Effects of complementary therapies on physiological and psychological outcomes in chronic obstructive pulmonary disease patients: A systematic review and meta-analysis of randomized controlled trials

Background: Pulmonary rehabilitation (PR) is the cornerstone intervention for improving respiratory function and symptoms in patients with chronic obstructive pulmonary disease (COPD). However, evidence on the effects of complementary therapies (CTs), such as yoga, tai chi/qigong, music therapy, cognitive behavioral therapy (CBT), relaxation techniques, and water-based exercise, remains limited. Methods: Randomized controlled trials (RCTs) involving patients with COPD were systematically searched in Embase, Scopus, PubMed, and MEDLINE (Ovid). Study selection followed PRISMA guidelines. Continuous outcomes were pooled as mean differences (MDs) using random-effects models. Results: Thirty-six RCTs involving 3148 participants were included. Compared with usual care, effects on exercise capacity varied across different CTs, with improvements observed primarily in exercise-based approaches (6-min walk distance [6MWD]; MD = 58.73 m), pulmonary function (FEV1% predicted; MD = 4.65), dyspnea (modified Borg scale; MD = −0.79; CRQ dyspnea; MD = 1.03), symptom burden (COPD Assessment Test; MD = −3.36), and health-related quality of life (SGRQ total score; MD = −8.40). Anxiety and depression (HADS-A and HADS-D) were also reduced (MD = −1.70 and −1.02, respectively). Compared with PR, CTs showed greater improvements in 6MWD (MD = 8.17) and HADS-D (MD = −0.74). Conclusion: Complementary therapies may improve both physiological and psychological outcomes in patients with COPD and may serve as adjunctive strategies to conventional pulmonary rehabilitation. Further research is needed to identify optimal modalities and patient-specific responses. © 2026 Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.