A foundational framework for high-intensity interval training in chronic obstructive pulmonary disease: a systematic review and meta-analysis of randomized controlled trials

This study aimed to evaluate the effects of high-intensity interval training on patients with chronic obstructive pulmonary disease and to synthesize the evidence into a Frequency, Intensity, Time, and Type framework for clinical application. We conducted a systematic review and meta-analysis of randomized controlled trials from PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) within the Cochrane Library through 14 July 2025. Trials evaluating structured high-intensity interval training programs in patients with chronic obstructive pulmonary disease were included. Two reviewers independently extracted data and assessed methodological quality. Sixteen trials were included, with data from 11 pooled for meta-analysis. Compared to moderate-intensity continuous training, high-intensity interval training significantly improved walking distance, peak workload, and quality of life. High-intensity interval training combined with resistance training also yielded greater improvements in exercise capacity than usual care. No serious adverse events were directly attributed to the training. High-intensity interval training is a safe and superior strategy compared to continuous training for enhancing outcomes in patients with chronic obstructive pulmonary disease. This review successfully translates these findings into a practical Frequency, Intensity, Time, and Type framework, providing a scientific model to standardize clinical practice and guide future research. High-intensity interval training is a safe and more effective rehabilitation strategy than traditional continuous training for improving exercise capacity and quality of life in patients with chronic obstructive pulmonary disease.This research translates evidence into a practical Frequency, Intensity, Time, and Type framework, offering clinicians a clear, evidence-based guide for prescribing high-intensity interval training and standardizing care.High-intensity interval training is a targeted intervention for the peripheral muscle dysfunction common in chronic obstructive pulmonary disease, providing a potent stimulus that may be more effective at reversing muscle atrophy and improving physical function than moderate-intensity exercise.The intermittent structure of high-intensity interval training, with its built-in recovery periods, presents a valuable and potentially more tolerable alternative for patients with significant dyspnea who find sustained, continuous exercise difficult to maintain. High-intensity interval training is a safe and more effective rehabilitation strategy than traditional continuous training for improving exercise capacity and quality of life in patients with chronic obstructive pulmonary disease. This research translates evidence into a practical Frequency, Intensity, Time, and Type framework, offering clinicians a clear, evidence-based guide for prescribing high-intensity interval training and standardizing care. High-intensity interval training is a targeted intervention for the peripheral muscle dysfunction common in chronic obstructive pulmonary disease, providing a potent stimulus that may be more effective at reversing muscle atrophy and improving physical function than moderate-intensity exercise. The intermittent structure of high-intensity interval training, with its built-in recovery periods, presents a valuable and potentially more tolerable alternative for patients with significant dyspnea who find sustained, continuous exercise difficult to maintain.