# The effects of traditional Chinese mind-body exercise on pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis

## TL;DR

This study finds that traditional Chinese mind-body exercises like Tai Chi and Liuzijue improve lung function and quality of life in COPD patients.

## Contribution

This is the first systematic review and meta-analysis evaluating the effectiveness of traditional Chinese mind-body exercises in COPD pulmonary rehabilitation.

## Key findings

- TCMBEs significantly improved FEV1, FVC, and 6MWD in COPD patients.
- Quality-of-life scores improved with reductions in SGRQ, CAT, and mMRC scores.
- Liuzijue and Yijinjing showed the greatest gains in pulmonary function.

## Abstract

Chronic obstructive pulmonary disease (COPD) remains the leading cause of illness and death. Traditional Chinese mind-body exercises (TCMBEs), such as Tai Chi, Baduanjin, Liuzijue, and Yijin Jing, have emerged as additional treatment options for pulmonary rehabilitation (PR). This meta-analysis sought to find out the extent to which TCMBEs affect lung function, exercise capacity, and health-related quality of life (HRQoL) in patients with COPD.

Five international databases (PubMed, Embase, Web of Science, Cochrane Library, and Scopus) were examined until October 2025. Twenty-two randomized controlled trials (RCTs) with 1,871 individuals fulfilled the qualifying criteria. Outcomes included forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), the FEV1/FVC ratio, percent predicted FEV1 (FEV1 % predicted), six-min walk distance (6MWD), and patient-reported measures such as the St. George's Respiratory Questionnaire (SGRQ), COPD Assessment Test (CAT), and the modified Medical Research Council (mMRC) dyspnea scale. Data were synthesized using a random-effects model, with subgroup analyses conducted according to exercise type. The risk of bias was evaluated using the Cochrane Risk of Bias 2.0 tool.

Compared with usual care or conventional PR, TCMBEs significantly improved FEV1 (MD = 0.20 L; 95% CI 0.09–0.30), FVC (MD = 0.22 L; 95% CI 0.06–0.38), FEV1/FVC (MD = 3.42 %; 95% CI 2.54–4.29), FEV1 % predicted (MD = 4.98 %; 95% CI 2.53–7.42), and 6MWD (MD = 42.05 m; 95% CI 29.06–55.05; p < 0.01). Quality-of-life scores improved significantly, as reflected by reductions in SGRQ (−13.76 points), CAT (−2.62 points), and mMRC (−0.50 points). Subgroup analyses revealed that Liuzijue and Yijinjing produced the greatest gains in pulmonary function, while Tai Chi yielded the most pronounced improvement in functional endurance. No serious adverse events were reported across the included studies.

TCMBEs are effective and safe adjuncts for COPD rehabilitation. By focusing on controlled breathing, gentle movement, and mindful awareness, these practices can enhance lung function, improve exercise capacity, and support psychological well being. Incorporating approaches such as Liuzijue, Tai Chi, and Yijinjing into structured PR programs may provide a sustainable and cost-effective way to promote functional recovery and improve overall quality of life in people with COPD.