We would like to compliment the authors of the article “Pulmonary Rehabilitation: Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines” (May 2007)1 for their comprehensive review of the literature and their effort to formulate up-to-date, evidence-based recommendations for clinical practice. However, we have concerns about the grading of recommendations concerning upper extremity training (UET) and inspiratory muscle training (IMT). It is surprising to us that the current recommendations grade the quality of evidence for UET as “high” (A), whereas the quality of evidence for IMT is graded as “moderate” (B). Further, it is unclear to us why (unsupported) UET is strongly recommended (grade 1), whereas the use of IMT is not recommended (grade 1). This would mean that the benefits outweigh the burdens for UET, while the opposite is true for IMT. This is, in our opinion, not a balanced summary of the available evidence.