SYSTEMATIC REVIEW article
Front. Med.
Sec. Pulmonary Medicine
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1668578
Effects of Various Exercise Therapies on 6-Minute Walk Distance in Patients with Stable Chronic Obstructive Pulmonary Disease: A Systematic Review and Network Meta-Analysis
Provisionally accepted
- 1Beijing Key Laboratory of Information Service Engineering, Beijing Union University, Beijing, China
- 2Capital University of Physical Education and Sports, Beijing, China
- 3Fujian Normal University, Fuzhou, China
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Purpose: This study aimed to compare the effects of various exercise interventions on the six-minute walk distance (6MWD) in patients with stable chronic obstructive pulmonary disease (COPD) using network meta-analysis and to explore their optimal dosage configurations. Methods: Randomized controlled trials (RCTs) on exercise interventions for patients with COPD published before January 1, 2025, were retrieved from CNKI, PubMed, PsycINFO, Web of Science, and the Cochrane Library. A total of 55 eligible RCTs were included. A meta-analysis and network meta-analysis (using R software) evaluated the effects of water-based exercise, traditional Chinese mind-body training, and general exercise on 6MWD. For the optimal intervention method, subgroup analysis of the conventional meta-analysis and nonlinear meta-regression were used to examine the dosage-efficacy relationship. Results: Network meta-analysis showed water-based exercise (WBE) most favorably improved 6MWD (SUCRA = 98.9, MD = 83.91, 95% CI: 55.98–111.83), significantly outperforming traditional Chinese mind-body training (CTMBT) and general exercise (GE). Nonlinear meta-regression linked efficacy to dosage, with optimal outcomes achieved with ≥3 sessions/week (5 sessions as ideal), ≥60 minutes/session (90 minutes as perfect), an 8-week duration, and a total of 270 minutes/week. Patients aged ≤61.67 years showed more pronounced improvements. Conclusion: WBE was the most effective intervention for improving the 6MWD of COPD patients. Optimal results required managing frequency (≥3 times/week, ideally 5 times/week), session duration (≥60 minutes, ideally 90 minutes), 8 weeks, and a total of 270 minutes/week. Older patients (≤61.67 years) benefited more. This study supported individualized, evidence-based exercise rehabilitation strategies for COPD.
Keywords: chronic obstructive pulmonary disease, six-minute walk distance, Exercise Therapy, Network meta-analysis, Water-based exercise, Chinese TraditionalMind-Body Training
Received: 06 Aug 2025; Accepted: 06 Oct 2025.
Copyright: © 2025 He, Qin, Liu and Shen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Guilan Shen, guilan.shen@buu.edu.cn
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