Comparative efficacy of digital health interventions and traditional mind-body exercises for pulmonary rehabilitation in chronic obstructive pulmonary disease: a systematic review and network meta-analysis

Vollständiger Abstract

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Background Digital health interventions (DHIs) and traditional mind-body exercises (TMBEs) have shown potential benefits for pulmonary rehabilitation in stable COPD, but their comparative efficacy remains unclear. Objective To compare DHIs (Synchronous telerehabilitation, Composite digital interventions) and TMBEs (Tai Chi, Baduanjin, Yoga) for stable COPD using network meta-analysis. Methods PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, and VIP were searched from inception to April 2026. RCTs comparing DHIs or TMBEs with usual care were included. Bayesian network meta-analysis and network meta-regression were performed. Outcomes included 6MWD, FEV1, FVC, SGRQ and CAT. Treatment effects were expressed as mean differences (MDs) with 95% credible intervals (CrIs), and treatment ranking probabilities and certainty of evidence were assessed using SUCRA and GRADE, respectively. Results Forty-seven RCTs enrolling 4,720 stable COPD patients were included. Compared with usual care, Baduanjin and Yoga significantly elevated 6MWD, FEV1 and FVC. Tai Chi and Baduanjin produced meaningful SGRQ reductions; four interventions (Baduanjin, Composite digital interventions, Synchronous telerehabilitation, Tai Chi) yielded significant CAT score improvements. SUCRA results revealed Yoga possessed the highest likelihood of top ranking for exercise capacity (6MWD:82.9%) and lung function (FEV1: 90.5%; FVC: 100.0%), with Baduanjin second for FVC (74.8%). Tai Chi ranked best for quality-of-life indicators (SGRQ: 80.7%; CAT: 92.3%). These rankings stemmed mostly from indirect comparisons and cannot confirm definitive superiority between active interventions. Meta-regression indicated longer intervention duration correlated with larger 6MWD improvements. Conclusion Targeted mind-body exercises and synchronous telerehabilitation exert beneficial effects vs. usual care for stable COPD. Yoga is most likely optimal for exercise endurance and lung function, while Tai Chi performs best for symptom-related quality of life. These rankings rely heavily on indirect evidence and fail to prove clear superiority of any single intervention. Baduanjin shows consistent benefits across all measured outcomes; Synchronous telerehabilitation serves as a viable choice for alleviating respiratory symptoms. Composite digital interventions require more high-quality trials to verify their clinical value. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=261380778 , Identifier: CRD420261380778