Effects of Mind–Body Exercise on Pulmonary Function and Functional Exercise Capacity in Older Adults with COPD: A Three-Level Meta-Analysis

Vollständiger Abstract

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Background/Objectives: Mind–body exercise may improve pulmonary function and exercise capacity in older adults with chronic obstructive pulmonary disease (COPD), but its overall effects and potential variation by exercise modality and intervention duration remain uncertain. This study evaluated its effects on pulmonary function and six-minute walk distance (6MWD) in COPD samples with a mean age of ≥60 years. Methods: PubMed, Web of Science Core Collection, Embase, the Cochrane Library, CNKI, and Wanfang Data were searched from inception to June 2026. Randomized controlled trials comparing mind–body exercise with control conditions were included. Pulmonary function was analyzed using a three-level random-effects meta-analysis with study-clustered CR2 robust inference; 6MWD was analyzed using two-level random-effects models with Knapp–Hartung inference. Hedges’ g and raw mean differences (MDs) were reported. Exploratory subgroup and meta-regression analyses examined exercise modality and intervention duration, with Holm correction for multiple comparisons. The review was retrospectively registered with INPLASY (INPLASY202670087). Results: Thirty-five independent studies involving 2955 participants were included. Mind–body exercise improved overall pulmonary function (Hedges’ g = 0.62, 95% CI 0.40–0.83, p < 0.001), with substantial heterogeneity (I2 = 91.0%; 95% prediction interval [PI] −0.61 to 1.84). Pooled effects for FEV1, FVC, and FEV1/FVC were g = 0.71, 0.52, and 0.53, respectively. For 6MWD, g = 0.78 (95% CI 0.57–0.99), corresponding to an MD of 34.07 m (95% CI 25.88–42.25; 95% PI 7.53–60.60). After Holm correction, neither exercise modality nor intervention duration showed a significant moderating effect, and no robust linear or quadratic duration association was identified. Conclusions: Mind–body exercise may improve pulmonary function and functional exercise capacity in older adults with COPD. However, benefits may vary across settings, and current evidence is insufficient to identify a superior modality or optimal intervention duration. Mind–body exercise may be considered an adjunctive or optional component of comprehensive pulmonary rehabilitation.