Network meta-analysis of exercise interventions for COPD rehabilitation
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Key Takeaway
Consider that water-based Liuzijue and Yijinjing may improve COPD outcomes, but evidence is limited.
This is a systematic review and network meta-analysis of single exercise interventions for patients with chronic obstructive pulmonary disease. The review synthesized evidence from 5,831 participants on interventions including walking, cycling, respiratory muscle training, Taichi, land-based Liuzijue, water-based Liuzijue, Wuqinxi, Baduanjin, Yijinjing, and Yoga.
The authors found that water-based Liuzijue was the most effective intervention for improving forced expiratory volume in 1 s as a percentage of the predicted value (FEV1%pred), with a mean difference of 9.51 (95% CI: 3.23 to 15.78). Yijinjing was the most effective intervention for reducing COPD Assessment Test (CAT) scores, with a mean difference of -8.37 (95% CI: -12.83 to -3.91).
The authors noted limitations, including a limited number of studies on water-based Liuzijue and Yijinjing. Safety outcomes such as adverse events, serious adverse events, discontinuations, and tolerability were not reported.
The review provides evidence for individualized rehabilitation strategies, but the certainty of the evidence is limited. Practice relevance should consider the specific interventions and the cautious interpretation of results.
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View Original Abstract ↓
ObjectiveTo systematically compare the effects of various single exercise interventions, including walking, cycling, respiratory muscle training, Taichi, land-based Liuzijue, water-based Liuzijue, Wuqinxi, Baduanjin, Yijinjing, and Yoga, on pulmonary function and quality of life in patients with chronic obstructive pulmonary disease (COPD), and to provide evidence for individualized rehabilitation strategies.MethodsRandomized controlled trials (RCTs) on single exercise interventions in patients with COPD were systematically searched in PubMed, EMBASE, Web of Science, Cochrane Library, Scopus, and CNKI from database inception to January 12, 2026. The risk of bias of the included studies was assessed using the Cochrane Risk of Bias Tool in RevMan 5.4, and the quality of evidence was further evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. The network meta-analysis was performed using the “network” command in STATA 17.0.ResultsA total of 77 RCTs involving 5,831 participants were included. The network meta-analysis showed that water-based Liuzijue was the most effective intervention for improving forced expiratory volume in 1 s as a percentage of the predicted value (FEV1%pred) (MD = 9.51, 95% CI: 3.23 to 15.78; SUCRA = 88.4%), whereas Yijinjing was the most effective intervention for reducing COPD Assessment Test (CAT) scores (MD = −8.37, 95% CI: −12.83 to −3.91; SUCRA = 95.9%).ConclusionAmong single exercise interventions for patients with COPD, water-based Liuzijue showed the greatest benefit in improving pulmonary function, while Yijinjing demonstrated the most pronounced effect on quality of life. However, given the limited number of studies on water-based Liuzijue and Yijinjing, these results should be interpreted with caution, and further high-quality randomized controlled trials are needed to validate these findings.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261280662, CRD420261280662.
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