Copyright © 2015 by the American Osteopathic Association. From: Improving Exercise Tolerance and Quality of Life in Patients With Chronic Obstructive Pulmonary Disease J Am Osteopath Assoc. 2009;109(5):268-278. doi:10.7556/jaoa.2009.109.5.268 Figure Legend: Dyspnea activity spiral. Patients with chronic obstructive pulmonary disease may have dyspnea after performing certain activities, causing patients to avoid such dyspnea-inducing activities. However, as the patient becomes more sedentary, tolerance for activities decreases further, likewise decreasing patient activity. Date of download: 10/13/2017 Copyright © 2015 by the American Osteopathic Association. All rights reserved.