Introduction

Chronic obstructive pulmonary disease (COPD) is a common lung disease characterized by persistent and progressive airflow restriction, which can lead to dyspnea, cough, fatigue, and repeated chest infections, with a severe reduction in patients' quality of life1. In 2018, Chinese scholars completed the first results of the study on adult lung health in China, revealing that the prevalence rate of COPD in Chinese adults aged 20 years and above was 8.6%, that of adults aged 40 years and above was 13.7%, and that of people aged 60 years and above was more than 27%. The older the age, the higher the prevalence rate of COPD2. In recent years, COPD has developed into the fourth leading cause of lung disease death3. This situation poses a significant threat to public health safety. Exercise training is considered an essential part of the rehabilitation process for COPD. On the one hand, various ways of sports training can meet the choices of people with different sports preferences. On the other hand, sports training has lower costs and is easy to implement. In the exercise program of lung rehabilitation, resistance training, aerobic training and traditional Chinese medicine exercise are often used to intervene. Among them, the effectiveness of traditional Chinese medicine sports projects in promoting body health has been common. It is worth noting that the rehabilitation effect of traditional Chinese medicine exercise "Ba Duan Jin" on COPD patients has been confirmed by relevant studies. It has been confirmed in the exploration of the intrinsic mechanism of the therapeutic effect of Ba Duan Jin that periodic exercise can significantly improve the left parasubiculum and hippocampal Amygdala Transition Area in elderly people with cognitive impairment4. Meanwhile, long-term Ba Duan Jin exercise can promote central nervous system nerve regeneration and migration by upregulating neurotrophic factors such as brain-derived neurotrophic factor and vascular endothelial growth factor5. The improvement of the respiratory function of the organism by Ba Duan Jin is mainly manifested in the enhancement of diaphragm elasticity and the increase of thoracic volume. This leads to a substantial increase in lung inhalation, which in turn improves exercise capacity6,7. However, there are fewer studies globally on the application of Ba duan jin exercise to improve the condition of COPD patients. Relevant studies have shown that Ba duan jin can improve pulmonary function, cognitive function, exercise ability, quality of life and other aspects of COPD patients8,9,10. A small number of meta-analysis studies have been conducted to analyze experimental outcome metrics in terms of lung function and 6-min walk-in patients with COPD, but most of the relevant research results are focused on the last three years. And the analysis of outcome indicators needs to be further supplemented and improved. There was no subgroup analysis of relevant outcome indicators. Few kinds of literature were included. The analysis is relatively simple and other problems. At the same time, in the previous experimental study cases, the sample size was small and the evaluation criteria of outcome indicators were inconsistent, which caused certain disputes in the research conclusions11,12. Therefore, this study used Meta-analysis to focus on the objective analysis of lung function and outcome indicators of the 6-min walking trial in stable COPD patients after the Ba duan jin intervention. Thus, more COPD patients and related researchers will be aware of this intervention, which will provide a reference basis for clinical application.

Research methods

This study is in strict accordance with the PRISMA declaration and has completed the Systematic evaluation program registration on the International System Evaluation Registration Platform (PROSPERO). Registration number: CRD42024517086.

Inclusion and exclusion criteria

Inclusion criteria: (1) Study type: all included literature are randomized controlled trials (RCTs) that have been published, with language limitations in Chinese or English, (2) The research subjects meet the diagnostic criteria for stable COPD and the patients are adults (≥ 18 years old), (3) All included in the study were intervention studies on the effects of Ba Duan Jin exercise on COPD patients, (4) Ba Duan Jin exercise lasts for more than 2 weeks, including Ba Duan Jin exercise in different positions (such as sitting Ba Duan Jin, horizontal Ba Duan Jin), (5) The search date range is from database establishment to January 2024 in various databases, (6) The experimental results were selected as forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), the first second forced vital capacity percentage of expected value(FEV1%), the ratio of the first second forced vital capacity of forced vital capacity(FEV1/FVC%), 6-min walking distance(6MWD), (7) Include at least one measurement related to lung function or 6MWD in the study.

