Which Remote Exercise Interventions are Most Effective in Improving Physical Activity and Quality of Life in Patients with Chronic Obstructive Pulmonary Disease? A Systematic Review and Network Meta-Analysis.

Background: Remote technology is recommended for exercise management in chronic obstructive pulmonary disease (COPD) patients to enhance health and exercise function. Despite numerous studies, the optimal combination of remote technologies and auxiliary interventions remains unclear. Objective: Evaluate which remote exercise interventions and their additional behavioral support measures are most effective in improving exercise function, exercise behavior, and healthy quality of life in COPD patients. Methods: A systematic review using a network meta-analysis (NMA) of randomized controlled trials (RCTs). We searched PubMed, the Cochrane Central Register of Controlled Trials, Web of Science, EMBASE, CINAHL, and Medline from their inception to December 31, 2024. RCTs evaluating remote exercise interventions were included. The NMA was performed using STATA software. Results: Twenty-nine RCTs were included (3,234 participants). Remote device & Exercise was superior in improving 6-minute walking distance (6MWD, SMD 0.51, 95% CI 0.10-0.93, SUCRA 81.8%) compared to usual care, traditional face-to-face rehabilitation, and other remote exercise intervention types; Online self-management & Exercise was superior in facilitating daily activity time (SMD 0.48, 95% CI 0.08-0.88, SUCRA 90.1%); Application & Exercise significantly improved healthy quality of life (Negative scale, SMD -0.67, 95%CI-1.05--0.29, SUCRA 81.1%); increased behavioral aids had an integrative effect with the remote exercise intervention, Motivation & Feedback + Health education significantly improved exercise function and quality of life; Motivational interviewing + Goal setting + Activity monitor/Pedometer + Health education significantly promoted exercise behavior. On average, the quality of evidence ranged from low to very low. Conclusion: This review found evidence that remote exercise series of interventions is superior in improving outcomes such as exercise function, promoting exercise behavior and enhancing healthy quality of life in patients with COPD. Additional behavioral aids had an integrative effect on outcome improvement.