@article{Fan2026, 
author = {Mo-han Fan and Robin W. M. Vernooij and Zhan-ju Fu and Bao-yi Shao and Jia-qi Li and Hua-xi Yang and Er-yu Wang and Lin-jing Qiu and Lei Wang and Ying Zhang},
title = {Liuzijue as an effective rehabilitation exercise for chronic obstructive pulmonary disease: a systematic review and meta-analysis},
year = {2026},
journal = {Evidence-Based Chinese Medicine and Technology Assessment},
volume = {2},
number = {2},
pages = {9570032},
keywords = {Liuzijue, chronic obstructive pulmonary disease, traditional Chinese medicine, randomized controlled trials, systematic review, meta-analysis, GRADE},
url = {https://www.sciopen.com/article/10.26599/eCMTA.2026.9570032},
doi = {10.26599/eCMTA.2026.9570032},
abstract = {IntroductionLiuzijue (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. MethodsThe 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. ResultsWe 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. ConclusionRegularly 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).}
}