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COPD – Reduced feeling of breathlessness

Evidence summary (Updated 2022)
A large body of interventional data shows a reduction in dyspnoea symptoms as measured by outcome scores. This is further confirmed by a recent review of evidence with reduced breathlessness and improved respiratory muscle strength .
A meta-analysis by Pan et al, of 7 studies, and 240 patients, examining whether unsupported upper limb exercise reduces dyspnoea and arm fatigue, found that ADL dyspnoea (breathlessness during activities of daily living) reduced (WMD=-0.58; 95% CI = -1.13 to -0.02), however the overall treatment effects were lower than the MCID of 1 unit for the Borg scale.(1)
Gao et al compared HIIT vs usual care. 5 RCTs (n = 297) showed statistically decreased dyspnoea scores with Borg and MRC (SMD = − 0.32, 95% CI [− 0.56, − 0.09], P = 0.007).(2)

A 7 study MA showed land or water-based training group significantly improved dyspnoea (MD –0.61 [–1.08, –0.15]; P=0.01). There were no statistically significant benefits found on subgroup analysis for the water-based group (MD –1.09 [–2.25, 0.07]; P=.06).(3)

A 20 study (n = 992) MA showed significantly improved Borg with SMD of 0.37 (95% CI, 0.52 to 0.22), indicating that participation in a PR program significantly reduced dyspnoea in patients with COPD (Z ¼ 4.90, p < .001), as well as improving respiratory muscle strength (Max Expiratory Pressure (SMD, 0.87; 95% CI, 0.42-1.32; p < .001), MIP (SMD, 0.53; 95% CI, 0.13-0.93; p = .009)).(4)

An eight RCT meta-analysis (n =758) looking at telemedicine-based PR compared with none or centre-based rehabilitation. Tele-R compared to no rehabilitation improved the mMRC of -1.02U (CI: -1.49, -0.59; p<0.001) but no difference was seen compared to centre-based rehabilitation (p=0.911).(5)

An 11 study meta-analysis of PR with Yoga and Tai Chi. Pulmonary rehabilitation, compared to control group, showed significant changes in the MRC (WMD, −0.59; 95% CI: −0.81 to −0.37; p < .001; I2 = 76.8%) , but no significant difference was found in 8 studies using Borg scores (WMD, −0.33; 95% CI: −0.91–0.24; p < .001; I2 = 76.4%). There were also significant observed changes in FEV1% predicted values (WMD, 0.20; 95% CI: 0.03–0.36; p < .001; I2 = 92.7%).(6)
A total of 42 studies (n = 2150) were analysed in the SR/MA which looked at the positive effects of PR programmes, including lower limb endurance training. For MRC, 5 studies found improved changes with PR (MD, −0.64; 95% CI, −0.99 to −0.30; p = 0.0003; I2 = 68%). In the transitional Dyspnoea Index, 5 studies showed improvements again (MD, 1.95; 95% CI, 1.09 to 2.81; p = 0.0001; I2 = 65%). The Borg scale improved in 12 studies (MD, −0.62; 95% CI, −1.10 to −0.14; p = 0.01; I2 = 54%) and CRQ also improved over 12 studies (MD, 0.91; 95% CI, 0.39 to 1.44; p = 0.0007; I2 = 40%).(7)

A 6 study MA showed the mMRC was significantly lower in the early PR group following an AECOPD compared to usual care (MD = −0.36, 95%CI −0.52 to −0.21, Z = 4.56, p ˂ 0.00001). 4 studies however, showed no significant difference in FEV1% predicted compared with usual care (MD = 0.50, 95%CI −1.43 to 2.44, Z = 0.51, p = 0.61).(8)

This SR/MA of 15 studies (n = 514) looked at the effects of upper limb training. Upper limb endurance showed significantly greater improvement in dyspnoea than the control (SMD=-0.56; 95% CI, -0.95 to -0.16; p=0.006) with similar effects seen for upper limb strength programmes (SMD=-0.36; 95% CI, -0.61 to -0.11; p=0.004). When all modes of upper limb training were analysed, it showed a significantly greater improvement in dyspnoea than the control (SMD=-0.44; 95% CI, -0.64 to -0.23; p<0.001), with the greatest effect seen in severe COPD sufferers.(9)

A qigong SR/MA showed, on analysis of 3 studies a significantly lowered mMRC compared with the control group (MD = −0.73, 95% CI [−0.96, −0.50], P < .00001) as well as improvements in forced expiratory volume in one second (FEV1) (MD = −0.16, 95% CI [0.09, 0.23], P < .00001) and FEV1% (MD = 9.71, 95% CI [8.44, 10.98], P < .00001).(2)

The following were shown to be beneficial: continuous training, HIIT, land or water-based training, pulmonary rehabilitation(PR), telemedicine PR, Tai Chi, Yoga & qigong.(10–13) Whole body vibration had no significant benefit.(14)

Quality of evidence
Grade B – Moderate quality

Strength of recommendation
Grade 1 – Strong recommendation

Overall a considerable number of physical activity interventions can improve dyspnoea and feelings of breathlessness in patients with COPD.


  1. Pan L, Guo YZ, Yan JH, Zhang WX, Sun J, Li BW. Does upper extremity exercise improve dyspnea in patients with COPD? A meta-analysis. Respir Med [Internet]. 2012 Nov [cited 2022 Oct 6];106(11):1517–25. Available from:
  2. 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:
  3. 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:
  4. Lee EN, Kim MJ. Meta-analysis of the Effect of a Pulmonary Rehabilitation Program on Respiratory Muscle Strength in Patients with Chronic Obstructive Pulmonary Disease. Asian Nurs Res (Korean Soc Nurs Sci) [Internet]. 2019 Feb 1 [cited 2022 Oct 6];13(1):1–10. Available from:
  5. Ora J, Prendi E, Attinà ML, Cazzola M, Calzetta L, Rogliani P. Efficacy of respiratory tele-rehabilitation in COPD patients: Systematic review and meta-analysis. Monaldi Arch chest Dis = Arch Monaldi per le Mal del torace [Internet]. 2022 Jan 27 [cited 2022 Oct 4];92(4). Available from:
  6. Zhang H, Hu D, Xu Y, Wu L, Lou L. Effect of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis of randomized controlled trials. Ann Med [Internet]. 2022 [cited 2022 Oct 5];54(1):262–73. Available from:
  7. Higashimoto Y, Ando M, Sano A, Saeki S, Nishikawa Y, Fukuda K, et al. Effect of pulmonary rehabilitation programs including lower limb endurance training on dyspnea in stable COPD: A systematic review and meta-analysis. Respir Investig. 2020 Sep 1;58(5):355–66.
  8. 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. [Internet]. 2022 [cited 2022 Oct 5];19(1):69–80. Available from:
  9. Kruapanich C, Tantisuwat A, Thaveeratitham P, Lertmaharit S, Ubolnuar N, Mathiyakom W. Effects of Different Modes of Upper Limb Training in Individuals With Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis. Ann Rehabil Med [Internet]. 2019 [cited 2022 Oct 5];43(5):592–614. Available from:
  10. 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:
  11. 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:
  12. 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:
  13. 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:
  14. Zhou J, Pang L, Chen N, Wang Z, Wang C, Hai Y, et al. Whole-body vibration training – better care for COPD patients: a systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis [Internet]. 2018 [cited 2022 Oct 6];13:3243–54. Available from: