Virtual reality/exergaming-complemented pulmonary rehabilitation in chronic obstructive pulmonary disease: an umbrella review of systematic reviews and meta-analyses

Evidence from meta-analyses on VR/exergaming-complemented pulmonary rehabilitation for chronic obstructive pulmonary disease (COPD) has expanded rapidly. This umbrella review appraised that evidence, with emphasis on methodological quality, intervention type, and overlap among the primary studies included in the reviews. We conducted an umbrella review of systematic reviews/meta-analyses retrieved from nine databases. Methodological quality was assessed with AMSTAR-2, primary-study overlap with the Corrected Covered Area (CCA), and certainty of evidence with GRADE. Because dependent review-level estimates should not be treated as independent observations, we used a structured descriptive presentation of individual meta-analytic estimates rather than a second-level pooled analysis of overlapping reviews. Twelve meta-analyses published between 2020 and 2025 were included; five were rated as low quality and seven as critically low quality using AMSTAR-2. Outcome-specific CCA values ranged from 20.00% to 50.00%, indicating very high primary-study overlap across all assessed outcomes. Most primary studies evaluated screen-based or motion-sensing exergaming interventions, whereas fewer evaluated immersive VR systems. Review-level estimates generally favored VR/exergaming-complemented PR for several rehabilitation outcomes, although dyspnea findings were inconsistent and most 6MWD estimates did not clearly exceed the commonly cited MCID range of 25–30 m. Because of the low methodological quality, very high overlap, and very low certainty of evidence, statistically significant findings were not interpreted as definitive evidence of clinically important benefit. VR/exergaming-complemented PR may improve selected rehabilitation-related outcomes in COPD, but the clinical importance and certainty of these changes remain uncertain. Certainty of evidence was very low for all assessed outcomes, so the findings should be interpreted as exploratory rather than confirmatory. Because the current evidence base mainly reflects screen-based or motion-sensing exergaming rather than immersive VR, the findings should not be interpreted as firm evidence for immersive VR interventions specifically. Firm clinical recommendations require better primary trials and rigorously conducted systematic reviews that clearly distinguish immersive VR from screen-based exergaming. PROSPERO CRD420251143714.