The Effects of Aerobic Exercise on Prognosis, Quality of Life, and Psychological Outcomes of Patients With Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

Abstract

Objectives: This meta-analysis assessed the effects of aerobic exercise on the function, prognosis, quality of life, and psychological outcomes of patients with chronic obstructive pulmonary disease (COPD). Methods: The Cochrane Library, Scopus, PubMed, and Web of Science were searched from the inception to June 20, 2025 to identify eligible studies. A random-effects model was employed for meta-analysis. Results: Twenty randomized controlled trials with 1003 participants were included. The risk of bias was high in most studies, particularly because blinding was not feasible. For most outcomes, we observed high heterogeneity among studies. The meta-analysis indicated that compared to the control group, patients with COPD undergoing exercise training had a significantly increased 6-minute walk test (weighted mean difference [WMD] 42.44m), forced expiratory volume in 1 second (FEV1) (WMD 0.08L), FEV1 to forced vital capacity (FVC) (WMD 5.42%), and peripheral capillary oxygen saturation (WMD 1.56%), which suggests that aerobic exercise can improve the functional capacity and respiratory reserve of patients with COPD. On the other hand, the results revealed that compared to the control group, aerobic exercise markedly decreased the St George’s Respiratory Questionnaire (SGRQ) symptom score (standard mean difference [SMD]-1.13), the SGRQ total score (SMD-1.44), the modified Medical Research Council score for dyspnea (SMD-0.81), and the Hospital Anxiety and Depression Scale (HADS)-anxiety score (SMD-1.17), but its effect on the HADS-depression score (SMD-0.25) did not meet the threshold of statistical significance. Subgroup analysis unveiled that aerobic exercise can offer greater benefits in the long term, and those with FEV1 and FEV1/FVC of more than 50% can benefit more from aerobic exercise. Conclusions: Aerobic exercise may improve the functional capacity, symptoms, respiratory reserve, quality of life, and psychological outcomes of patients with COPD.