Inclusion Criteria:  hospitalization due to acute exacerbation of chronic obstructive pulmonary disease in preceding 1-year history age was between 40 to 85 years old  Exclusion Criteria:  having a pulmonary rehabilitation in the past 1 month comorbidities that don't suitable for pulmonary rehabilitation, such as, untreatable cardiovascular disease, sinus tachycardia (HR>120), hypertension at rest if not adequately controlled, resting systolic blood pressure < 90 mmHg, and exercise contraindication advanced cancer with fatigue syndrome can't follow the orders physical impairment psychological impairment