Exclusion criteria: (1) Outcome indicators are not required, (2) The experimental data is incomplete, (3) non-randomized controlled experiments, (4) Patients with non-stable COPD, (5) Conference or review literature, (6) Repeated publication of literature, (7) The subjects have a history of comorbidities (such as malignant tumors, symptomatic cardiovascular diseases, other lung diseases, etc.), (8) Intervention duration less than 2 weeks, (9) studies with overlapping periods at the same medical institution.

Search strategy

Web of Science, Embase, PubMed, Cochrane Library, China Biomedical Literature Database (CBM), China National Knowledge Network (CNKI), Wanfang Database, and China Science and Technology Journal Database (VIP) were searched by computer. Among them, the English database search terms include Chronic Obstructive lung disease, Chronic Obstructive Pulmonary Diseases, COPD, Chronic Obstructive Airway Disease, Chronic Obstructive Pulmonary Disease, Chronic Airflow Obstructions, Chronic Airflow Obstruction, Qigong, Ba duan jin, Ba duan jin Workout, Ba duan jin Exercise, Ba duan jin Intervention, Ba duan jin Practice, Ba duan jin Training, etc. Chinese search terms included: chronic obstructive pulmonary disease, COPD, COPD, Ba duan jin, Ba duan jin Exercise, Ba duan jin exercise, Ba duan jin training, Ba duan jin intervention, Ba duan jin exercise, etc. The search period is from the establishment of the database to January 2024, and the corresponding search style is formulated according to the search characteristics of each database to ensure the integrity of the search results.

Literature screening and data extraction

The retrieved literature is downloaded and imported into Endnote X9 software, and duplicate studies are eliminated through the software's automatic screening function for duplicate literature. According to the inclusion and exclusion criteria established in this study, all included articles were independently evaluated by two researchers (Kexin Ding and Wei Qi). Firstly, nonrelevant studies are excluded by reading the titles and abstracts, while identifying potentially relevant titles and abstracts by reading the entire text. Secondly, the remaining articles were further screened by reading the entire text (such as excluding articles with low research quality, poor representativeness of outcome indicators, and review articles). The following information was extracted by two researchers (Kexin Ding and Wei Qi) from the included studies: basic characteristics of the literature (title, first author, publication date), characteristics of the subjects (sample size, group, age, gender), intervention characteristics (time, frequency, intervention measures), outcome indicators (FVC, FEV1, FEV1%, FEV1/FVC%, 6MWD). In the process of literature screening and data extraction, if there are any differences, another independent researcher (Wen Sun) will be invited to decide until a consensus is reached.

Quality evaluation

Two researchers (Kexin Ding and Wei Qi) assessed the quality of the included literature using the Cochrane Risk Assessment Scale and the modified Jadad scale, respectively. The Cochrane Risk of Bias Assessment Tool mainly consists of: ① sample random sequence generation, ② The method of allocation hiding, ③ The implementation of the blind method for participants and researchers, ④ Blind strategy of outcome index evaluation, ⑤ the integrity of the research results, ⑥ Selective reporting of research results, ⑦ Other biases. The quality evaluation results of each article are divided into three levels: "low bias risk" ( +), "high bias risk" (-), and "undetermined bias risk" (?). The modified Jadad scale includes ① sample random sequence generation, ② Hidden allocation method, ③ Implementation of blind method, ④ Exit and loss of follow-up records. Each evaluation criterion will also have specific evaluation criteria, such as using computer-generated random numbers or similar methods to score 2 points in the generation of random sequences, using random experimental methods but without specific descriptions to score 1 point, and using alternating classification methods to score 0 points. Literature quality was evaluated after comprehensive scores, with 1–3 classified as low-quality studies and 4–7 as high-quality studies. The 2 investigators (Kexin Ding and Wei Qi) independently completed the quality assessment of each study, and in case of disagreement, a third investigator (Wen Sun) adjudicated until a consensus was reached.

