Exercise training, widely regarded as the cornerstone of pulmonary rehabilitation, is the best available means of improving exercise capacity, exertional dyspnea, and activities of daily living in COPD. However, optimal intensity of training, long-term benefits and more efficient ways for severe patients with COPD remain uncertain. Adjunctive strategies, such as neuromuscular electrical stimulation (NMES) and noninvasive positive pressure ventilation (NPPV), must be developed. Although nutritional status is an important determinant of symptoms, disability, and prognosis in COPD, present evidence suggests that nutritional supplementation alone may not be sufficient strategy. Nutritional support to be accompanied by exercise training and to attenuate systemic inflammation should be established. In addition, administration of orexigenic factor(e.g. ghrelin) may be new strategy for COPD patients with nutritional depletion.