Exercise Training Improves Depression and Anxiety in Patients with COPD: A Dose-Response Meta-Analysis of Randomized Controlled Trials

Objective: To evaluate the effects of exercise training on depressive and anxiety symptoms in patients with chronic obstructive pulmonary disease (COPD). Methods: We searched PubMed, Embase, Cochrane Library, and Web of Science from inception to May 7, 2025, for randomized controlled trials (RCTs) investigating exercise training for depression or anxiety in COPD patients. Two researchers independently screened literature, extracted data, and assessed methodological quality. To reduce measurement heterogeneity, only studies reporting the Hospital Anxiety and Depression Scale (HADS-D for depression, HADS-A for anxiety) were included as outcome indicators. Meta-analysis was performed using a random-effects model, and subgroup analysis explored the influence of cumulative intervention duration. Results: Eleven RCTs involving 1208 COPD patients were included. Using HADS-D and HADS-A as outcome measures, exercise training significantly improved depressive symptoms [SMD = − 0.35 (95% CI: − 0.58, − 0.12), P < 0.05] and anxiety symptoms [SMD = − 0.27 (95% CI: − 0.53, − 0.01), P < 0.05]. Subgroup analysis indicated that improvement in depression was significant when cumulative intervention duration exceeded 1500 minutes ( P < 0.05). For anxiety, although subgroup differences were not significant, the overall trend supported a positive effect. Conclusion: Exercise training is an effective non-pharmacological intervention for depression and anxiety in COPD patients. Integrating exercise into comprehensive COPD management is recommended, with exploratory evidence suggesting benefit when cumulative durations exceed 1500 minutes. More high-quality, long-term follow-up RCTs are needed to clarify optimal exercise regimens and mechanisms. Keywords: COPD, exercise, depression, anxiety, meta-analysis, randomized controlled trial