Chronic Obstructive Pulmonary Disease (COPD) is a medical condition characterized by the inability of air flow to effectively transit through the airways, attributable to chronic obstruction in these structures. This pathology originates as a consequence of an exacerbated inflammatory response of the respiratory system, which is triggered by prolonged exposure to irritants and contaminants such as tobacco smoke [1].

This condition must be a primary focal point in the healthcare arena, considering that COPD is significantly linked to a heightened risk of mortality. Hazard Ratios observed are 1.6 and 2.7 for moderate and severe stages of COPD, respectively [2]. Furthermore, it is crucial to highlight that COPD ranks third among the leading causes of death worldwide [3]. In fact, in 2017 statistics reported that COPD contributed to approximately 3,200,000 deaths, accounting for 81.7% of all deaths attributable to chronic respiratory diseases [4].

During the progression of the disease, the most prevalent symptoms often manifest as difficulty in breathing and the presence of chronic cough, which may or may not be accompanied by sputum production [5]. However, it is crucial to note that these do not constitute the entirety of symptoms, as the severity, phenotype, and stage of the disease can give rise to a variety of additional manifestations. These include significant loss of muscle mass with decreased functionality and quality of life, right-sided heart failure, edema in the lower extremities, wheezing, increased anteroposterior diameter of the chest wall (known as barrel chest), and central cyanosis [6].

A frequently adopted and coherent strategy to address deficits in endurance and muscle strength in COPD patients is the implementation of physical exercise [7]. However, it is common for COPD patients to frequently experience exacerbation of dyspnea and hypoxia during exercise practice, hindering patients’ tolerance to a therapeutic exercise program [8].

In response to this challenge, researchers have conducted studies employing eccentric cycling training as a therapeutic exercise program for COPD patients [9], [10]. It has been demonstrated that this exercise modality imposes a lower burden on the cardiopulmonary system and is generally better tolerated by COPD patients [11], [12], [13], [14], [15]. However, to date, only one scoping review mapping all existing literature on eccentric exercise in COPD patients has been identified [16], while other systematic reviews have not exclusively focused on this group but have included individuals with various pathologies [17], [18], [19].

That said, the primary objective of this study is to determine the effects of eccentric cycling training on the physical performance of COPD patients through a systematic review of randomized clinical trials.