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COPD – Able to walk further

Evidence Summary (Updated 2022)
A large body of good quality randomised controlled trial study data shows an improvement in physical and functional capacity as measured by mean walking distance(1–6) .
A Meta-analysis, of 10 RCTs (n =437), analysing HIIT effects on exercise capacity and pulmonary function found that the 6MWT improved more than control group (predominantly continuous exercise) (MD = 30.31m, 95% CI [14.52, 46.10], P = 0.0002). There was no statistically significant difference in VO2 max though (SMD = 0.15, 95% CI [− 0.04, 0.35], P = 0.12).(7)
Meta-analysis looking at the effects of land and water-based aerobic exercise, Nine studies looked at 6MWT and 5 studies ESWT. The intervention group significantly improve 6MWT (MD: 56.37m, 95% CI [32.61, 80.13], P < .05) and ESWT (MD: 254.81, 95% CI [166.41, 343.22], P < .05). There was no difference between LG and WG, except in a 2 study meta-analysis which showed significant improvement in WG (MD: 272.03m, 95% CI [66.76, 477.31], P = .009).(8)
An 11 study (n= 405) systematic review looking at the effects of resistance training on elderly COPD patients and meta-analysis showed that resistance training led to improvements in upper limb endurance and peak exercise capacity . A 5 study MA showed a clinically significant improvement in 6MWD for patients in the resistance training group (WMD, 54.52m; 95% CI 25.47–83.56; I2 = 43%; P = 0.14).(9)
An 18 study (n= 1267) SR looking at the effectiveness of Tai Ji and Qigong (AJQ) as an adjunct to PR . This 13 study MA showed AJQ can increase the 6MWD by 41.51m on average (MD = 41.51; 95% CI: 28.49 to 54.53; P < 0.00001). AJG also reduced COPD patient’s CAT score by −5.91 on average (MD = −5.91; 95% CI: −8.25 to −3.75; P < 0.00001),(10)
A 13 study (n= 856) SR/MA looking at the effects of early PR(11) following an acute exacerbation of COPD. Study interventions included breathing training, continuous exercise, and resistance training. A 9 study Meta-analysis (n = 547) showed that the 6MWD was significantly higher in the PR group (MD = 97.58, 95%CI 17.21 to 177.96, Z = 2.38, p = 0.02) finding that early PR improved mobility and prevented muscle atrophy.
More recent studies reviewed multiple activity modalities and all showed benefits: HIIT(7), land and water based aerobic activity, resistance training(9), Tai Ji and Qigong (10)

Quality of Evidence
Grade B – moderate quality.

Strength of recommendation
Grade 1 – strong recommendation

Physical activity can improve physical and exercise capacity. On the basis of the existing evidence, clinical opinion is that all or most patients will be best served by following this evidence -based advice.


  1. Arnardóttir RH, Boman G, Larsson K, Hedenström H, Emtner M. Interval training compared with continuous training in patients with COPD. Respir Med [Internet]. 2007 Jun [cited 2022 Oct 5];101(6):1196–204. Available from:
  2. Mador MJ, Krawza M, Alhajhusian A, Khan AI, Shaffer M, Kufel TJ. Interval training versus continuous training in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil Prev [Internet]. 2009 Mar 1 [cited 2022 Oct 4];29(2):126–32. Available from:
  3. Nasis IG, Vogiatzis I, Stratakos G, Athanasopoulos D, Koutsoukou A, Daskalakis A, et al. Effects of interval-load versus constant-load training on the BODE index in COPD patients. Respir Med [Internet]. 2009 Sep [cited 2022 Oct 5];103(9):1392–8. Available from:
  4. Puhan MA, Büsching G, Schünemann HJ, VanOort E, Zaugg C, Frey M. Interval versus continuous high-intensity exercise in chronic obstructive pulmonary disease: A randomized trial. Ann Intern Med [Internet]. 2006 Dec 5 [cited 2022 Oct 4];145(11):816–25. Available from:
  5. Santos C, Rodrigues F, Santos J, Morais L, Bárbara C. Pulmonary Rehabilitation in COPD: Effect of 2 Aerobic Exercise Intensities on Subject-Centered Outcomes–A Randomized Controlled Trial. Respir Care [Internet]. 2015 Nov 1 [cited 2022 Oct 4];60(11):1603–9. Available from:
  6. Zwerink M, Brusse-Keizer M, van der Valk PDLPM, Zielhuis GA, Monninkhof EM, van der Palen J, et al. Self management for patients with chronic obstructive pulmonary disease. Cochrane database Syst Rev [Internet]. 2014 Mar 24 [cited 2022 Oct 5];2014(3). Available from:
  7. Gao M, Huang Y, Wang Q, Liu K, Sun G. Effects of High-Intensity Interval Training on Pulmonary Function and Exercise Capacity in Individuals with Chronic Obstructive Pulmonary Disease: A Meta-Analysis and Systematic Review. Adv Ther [Internet]. 2022 Jan 1 [cited 2022 Oct 4];39(1):94–116. Available from:
  8. Chen H, Li P, Li N, Wang Z, Wu W, Wang J. Rehabilitation effects of land and water-based aerobic exercise on lung function, dyspnea, and exercise capacity in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis. Medicine (Baltimore) [Internet]. 2021 Aug 20 [cited 2022 Oct 5];100(33). Available from:
  9. Li N, Li P, Lu Y, Wang Z, Li J, Liu X, et al. Effects of resistance training on exercise capacity in elderly patients with chronic obstructive pulmonary disease: a meta-analysis and systematic review. Aging Clin Exp Res [Internet]. 2020 Oct 7 [cited 2022 Oct 5];32(10):1911–22. Available from:
  10. Yang TT, Liu X, Wang YQ, Song CY, Ma RC, Yin YY, et al. The effect of Tai Ji and Qigong in patients with chronic obstructive pulmonary disease: A systematic review and meta-analyses. Eur J Integr Med. 2020 Dec 1;40:101223.
  11. Zhang D, Zhang H, Li X, Lei S, Wang L, Guo W, et al. Pulmonary Rehabilitation Programmes Within Three Days of Hospitalization for Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. Int J Chron Obstruct Pulmon Dis [Internet]. 2021 [cited 2022 Oct 4];16:3525. Available from: /pmc/articles/PMC8713718/