Supplementary file 1_The effects of traditional Chinese mind-body exercise on pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis.docx

BackgroundChronic obstructive pulmonary disease (COPD) remains the leading cause of illness and death. Traditional Chinese mind-body exercises (TCMBEs), such as Tai Chi, Baduanjin, Liuzijue, and Yijin Jing, have emerged as additional treatment options for pulmonary rehabilitation (PR). This meta-analysis sought to find out the extent to which TCMBEs affect lung function, exercise capacity, and health-related quality of life (HRQoL) in patients with COPD.
MethodsFive international databases (PubMed, Embase, Web of Science, Cochrane Library, and Scopus) were examined until October 2025. Twenty-two randomized controlled trials (RCTs) with 1,871 individuals fulfilled the qualifying criteria. Outcomes included forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), the FEV1/FVC ratio, percent predicted FEV1 (FEV1 % predicted), six-min walk distance (6MWD), and patient-reported measures such as the St. George's Respiratory Questionnaire (SGRQ), COPD Assessment Test (CAT), and the modified Medical Research Council (mMRC) dyspnea scale. Data were synthesized using a random-effects model, with subgroup analyses conducted according to exercise type. The risk of bias was evaluated using the Cochrane Risk of Bias 2.0 tool.
ResultsCompared with usual care or conventional PR, TCMBEs significantly improved FEV1 (MD = 0.20 L; 95% CI 0.09–0.30), FVC (MD = 0.22 L; 95% CI 0.06–0.38), FEV1/FVC (MD = 3.42 %; 95% CI 2.54–4.29), FEV1 % predicted (MD = 4.98 %; 95% CI 2.53–7.42), and 6MWD (MD = 42.05 m; 95% CI 29.06–55.05; p < 0.01). Quality-of-life scores improved significantly, as reflected by reductions in SGRQ (−13.76 points), CAT (−2.62 points), and mMRC (−0.50 points). Subgroup analyses revealed that Liuzijue and Yijinjing produced the greatest gains in pulmonary function, while Tai Chi yielded the most pronounced improvement in functional endurance. No serious adverse events were reported across the included studies.
ConclusionsTCMBEs are effective and safe adjuncts for COPD rehabilitation. By focusing on controlled breathing, gentle movement, and mindful awareness, these practices can enhance lung function, improve exercise capacity, and support psychological well being. Incorporating approaches such as Liuzijue, Tai Chi, and Yijinjing into structured PR programs may provide a sustainable and cost-effective way to promote functional recovery and improve overall quality of life in people with COPD.