The purpose of this study was to evaluate whether strength or recreational activities are a useful addition to aerobic training in patients with chronic obstructive pulmonary disease (COPD). Thirty-three patients with moderate to severe COPD were randomly assigned to 12 weeks of aerobic combined with strength training (AERO+ST) or combined with recreational activities (AERO+RA). The AERO regimen consisted of three weekly 20-min walking exercise sessions; the ST regimen included three series of 10 repetitions of four exercises; and the RA regimen consisted of training using exercise balls to perform smoothly for instrumental activity of daily living. Baseline and after-training measurements of peripheral muscular strength and endurance, cardio respiratory fitness, and 6-min walking distance were obtained, whereas quality of life was assessed with the Short Form 36 questionnaire. Change in grip strength showed a significant difference between the AERO+ST group (8.3+/-6.7%) and the control group (-1.3+/-10.5%), and AERO+RA group (-4.7+/-5.6%) (P<0.05). A significant increase was found in percentage change in peak (.)V(O2) between the AERO+ST group (5.1+/-11.8%) and the control group (-9.2+/-8.6%) (P<0.05). In the health-related quality of life scores, there was a significant difference in mean percentage change in physical functioning between the AERO+ST group (7.9+/-24.4%) and the control group (-14.8+/-19.1%) (P<0.05). A significant difference was found in mean percentage change in social functioning between the AERO+RA group (9.4+/-20.0%) and the control group (-14.9+/-23.2%) (P<0.05). A significant difference in mean percentage change in mental health was also found between the AERO+RA group (12.2+/-12.4%) and the control group (-5.0+/-7.8%) (P<0.05). It is preferable to introduce various forms of exercise that use different muscles involving the whole body, such as recreational activities, as they are an appropriate approach to stimulating physical activity and to improving functional fitness gradually while improving health-related quality of life, though it is necessary to practice exercises for maintenance and improvement in patients with COPD.