Data analysis

Use Review Manager 5.3 software (The Cochrane Collaboration, San Francisco, California, USA) and StataMP 18 (64 bit) software for data processing and chart making. The lung function and 6MWD involved in this study were continuous variables. Mean difference (MD) and 95% confidence interval (CI) were used to analyze outcome indicators. For the heterogeneity test, the χ2 test was used to judge. If there was no statistical heterogeneity (P > 0.1 and/or I2 ≤ 50%), the fixed-effect model was selected for combined analysis. If statistical heterogeneity was present (P ≤ 0.1 and/or I2 > 50%), a random-effects model was selected for combined analysis. Sources of heterogeneity were further analyzed by subgroup analysis. In order to reduce the limitations of single factor subgroup analysis, we conducted subgroup analysis from three aspects: exercise duration, frequency, and research quality. The sensitivity of the evaluation results was analyzed by using a method of gradually excluding the included studies. When more than 10 articles are included, funnel plots and Egger tests are used to evaluate the risk of publication bias in the study. P < 0.05 indicates significant differences.

Results

Literature search results

A total Of 2193 articles were obtained in the preliminary search, including 72 Web of Science articles, 14 Embase articles, 35 PubMed articles, 60 Cochrane Library articles, 1587 Chinese biomedical database articles, 198 Chinese National Knowledge Network articles, 57 VIP Journal articles and 170 Wanfang articles. 219 duplicates were eliminated by reading the titles, leaving 1974. Initial screening was done by reading article titles and abstracts, and 1,606 articles remained after the exclusion of literature not related to this study. Literature on non-randomized controlled trials, interest-related, and missing findings were excluded by reading the full text, and finally 16 papers were included in the study, including 15 papers in Chinese and 1 paper in English. Details of the literature screening process and exclusion are shown in Fig. 1.

Figure 1
figure 1

Literature screening process.

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Research characteristics and quality evaluation of the included literatures

The study included 16 RCT studies involving 1184 patients with stable COPD. There were 594 males and 590 females. All the experimental groups underwent periodic Ba duan jin exercises. Of these, nine studies conducted a 12-week Ba duan jin training, five studies conducted a 24-week Ba duan jin training, and two studies conducted a 48-week Ba duan jin training. The control group did not carry out regular exercise training. The characteristics of the included studies are shown in Table 1.

Table 1 Characteristics of 16 eligible articles.
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The RevMan 5.3 bias table was used to assess the risk of bias in the included studies (Fig. 2). The quality of the included studies was scored using a modified Jadad rating scale and the total quality assessment score for each study is shown in Table 1.

Figure 2
figure 2

Cochrane bias risk assessment.

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Results of meta-analysis

Meta-analysis of Ba duan jin Exercise on FEV1 in stable COPD patients

Among the included literature, 9 reported the effects of Ba duan jin exercise on FEV1 in stable COPD patients. Among them, 302 people were in the experimental group and 298 people were in the control group. The results of the meta-analysis showed that FEV1 in Ba duan jin group was significantly higher than that in the control group [MD = 0.29, 95% CI (0.20, 0.37), P < 0.00001] (Fig. 3). Heterogeneity test showed significant heterogeneity (I2 = 63%, I2 > 50%). Therefore, the random effects model was used to analyze the results and explore the source of heterogeneity.

Figure 3
figure 3figure 3

Forest map of the effect of Baduanjin Exercise on FEV1 in COPD patients. (A) Subgroup analysis of FEV1 outcome indicators included in the study based on the duration of Baduanjin exercise. (B) Subgroup analysis of FEV1 outcome measures included in the study based on research quality. (C) Subgroup analysis of FEV1 outcome indicators included in the study based on the frequency of Ba Duan Jin exercise.

