) efforts to enhance the accessibility and adherence to pulmonary rehabilitation programmes. Further research is needed in order to apply the now well-established principles of pulmonary rehabilitation to unusual patient populations, or patient populations that are unlikely to participate in conventional outpatient programmes.