Effects of different exercises on psychological anxiety and depression in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis.

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is frequently complicated by anxiety and depression, which are underdiagnosed and adversely affect prognosis and quality of life. Pharmacological and cognitive behavioural therapies have limitations in efficacy and accessibility. Exercise is a promising non‑pharmacological intervention, but evidence specifically targeting anxiety and depression in COPD, and the differential effects of exercise modalities, remains unclear. This study aims to evaluate the efficacy of exercise interventions on psychological anxiety and depression in patients with COPD.

METHODS

A comprehensive search was conducted across six databases (PubMed, Web of Science, Embase, Cochrane Library, SPORTDiscus and PsycINFO) from their inception to 16 June 2026, focusing on randomized controlled trials (RCTs) that investigated the effects of exercise on anxiety and depression in patients with COPD. Studies that examined exercise training as an intervention and reported anxiety or depression as outcome measures were included. Two researchers independently evaluated papers, extracted data and assessed study quality, using Cochrane Bias Risk Assessment Tool RoB 2.0. A random-effects model was employed for the meta-analysis, and potential sources of heterogeneity were identified using subgroup analyses.

RESULTS

A total of 18 RCTs involving 1,034 participants were included. The results showed that exercise was significantly associated with reduced anxiety [standardized mean difference (SMD) =-0.85; 95% confidence interval (CI): -1.16 to -0.53] and depression (SMD =-0.77; 95% CI: -1.11 to -0.44). Subgroup analysis revealed that exercise interventions were more effective in alleviating severe anxiety (SMD =-5.04; 95% CI: -6.22 to -3.87) and depression (SMD =-3.33; 95% CI: -4.15 to -2.51) compared with mild-to-moderate symptoms.

CONCLUSIONS

Exercise training may exert positive effects on the mental health of patients with COPD, and its efficacy is more pronounced in individuals with higher degrees of anxiety and depression.