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Subgroup analysis

In these 9 reports, subgroup analyses were conducted based on the duration of intervention cycles (Fig. 3A), study quality (Fig. 3B), and intervention frequency (Fig. 3C). The results showed that there was no statistical heterogeneity (P = 0.46, I2 = 0%) among the subgroups of intervention cycles ≥ 6 months. At the same time, there was no statistical heterogeneity (P = 0.54, I2 = 0%) among the subgroups of study quality scores with improved JADAD scores > 4 points. The use of random effects models showed that in subgroup analysis based on the duration of intervention cycles, the FEV1 levels in the experimental group under 6 months of Ba duan Jin exercise were higher than those in the control group, and the difference was statistically significant [MD = 0.27, 95% CI (0.13, 0.41), P = 0.0001]. The comparison of FEV1 levels between two groups of Ba Duan Jin exercise for 6 months or more showed statistically significant differences [MD = 0.32, 95% CI (0.27, 0.38), P < 0.00001]. Subgroup analysis based on research quality showed that the FEV1 levels in the experimental group with improved JADAD score ≤ 4 and improved JADAD score > 4 were both better than those in the control group, and the differences were statistically significant [MD = 0.27, 95% CI (0.17, 0.38), P < 0.00001], [MD = 0.3, 95% CI (0.17, 0.44), P < 0.0001]. Subgroup analysis based on exercise frequency showed that the FEV1 levels in the experimental group with exercise frequency ≤ 5 times and > 5 times per week were higher than those in the control group, and there was a significant statistical difference [MD = 0.18, 95% CI (0.00, 0.36), P = 0.04], [MD = 0.3, 95% CI (0.21, 0.39), P < 0.00001].

Meta-analysis of Ba duan jin Exercise on FEV1% of stable COPD patients

Among the relevant literature included, 9 reported the effect of Ba duan jin exercise on FEV1% in stable COPD patients. Among them, the experimental group 290 and the control group 288. The results of the meta-analysis showed that there was no significant difference in FEV1% level between the Ba duan jin group and the control group [MD = 1.90, 95% CI (− 2.15, 5.94), P = 0.36], and heterogeneity test showed significant heterogeneity (I2 = 84%, I2 > 50%). The results were analyzed by a random response model, as shown in Fig. 4.

Figure 4
figure 4figure 4

Forest map of the effect of Baduanjin Exercise on FEV1% of COPD patients. (A) Subgroup analysis of FEV1% outcome indicators included in the study based on the duration of Baduanjin exercise. (B) Subgroup analysis of FEV1% outcome measures included in the study based on research quality. (C) Subgroup analysis of FEV1% outcome indicators included in the study based on the frequency of Ba Duan Jin exercise.

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Subgroup analysis

Considering the high heterogeneity, subgroup analysis was conducted on the 9 reports to be included based on the duration of the intervention cycle (Fig. 4A), study quality (Fig. 4B), and intervention frequency (Fig. 4C). The results showed that there was no statistical heterogeneity (P = 0.67, I2 = 0%) between studies with an intervention period of ≥ 6 months in the subgroups of the intervention period, and no statistical heterogeneity (P = 0.87, I2 = 0%) between studies with an improved JADAD score > 4 points in the subgroups of the study quality score. Random response model analysis showed that in subgroup analysis based on the duration of the intervention period, there was no statistically significant difference in FEV1% levels between the experimental group and the control group within 6 months of Ba Duan Jin exercise [MD = − 1.41, 95% CI (− 8.73, 5.90), P = 0.71]. There was no statistically significant difference in FEV1% levels between the experimental group and the control group who underwent Ba Duan Jin exercise for 6 months or more. The difference between FEV1% levels was statistically significant [MD = 5.75, 95% CI (3.98, 7.53), P < 0.00001]. Subgroup analysis based on research quality showed that there was no statistically significant difference in FEV1% levels between the experimental group with improved JADAD scores ≤ 4 and the control group [MD = 0.43, 95% CI (− 4.88, 5.75), P = 0.87]. However, the FEV1% levels in the experimental group with improved JADAD scores > 4 were better than those in the control group, and the difference was statistically significant [MD = 6.14, 95% CI (3.12, 9.16), P < 0.0001]. Subgroup analysis based on exercise frequency showed no statistically significant difference between groups with exercise frequency ≤ 5 times per week [MD = − 5.33, 95% CI (− 12.67, 2.01), P = 0.16], while there was a statistically significant difference between groups with exercise frequency > 5 times per week [MD = 4.69, 95% CI (2.26, 7.12), P = 0.0002].

Meta-analysis of Ba duan jin Exercise on FVC in stable COPD patients

A total of 8 papers reported the effect of Ba duan jin exercise on FVC in stable COPD patients. There were 274 people in the experimental group and 270 in the control group. The results of the meta-analysis showed that there was no significant difference in FVC between the Ba duan jin group and the control group [MD = 0.09, 95% CI (− 0.26, 0.45), P = 0.61] (Fig. 5). The heterogeneity test showed significant heterogeneity (I2 = 95%), I2 > 50%, and then the random effects model was used to analyze the results.

