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In people with COPD, pulmonary rehabilitation reduces anxiety and depression symptoms

Gordon CS, Waller JW, Cook RM, et al. Effect of Pulmonary Rehabilitation on Symptoms of Anxiety and Depression in COPD: A Systematic Review and Meta-Analysis. Chest. 2019;156:80-91.

Review question

In people with chronic obstructive pulmonary disease (COPD), does pulmonary rehabilitation reduce symptoms of anxiety or depression?


COPD is a lung disease that affects your ability to breathe. Pulmonary rehabilitation is a treatment for COPD. It can help to improve outcomes such as ability to exercise and quality of life. People with COPD often also have anxiety or depression. This review looks at whether pulmonary rehabilitation can improve symptoms of anxiety or depression in people who have COPD.

How the review was done

The researchers did a systematic review of studies available up to February 2018. They found 11 randomized controlled trials that included 734 people. Most people were men and were older than 60 years of age.

The key features of the studies were:

  • people were outpatients who had COPD;
  • studies compared pulmonary rehabilitation lasting 4 to 16 weeks with usual care;
  • pulmonary rehabilitation included exercise training; it may or may not have also included education or psychological support; and
  • most people had pulmonary rehabilitation 3 times each week for 4 to 8 weeks.

What the researchers found

Compared with usual care, pulmonary rehabilitation:

  • reduced depression symptoms by a large amount; and
  • reduced anxiety symptoms by a moderate amount.


In people with chronic obstructive pulmonary disease, pulmonary rehabilitation lasting for 4 to 16 weeks reduces anxiety and depression symptoms compared with usual care.

Effects of pulmonary rehabilitation vs usual care in adults with chronic obstructive pulmonary disease


Number of trials (people)

Effects of pulmonary rehabilitation*

Quality of the evidence†

Anxiety symptoms

10 trials (582 people)

Reduced anxiety scores by a moderate amount (about −2.2 points on the HADS Anxiety subscale)


Depression symptoms

10 trials (582 people)

Reduced depression scores by a large amount (about −2.5 points on the HADS Depression subscale)


HADS = Hospital Anxiety and Depression Scale.

*People would probably notice a change of −1.3 points for the HADS Anxiety subscale and −1.5 points for the HADS Depression subscale.

†Evidence quality was rated using GRADE (Grading of Recommendations Assessment, Development, and Evaluation).

Related Topics


Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.

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