Evidence Summary (Updated 2022)
There are some good quality interventional study data that shows a reduction in anxiety and depression as measured by outcome scores.
Several intervention types have been found to make a difference to mental health outcomes. Continuous versus interval training in a study by a team in Sweden found that depression and anxiety scores (HADS) improved in both groups.(1) Along with measuring depression related systemic inflammatory markers, El-Kade et al also showed significant improvements in the beck depression Index in the aerobic exercise group compared to controls (p<0.05).(2)
A meta-analysis of 11 studies demonstrates mind-body exercise to have significant effects on reducing anxiety in COPD patients (SMD = -.76, 95% Cl -0.91 to -0.60, p= 0.04, I2 = 47.4%) compared to controls. For depression outcome indicator, the meta-analysis of 13 studies showed mind-body exercise to have significant effects on reducing depression in COPD patients (SMD = -0.86, 95% CI -1.14 to -.58, p= 0.000, I2 = 71.4%).(3)
A 10 RCT systematic review (n = 762) look at active mind-body movement therapies (AMBMT). One study (n = 80) showed improvements in SF-36 mental health summary score AMBMT and PR vs PR alone (MD 3.29, 95% Cl 1.45 to 4.95; very low-quality evidence).(4)
A further Tai Chi and Qi Gong intervention systematic review and meta-analysis of 16 RCTs (n=1096), results showed a decrease in hospital anxiety and depression scale score (anxiety: mean difference= -1.04, 95% Cl: -1.58 to -0.51; depression: mean difference + -1.25, 95% Cl: -1.77 to -0.73).(5)
Conflicting evidence exists in that a 13 RCT (n = 866) meta-analysis comparing early pulmonary rehabilitation with usual care. The SF-36 mental score showed non-significant improvement between the early PR group and control group (MD = 4.34, 95% Cl -1.64 to 10.32, Z = 1.42, p = 0.16).(6)
Quality of Evidence
Grade B – moderate quality.
Strength of recommendation
Grade 1 – strong recommendation.
There is a limited number of studies analysing mental health outcomes in COPD patients, however the evidence-base in general populations supporting improved mood with PA is overall strong and this should continue to be recommended despite limited COPD evidence.
There is more recent evidence that some physical activity modalities, e.g., mind-body movement therapies, have positive outcomes. But the mental health effects of physical activity in COPD is understudied and commonly a secondary outcome or forms part of a wider questionnaire in studies.
- 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: https://pubmed.ncbi.nlm.nih.gov/17188853/
- Abd El-Kader SM, Al-Jiffri OH. Exercise alleviates depression related systemic inflammation in chronic obstructive pulmonary disease patients. Afr Health Sci [Internet]. 2017 Mar 7 [cited 2022 Oct 5];16(4):1078–88. Available from: https://www.ajol.info/index.php/ahs/article /view/152543
- Li Z, Liu S, Wang L, Smith L. Mind–Body Exercise for Anxiety and Depression in COPD Patients: A Systematic Review and Meta-Analysis. Int J Environ Res Public Heal 2020, Vol 17, Page 22 [Internet]. 2019 Dec 18 [cited 2022 Oct 5];17(1):22. Available from: https://www.mdpi.com/1660-4601/17/1/22/htm
- Gendron LMC, Nyberg A, Saey D, Maltais F, Lacasse Y. Active mind-body movement therapies as an adjunct to or in comparison with pulmonary rehabilitation for people with chronic obstructive pulmonary disease. Cochrane database Syst Rev [Internet]. 2018 Oct 10 [cited 2022 Oct 5];10(10):CD012290. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012290.pub2/full
- Guo C, Xiang G, Xie L, Liu Z, Zhang X, Wu Q, et al. Effects of Tai Chi training on the physical and mental health status in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. J Thorac Dis [Internet]. 2020 Mar 1 [cited 2022 Oct 5];12(3):504–21. Available from: https://pubmed.ncbi.nlm.nih.gov/32274117/
- Du Y, Lin J, Wang X, Zhang Y, Ge H, Wang Y, et al. Early Pulmonary Rehabilitation in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Meta-Analysis of Randomized Controlled Trials. https://doi.org/101080/1541255520222029834 [Internet]. 2022 [cited 2022 Oct 5];19(1):69–80. Available from: https://www.tandfonline.com/doi/abs/10.1080/15412555.2022.2029834