Figure 5
figure 5figure 5

Forest map of the effect of Baduanjin Exercise on FVC in COPD patients. (A) Subgroup analysis of FVC outcome indicators included in the study based on the duration of Ba Duan Jin exercise. (B) Subgroup analysis of FVC outcome indicators included in the study based on research quality. (C) Subgroup analysis of FVC outcome indicators included in the study based on the frequency of Ba Duan Jin exercise.

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Subgroup analysis

Due to the high heterogeneity, subgroup analysis was conducted on the 8 included studies based on the intervention period duration (Fig. 5A), study quality (Fig. 5B), and intervention frequency (Fig. 5C). The results showed that there was no statistical heterogeneity (P = 1.00, I2 = 0%) among the subgroups with improved JADAD scores > 4 in the study quality score. The application of a random effects model analysis shows that. In subgroup analysis based on the duration of the intervention cycle, there was no statistically significant difference in FVC levels between the Ba Duan Jin exercise group and the control group within 6 months or more [MD = 0.01, 95% CI (− 0.44, 0.46), P = 0.97], [MD = 0.36, 95% CI (− 0.19, 0.90), P = 0.20]. Subgroup analysis based on research quality showed. There was no statistically significant difference in FVC levels between the experimental group with an improved JADAD score of ≤ 4 and the control group [MD = − 0.00, 95% CI (− 0.45, 0.45), P = 1.00]. However, the experimental group with an improved JADAD score of > 4 had better FVC levels than the control group, and the difference was statistically significant [MD = 0.37, 95% CI (0.37, 0.57), P = 0.0003]. Meanwhile, subgroup analysis based on exercise frequency showed no statistically significant differences between groups with a weekly exercise frequency of ≤ 5 times [MD = − 0.39, 95% CI (− 1.54, 0.75), P = 1.00]. The FVC of the experimental group with a weekly exercise frequency > 5 times was better than that of the control group, and there was a statistically significant difference [MD = 0.28, 95% CI (0.05, 0.50), P = 0.01].

Meta-analysis of Ba duan jin Exercise on FEV1/FVC (%) in stable COPD patients

Among the included literature, 9 reported the effect of Ba duan jin exercise on FEV1/FVC (%) in stable COPD patients. Among them, 295 people were in the experimental group and 291 people were in the control group. The results of meta-analysis showed that there was a significant difference in FEV1/FVC (%) level between the Ba duan jin group and the control group [MD = 3.86, 95% CI (2.24, 5.47), P < 0.00001] (Fig. 6). Heterogeneity test showed that the heterogeneity was not significant (I2 = 47%, I2 < 50%), and use a fixed effects model for data analysis.

Figure 6
figure 6

Forest map of the effect of Baduanjin Exercise on FEV1/FVC (%) in COPD patients.

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Meta-analysis of Ba duan jin Exercise on 6MWT in stable COPD patients

In this study, a total of 14 articles reported the effects of Ba duan jin exercise on 6MWT in stable COPD patients. Among them, 506 were in the experimental group and 509 were in the control group. The results of the meta-analysis showed that the 6MWT of the Ba duan jin group was significantly better than that of the control group [MD = 45.41, 95% CI (33.93, 56.89), P < 0.00001] (Fig. 7). After the heterogeneity test, the heterogeneity was significant (I2 = 86%, I2 > 50%). The random response model was used to analyze the results, and the source of heterogeneity was further discussed.

Figure 7
figure 7figure 7

Forest map of the effect of Baduanjin Exercise on 6MWT in COPD patients. (A) Subgroup analysis of 6MWT outcome indicators included in the study based on the duration of Baduanjin exercise. (B) Subgroup analysis of 6MWT outcome indicators included in the study based on research quality. (C) Subgroup analysis of 6MWT outcome indicators included in the study based on the frequency of Ba Duan Jin exercise.

