Chronic obstructive pulmonary disease (COPD) is a lung disease that causes ventilation abnormalities of respiratory tract obstruction that is progressive and not fully reversible. The disease is associated with a switch from a self?limiting inflammatory response, mainly initiated by smoke inhalation, to a chronic persistent inflammatory response after prolonged interaction with cigarette smoke. The pathological mechanisms and clinical manifestations of COPD are not restricted only to pulmonary inflammation and airway remodeling. The known systemic manifestations of COPD include systemic inflammation, cardiovascular comorbidities, and muscle dysfunction, leading to the decreased functional status of COPD. Chronic inflammation in the pulmonary tissue is also associated with systemic effects. Systemic inflammation may then lead to skeletal muscle atrophy and cachexia. It may also initiate and worsen comorbidities.1 It limits the patient?s exercise capacity and the ability to perform activities of daily living (ADL), leading to a reduced quality of life. Quantification of physical ADL revealed that COPD patients spend less time standing and walking daily than healthy elderly individuals.2 Pulmonary rehabilitation is a comprehensive, multidisciplinary intervention designed to reduce symptoms, increase functional status and quality of life, and focus on the primary and secondary impairments associated with respiratory disease in COPD patients. Strategies include exercise training, self-management education, nutritional intervention and psychosocial support.3