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

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 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 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. Registration: This study was registered with PROSPERO (https://www.crd.york.ac.uk/prospero/, CRD42021249739).