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Subgroup analysis

Among the 14 included reports, subgroup analysis was conducted based on the duration of the intervention cycle (Fig. 7A), study quality (Fig. 7B), and intervention frequency (Fig. 7C). The results showed that among the subgroups conducted according to exercise cycles, there was a more significant decrease in inter-study heterogeneity among those who exercised for < 6 months compared to other subgroups (P = 0.0002, I2 = 75%). It seems that the sources of heterogeneity may be influenced by the frequency of exercise studied. The application of a random effects model analysis shows that. In subgroup analysis based on the duration of the intervention cycle, the experimental group with 6MWT water content within 6 months or more of Ba Duan Jin exercise had an average higher than the control group, and the difference was statistically significant [MD = 36.34, 95% CI (24.47, 48.21), P < 0.00001], [MD = 56.73, 95% CI (37.03, 76.44), P < 0.00001]. Subgroup analysis based on research quality showed that the 6WMT levels in the experimental group were all better than those in the control group, and the differences were statistically significant [MD = 48.07, 95% CI (31.96, 64.18), P < 0.00001], [MD = 39.18, 95% CI (21.85, 56.51), P < 0.00001]. Subgroup analysis based on research quality showed that the 6WMT levels in the experimental group were all better than those in the control group, and the differences were statistically significant [MD = 48.07, 95% CI (31.96, 64.18), P < 0.00001], [MD = 39.18, 95% CI (21.85, 56.51), P < 0.00001].

Publication bias

Due to the limited inclusion of literature, this study only reported bias in the 6MWT outcome indicator test. Visual inspection shows that there is left–right symmetry in the funnel diagram. (Fig. 8). Then, the Eggers test was used to further confirm (Supplementary Appendix Fig. S1), and the results showed P > 0.05 (P = 0.426). There is no significant publication bias or other bias.

Figure 8
figure 8

Funnel diagram of the effect of Baduanjin Exercise on 6MWT in COPD patients.

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Sensitivity analysis

We used sensitivity analyses to assess the robustness of the combined data and to investigate sources of heterogeneity. Sensitivity analyses revealed no significant change in each group and result after excluding individual studies one by one. Therefore, sensitivity analysis indicates that the research results are reliable (Supplementary Appendix Figs. S2–S5).

Discussion

COPD is a public health problem of global concern, which seriously affects the quality of life of patients and is also the third leading cause of death from non-communicable diseases29. The Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) lists lung rehabilitation programs as one of the routine treatment methods for patients with chronic obstructive pulmonary disease and proposes that exercise training is the core of lung rehabilitation programs, which can reduce the number of exacerbations of chronic obstructive pulmonary disease, reduce complications, and improve quality of life for patients30. Meanwhile, due to the need for long-term exercise rehabilitation intervention for chronic obstructive pulmonary disease, more and more patients are choosing exercise rehabilitation training. Ba Duan Jin is one of the traditional sports in traditional Chinese medicine. During the practice process, there is no need for equipment or limited space, and it has significant effects on enhancing physical fitness, regulating respiratory function, and promoting the circulation of qi and blood in various organs and meridians in the body31. Yang et al.32 concluded through the study of COPD patients that traditional Ba duan jin exercise can prevent COPD pulmonary function deterioration and provide COPD patients with a simple, cheap and daily pulmonary rehabilitation measure. This study conducted a meta-analysis of Ba duan jin exercise in stable COPD patients, and the results showed that Ba duan jin exercise can improve the outcome indicators of FEV1, FEV1%, FEV1/FVC (%) and 6MWT of patients. This result is also consistent with the findings of Shuai et al.33.

Ba duan jin exercise belongs to aerobic exercise, and the mechanism of improving pulmonary function in stable COPD patients may be due to the expansion of spasmodic arterioles to prevent airway blockage of bronchus, diffuse oxygen in the lung and increase oxygen partial pressure. Increase patients' ventilation, thereby reducing the partial pressure of carbon dioxide in arterial blood and improving lung function34. It is not difficult to conclude from the analysis of various subgroups in this study that Ba Duan Jin exercise can improve the relevant lung function indicators of COPD patients to varying degrees, thereby reducing disease symptoms and improving their quality of life. However, the analysis of the results also reflects that factors such as short intervention cycles, low exercise frequency, and poor completion of the Ba Duan Jin exercise can also lead to poor rehabilitation effects.

