BACKGROUND: This study aimed to compare and rank the effects of aerobic exercise, resistance training, endurance training, and high-intensity interval training in COPD by network meta-analysis.

METHODS: PubMed, Cochrane, Embase, and the Web of Science were searched to identify randomized controlled trials that investigated the effects of exercise training on COPD. The search period began on the date of database establishment and ended on April 8, 2023. Two reviewers independently screened the retrieved articles, extracted relevant data, and assessed the risk of bias in the included studies. Network meta-analysis was performed by using statistical software.

RESULTS: This study included a total of 27 studies that involved 1,415 subjects. The network meta-analysis findings indicated that high-intensity interval training was the most-effective intervention for improving 6-min walk distance with a surface under the cumulative ranking curve score of 87.68%. In addition, high-intensity interval training showed the highest efficacy in improving FEV1 with a surface under the cumulative ranking curve score of 73.17%, FEV1/FVC with a surface under the cumulative ranking curve score of 79.52%, and St. George Respiratory Questionnaire score with a surface under the cumulative ranking curve score of 73.88%. Conversely, endurance training was found to be the most effective for ameliorating FVC with a surface under the cumulative ranking curve score of 73.39%.

CONCLUSIONS: The findings of this study suggest that high-intensity interval training may be more effective than endurance exercise, resistance exercise, and aerobic exercise in improving the 6-min walk distance, FEV1, FEV1/FVC, and St. George Respiratory Questionnaire scores in patients with COPD. In addition, endurance training may be better than resistance exercise, aerobic exercise, and high-intensity interval training in improving FVC in patients with COPD. However, due to the limited number of studies conducted on high-intensity interval training, more high-quality randomized controlled trials are required to verify these conclusions.