The effect of inspiratory muscle training (IMT) three times daily for 6 weeks was compared with that of general physical training (PT) (stair climbing) in 10 out-patients with severe chronic obstructive pulmonary disease (COPD). PT improved 12 min walking distance (12MWD) by 19% (1-28), stair climbing ability (SCA) over four floors at maximum speed by 11% (3-50), maximum oxygen uptake by 10% (2-33), inspiratory flow by 85% (19-113) and improved an index of breathlessness by 44% (3-786). During IMT, 12MWD and SCA decreased by 8% (0-33) and 10% (0-161), respectively, and the other variables decreased by 6-10%. No changes were seen in ventilation during maximum exercise, in maximum inspiratory and expiratory pressures, or in variables measured during spirometry. Thus work capacity can be improved by training in COPD maybe because of an increase in inspiratory flow rate, but without a change in maximum exercise ventilation.