Effectiveness of Baduanjin exercise on pulmonary function, quality of life, psychological well-being and exercise tolerance in postoperative patients with non-small cell lung cancer: Systematic review and meta-analysis of randomized controlled trials

Objective: To evaluate the influence of engaging in Baduanjin exercise on pulmonary function, quality of life (QoL), mental well-being and exercise tolerance among postoperative individuals diagnosed with non-small cell lung cancer (NSCLC). Methods: A comprehensive search of randomized controlled trials (RCTs) in eleven different electronic databases, spanning from their inception up until July 3, 2024, was conducted. Following this exhaustive search, the literature was thoroughly screened, relevant information was carefully extracted, and the potential for bias within the selected studies was critically evaluated by two independent researchers. Employing Revman 5.4 software, statistical analyses were then carried out. Results: A comprehensive compilation of 6 RCTs, involving a collective 540 patients diagnosed with NSCLC, was analyzed. The pooled findings revealed that engaging in Baduanjin exercise leads to a significant enhancement in forced vital capacity (FVC) (WMD=0.23, 95% CI=0.06 similar to 0.41, P = 0.009), forced expiratory volume in the first second (FEV1) (WMD=0.16, 95% CI=0.00 similar to 0.32, P = 0.05) in NSCLC patients, as well as QoL (WMD=24.09, 95% CI=20.68 similar to 27.51, P<0.00001) and functional well-being (WMD=6.70, 95% CI=5.50 similar to 7.90, P < 0.00001). Meanwhile, Baduanjin exercise reduced Self-Rating Anxiety Scale (SAS) (WMD=-9.58, 95% CI=-10.58 similar to -8.58, P < 0.00001) scores in patients with NSCLC. However, sensitivity analyses revealed that the results for physical well-being, social/family well-being, emotional well-being, lung cancer subscales, Self-Rating Depression Scale (SDS) scores, and 6 min walk distance (6MWD) lacked robustness. Subgroup analysis was conducted based on the intervention frequency, revealed that both 3 and 10 weekly training sessions improved 6MWD in NSCLC patients. Notably, 10 weekly training sessions (WMD=54.72, 95% CI=28.76 similar to 80.69, P<0.0001) were found to be twice as effective as 3 weekly training sessions (WMD=26.96, 95% CI=17.31 similar to 36.61, P<0.00001) in enhancing 6MWD . However, no improvement in 6MWD was observed in the 8 weekly training sessions (WMD=-18.34, 95%CI=-41.55 similar to 4.87, P<0.00001). Conclusion: The meta-analysis revealed that for individuals diagnosed with NSCLC, Baduanjin exercise demonstrated significant effectiveness in terms of pulmonary function enhancement, QoL elevation, anxiety alleviation and exercise endurance improvement. However, the methodological limitations significantly constrain the strength of clinical evidence. Meanwhile, the lack of robustness in some outcomes as indicated by sensitivity analyses, suggest significant constraints in the external validity and generalizability of the findings to broader populations.