Clinician Article

Effects of Breathing Exercises in Patients With Chronic Obstructive Pulmonary Disease: A Network Meta-analysis.

  • Cai Y
  • Ren X
  • Wang J
  • Ma B
  • Chen O
Arch Phys Med Rehabil. 2024 Mar;105(3):558-570. doi: 10.1016/j.apmr.2023.04.014. Epub 2023 May 6. (Review)
PMID: 37150427
Read abstract Read evidence summary
  • Physical Medicine and Rehabilitation
    Relevance - 5/7
    Newsworthiness - 6/7
  • Respirology/Pulmonology
    Relevance - 4/7
    Newsworthiness - 4/7


OBJECTIVE: A network meta-analysis of randomized controlled trials (RCTs) was conducted to compare and rank the effectiveness of various breathing exercises for patients with chronic obstructive pulmonary disease (COPD).

DATA SOURCES: We searched PubMed, Web of Science, Embase, and the Cochrane Library databases to determine the articles.

STUDY SELECTION: Publications investigating the effect of breathing exercises on exercise capacity (six-minute walk test [6MWT]), pulmonary function (the ratio of the first second forced expiratory volume of forced vital capacity [FEV1/FVC]), quality of life (St George's Respiratory Questionnaire [SGRQ]), inspiratory muscle pressure (maximum inspiratory pressure [PImax]), and dyspnea (Borg scale) were searched.

DATA EXTRACTION: Data extracted by 2 researchers were entered into predesigned tables for data extraction. The quality of the literature was assessed using the Cochrane Collaboration's tool.

DATA SYNTHESIS: A total of 43 RCTs involving 1977 participants were analyzed. To boost exercise capacity, the top 2 exercises were inspiratory muscle training (75%), Chinese traditional fitness exercises (13%); To improve pulmonary function, the top 2 exercises were Chinese traditional fitness exercises (32%), diaphragm breathing (30%); To raise patients' quality of life, the top 2 exercises were yoga (52%), diaphragm breathing (28%); To increase inspiratory muscle pressure, the top 2 exercises were pursed-lip breathing (47%), Chinese traditional fitness exercises (25%); To improve dyspnea, the top 2 exercises were yoga (44%), inspiratory muscle training (22%).

CONCLUSIONS: Various breathing exercises for COPD patients confer benefits that manifest in diverse ways. Pulmonary rehabilitation specialists could administer personalized breathing exercises tailored to each patient's condition to attain optimal therapeutic outcomes.

Clinical Comments


This meta-analysis suggests that a variety of breathing exercises can positively impact respiratory function and quality-of-life. This is not a new concept. Some modalities may not be available in all countries.

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