The efficacy of pulmonary rehabilitation on cognitive functions in patients with chronic obstructive pulmonary disease: systematic review

Background Pulmonary rehabilitation (PR) program is an essential non-pharmacological management in patients with chronic obstructive pulmonary disease (COPD). COPD can lead to cognitive impairment (CI) for about 36%.in COPD patients. Objective The aim of this study is to explore the efficacy of PR in improving cognitive functioning in patients with COPD. Method Electronic searches of three databases: PubMed, Scopus, and Web of Science were performed. The included studies assessed at least one cognitive function in patients with COPD before and after participating in PR program. Study quality was evaluated by two reviewers independently using risk-of-bias tool (RoB 2) for randomized control trials (RCT) and Risk of Bias In Non-Randomized Studies - of Interventions (ROBIN-I) for non-RCT. Result Eleven studies (six RCT and five non-RCT) were selected based on the inclusion criteria, representing ten components of PR intervention, and 25 cognitive tests (or subtests). The total number of participants was 864 patients with COPD. The age range was 48 to 76 years and both genders were included. The studies showed heterogeneity in the study design, PR intervention elements and cognitive tests. PR program showed significant improvement among COPD population in cognitive function in nine studies. The most frequent test used was Montreal Cognitive Assessment test and the most frequent PR component performed was aerobic exercise. Conclusion PR programs possibly improve cognitive function among patients with COPD especially those suffering from cognitive impairment. Future studies need to unify the PR intervention elements and the neuropsychological battery tests used to enable a proper evaluation of the program efficacy and application. Systematic review registration PROSPERO Registration ID: CRD42023471801.