In COPD patients, stiffness of the soft tissues and joints of the neck and shoulder may restrict physical activities, including head extension, high tension of the neck muscles35, thoracic kyphosis and shoulder pronation, weakened contraction characteristics of diaphragm fibers, and reduced elasticity, as the disease progresses. Serial myotome loss, destruction of myofibrin, and morphological changes of diaphragm36. These changes place the diaphragm at a mechanical disadvantage, resulting in reduced capacity of the diaphragm to generate flow and pressure, increased respiratory work, and resulting in diaphragm fatigue37, resulting in reduced motor capacity. The 6MWT is one of the indicators often used to assess a patient's exercise capacity. Meta-analysis of the 14 RCTs with combined outcome indicators included in this study showed that patients' 6-min walking distances were significantly improved after exercise through the Ba duan jin. Meanwhile, short-term or long-term Ba Duan Jin exercise can continuously increase the improvement of patients' exercise ability, as shown in the intervention cycle, exercise frequency, and research quality analysis. The results are consistent with the research results of Xie Qiurong et al.38 and Tong et al.39, suggesting that attention should be paid to developing good exercise habits.

This study indicates that Ba Duan Jin exercise can significantly improve the lung function, exercise endurance, and other abilities of COPD patients. It can be considered to integrate the Ba Duan Jin exercise into daily rehabilitation in the management practice of stable COPD patients. For example, using the Ba Duan Jin exercise as the main exercise rehabilitation method, combining daily medication therapy with the Ba Duan Jin exercise, and combining the Ba Duan Jin exercise with other lung rehabilitation methods. However, during the implementation process, the intervention effect of the Ba Duan Jin exercise is still affected by the duration of the exercise cycle, exercise frequency, and the completion of the exercise plan. Meanwhile, not all indicators of rehabilitation efficacy have been consistently improved. This viewpoint is also consistent with Shuai et al.33 This also reminds us to pay attention to the cultivation of exercise habits while participating in the Ba Duan Jin exercise, and strictly follow the relevant technical movement standards. Previous studies lacked multidimensional analysis of lung function and exercise ability in COPD patients, which reduced the persuasiveness of the research results40,41. This study analyzes the rehabilitation efficacy of the traditional Chinese medicine exercise Ba Duan Jin on COPD patients from a more comprehensive perspective. These results will provide a reference basis for such patients, thereby facilitating the development of the best exercise rehabilitation plan.

The investigation of the clinical effects of Ba duan jin exercise on COPD patients is in the developmental stage, and the global application of Ba duan jin exercise as a form of pulmonary rehabilitation for COPD patients remains rare. After regular exercise, the improvement of patients' body function is mainly analyzed around the outcome indicators such as exercise performance, scale evaluation and physical examination42. Some scholars have explored the changes in relevant brain areas and physiological indicators after the activation of neuroimaging in COPD patients after exercise43,44,45. This will provide more comprehensive and strong support for arguing the role of traditional Chinese medicine exercises in promoting COPD recovery.

The study still has the following limitations (1) The included literature is only published research, and the relevant high-quality research may not be included in the analysis, so the full-text analysis may be biased, (2) Failure to fully consider the supervision and follow-up during Ba duan jin exercise, resulting in interference with outcome indicators, (3) The rehabilitation effect of COPD patients is somewhat correlated with the course of the disease, smoking history, age, gender, etc., and the relevant information has not been specifically analyzed and discussed in the relevant studies included, so the comprehensiveness of this meta-analysis needs to be further improved, (4) The overall quality of the included literature was average, and there was a certain risk of bias. The scale of RCTs included at the same time needs to be further improved to enhance the scientificity of the argumentation results. With the continuous enrichment and deepening of related research, in future research, it may be considered to include and analyze articles with high research quality, large volume, and multiple research centers.

Conclusion

In summary, Ba Duan Jin exercise has a positive improvement effect on lung function and 6-min walking distance in stable COPD patients. And in the process of exercise implementation, attention should be paid to cultivating exercise habits, stabilizing and improving attendance rates, and strictly implementing training techniques to achieve the best clinical outcomes for these patients.