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Systematic Review | Open Access

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

Mo-han Fan1, Robin W. M. Vernooij2,3, Zhan-ju Fu4, Bao-yi Shao5, Jia-qi Li6, Hua-xi Yang7, Er-yu Wang8, Lin-jing Qiu9, Lei Wang10, Ying Zhang11( )
Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, 3584, The Netherlands
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, 3584, The Netherlands
School of Economics and Management, Beijing Jiaotong University, Beijing, 100044, China
School of Chinese Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, 999077, China
School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, 102488, China
Department of Breast Diseases, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
TCM Rehabilitation Center, Beijing Rehabilitation Hospital, Capital Medical University, Beijing, 100144, China
Department of Endocrinology, Guangwai Hospital, Beijing, 100055, China
Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 102488, China
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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.

Registration:

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

Keywords

Liuzijuechronic obstructive pulmonary diseasetraditional Chinese medicinerandomized controlled trialssystematic reviewmeta-analysisGRADE

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Evidence-Based Chinese Medicine and Technology Assessment
Volume 2 Issue 2,
June 2026
Article number: 9570032
DOI: 10.26599/eCMTA.2026.9570032

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Cite this article:
Fan M-h, Vernooij RWM, Fu Z-j, et al. Liuzijue as an effective rehabilitation exercise for chronic obstructive pulmonary disease: a systematic review and meta-analysis. Evidence-Based Chinese Medicine and Technology Assessment, 2026, 2(2): 9570032. https://doi.org/10.26599/eCMTA.2026.9570032

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Received: 01 February 2026
Revised: 08 April 2026
Accepted: 30 April 2026
Published: 24 June 2026
© 2026 Beijing University of Chinese Medicine. Production and hosting by Tsinghua University Press.

This is an open access article under the CC-BY license (http://creativecommons.org/licenses/by/4.0/).