One of the goals of PR is to enable patients with long-standing respiratory impairments to achieve an ongoing lifestyle change with increased physical activity and improved health. For early training, some may require an assist such as HH to help train to the point of continuing with unassisted exercise. For others in whom the ceiling set by their ventilatory capacity matches their chosen lifestyle, performance can be improved without an assistive device. A small number of patients, determined to improve their function and hopeful of potential reductions in cardiovascular risk, might be willing to attend a “special” exercise clinic that provides a level of training, using central ventilatory unloading, that would otherwise be unattainable in the usual PR programs. The report by Eves and colleagues4 is a creative step toward meeting these needs. The possibility of longer term improvements in health risk and even mortality, in keeping with the rationale for most fitness programs, makes pursuing this theme worthwhile.