Liuzijue as an effective rehabilitation exercise for chronic obstructive pulmonary disease: a systematic review and meta-analysis

Abstract

Introduction Liuzijue (LZJ), a traditional Chinese exercise, may improve quality of life and pulmonary function in patients with chronic obstructive pulmonary disease (COPD), but evidence for its efficacy and assessment of any subgroup differences remains insufficient. This systematic review of randomized controlled trials (RCTs) evaluated LZJ’s effects on patient outcomes. Methods The Cochrane Library, Web of Science, PubMed, and three Chinese databases were systematically searched from their inception until December 31, 2025. Rigorous screening, assessment of risk of bias, and data extraction were performed in duplicate by two reviewers. A random-effects model with predefined subgroup analyses was used. Statistical significance was set at P < 0.1, and subgroup effect credibility was assessed via a five-criteria checklist. A GRADE evidence profile was established to assess the certainty of evidence. Results We included 24 eligible RCTs comprising 1467 patients. Compared with usual care, the standardized mean difference (SMD) on quality of life in the LZJ group was −0.84 (95% confidence interval [CI]: −1.20, −0.47, P < 0.00001). There were statistical differences for LZJ group for forced expiratory volume in 1 second (FEV₁) (mean difference [MD] = 0.28, 95% CI: 0.13, 0.42, P = 0.0002), FEV₁% (MD = 5.19, 95% CI: 2.76, 7.62, P < 0.0001), FEV₁/forced vital capacity (FVC)% (MD = 6.97, 95% CI: 1.19, 12.75, P = 0.02), and 6-minute walk distance (m) (MD = 33.64, 95% CI: 22.17, 45.10, P < 0.00001). However, no differences were found for FVC (MD = 0.18, 95% CI: −0.06, 0.42, P = 0.14). The certainty of the evidence was low to very low because of the risk of bias, inconsistency, or indirectness. Conclusion Regularly performing LZJ is beneficial for COPD recovery, based on evidence of low to very low certainty. Rigorously designed RCTs that address patient outcomes with longer follow-up periods are required.

Keywords

Liuzijue / chronic obstructive pulmonary disease / traditional Chinese medicine / randomized controlled trials / systematic review / meta-analysisGRADE

Electronic Supplementary Material

The online version contains supplementary material available at https://doi.org/10.26599/eCMTA.2026.9570032.

Acknowledgements

We are grateful to Prof. Jian-ping Liu (Center for Evidence-Based Medicine, Hospital of Chengdu University of TCM, China) for his invaluable guidance, continuous support, and critical revisions throughout the study that greatly facilitated its completion.

Funding

This study was funded by the Special Project for Emergency Research on the Prevention and Control of COVID-19 by Traditional Chinese Medicine, supported by the National Administration of Traditional Chinese Medicine (grant no.: 2022ZYLCYJ01-4), and the Special Project for Emergency of the Ministry of Science and Technology of PR. China (grant no.: 2022YFC0868300).

Author Contribution Statement

Mo-han Fan: Data curation, investigation, visualization, formal analysis, and writing - original draft. Robin W. M. Vernooij: Methodology, software, validation, and writing - review & editing. Zhan-ju Fu: Formal analysis, investigation, visualization, and writing - review & editing. Bao-yi Shao: Investigation and data curation. Jia-qi Li: Investigation and formal analysis. Hua-xi Yang: Software and validation. Er-yu Wang: Investigation and writing - review & editing. Lin-jing Qiu: Validation. Lei Wang: Supervision and writing - review & editing. Ying Zhang: Conceptualization, funding acquisition, project administration, supervision, and writing - review & editing.

Declaration of Competing Interest

The authors have no competing interests to declare that are relevant to the content of this article.

Data Availability

Additional data related to this paper may be obtained from the corresponding author upon reasonable request.

Use of AI Statement

None.

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