Effectiveness of traditional Chinese Medicine Breathing-Daoyin Rehabilitation Techniques on lung function and exercise endurance in COPD: a systematic review and meta-analysis

Objective To evaluate the effects of Traditional Chinese Medicine Breathing-Daoyin Rehabilitation Techniques (TCM-BDRT) on lung function and exercise capacity in patients with chronic obstructive pulmonary disease. Methods We conducted a comprehensive search of Chinese and English databases up to August 2025. Primary outcome measures included pulmonary function parameters (FEV1%, FVC%, PEF%, FEV1/FVC%) and exercise endurance (6-min walk test, 6MWT). Secondary outcomes comprised Chronic Obstructive Pulmonary Disease Assessment Test (CAT) scores, blood gas variables, and incidence of adverse events. Meta-analysis was performed using Stata 17.0. Results Eleven RCTs involving 964 participants were included. The meta-analysis demonstrated that Traditional Chinese Medicine Breathing-Daoyin Rehabilitation Techniques significantly improved FEV1% MD = 5.00, 95% confidence interval (2.95, 7.05), FVC% MD = 6.34, 95% CI (4.04, 8.63), peak expiratory flow rate percentage MD = 6.55, 95% CI (4.93, 8.18), and 6-min walk distance MD = 19.53 m, 95% CI (7.94, 31.12). It also reduced arterial blood carbon dioxide partial pressure MD = −5.99, 95% CI (−8.28, −3.69) and increased arterial oxygen partial pressure MD = 11.06, 95% CI (8.84, 13.28). All differences were statistically significant. No significant differences were observed in improvements in FEV1/FVC% or CAT scores. None of the included studies reported adverse events. The certainty of evidence was moderate to low. Conclusion TCM-BDRT holds promise as a potential non-pharmacological intervention for enhancing lung function, exercise endurance, and gas exchange capacity in patients with COPD. This low-intensity, scalable therapeutic approach aligns with the integrated treatment paradigm of combining Traditional Chinese Medicine and Western Medicine. It may be particularly suitable for patients who are frail or have limited exercise capacity. Nevertheless, large-scale, multi-center, high-quality RCTs are warranted to validate its long-term efficacy, with a specific focus on safety profiles. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251114263 , identifier CRD420251114263.