Effect of exercise on quality of life in people with chronic obstructive pulmonary disease: A network meta-analysis of RCTs

Background: Chronic obstructive pulmonary disease (COPD) is characterized by a gradual deterioration of respiratory capacity, with worsening fatigue, weakness, activity intolerance, and dyspnea, influencing the person's emotional state and quality of life (QoL). Objective: A network meta-analysis (NMA) was performed to determine the effects of different physical activity interventions on overall QoL in people with COPD, followed by a meta-analysis on the effect of these interventions on the different domains of the QoL scales. Methods: A literature search was performed from inception to December 2023. Randomized controlled trials on the effectiveness of exercise programs on QoL in people with COPD were included. We assessed the risk of bias using the Cochrane Risk of Bias (RoB 2.0) tool and used the Grading of Recommendations, Assessment, Development, and Evaluation tool (GRADE) to assess the quality of the evidence. Pairwise meta-analysis and NMA for direct and indirect evidence were performed. Results: A total of 54 studies were included in the NMA. The largest effects were for active mind-body movement therapy (AMBMT) programs versus control interventions (usual practice) for total QoL (effect size [ES] 0.87; 95 % CI 0.65–1.09), followed by endurance (END) vs control (ES 0.75; 95 % CI 0.27–1.24) and combined (COMB) versus control (ES 0.73; 95 % CI 0.02–1.43). The results reflected an improvement in all subdomains of the QoL scales, except for social support. Conclusions: AMBMT should be considered the most effective strategy to improve overall QoL in people with COPD, followed by END and COMB interventions. Physical activity interventions produce a positive effect in all the QoL domains studied, except for social support. PROSPERO registration number: CRD42023393463.