Non-pharmacological interventions for fatigue in patients with chronic obstructive pulmonary disease: a systematic...

Fatigue is a common and debilitating symptom in patients with chronic obstructive pulmonary disease (COPD). It limits daily activities, lowers perceived health, and diminishes the overall quality of life. Although several interventions have been demonstrated to alleviate fatigue, the relative effectiveness of these interventions remains unclear.

To assess and compare the efficacy of various non-pharmacological interventions for managing fatigue in patients with COPD, and to provide evidence-based recommendations for the design of intervention programs.

A comprehensive literature search was conducted across MEDLINE, Cochrane Library, Web of Science, Embase, CINAHL, CNKI, Wanfang Database, CBM, and the VIP Chinese journal full-text database to identify randomized controlled trials and quasi-experimental studies evaluating non-pharmacological interventions for COPD-related fatigue. The search covered all records from the inception of each database up to August, 2025. The network meta-analysis was conducted using Stata 16.0 and Addis 1.16.8 software.

The analysis included 35 studies involving 2565 patients with COPD and examined 12 distinct non-pharmacological interventions. Results from the network meta-analysis demonstrated that acupressure [standardized mean difference (SMD) = -20.58, 95 %CI (-36.35, -5.19), P < 0.05], aerobic exercise [SMD = -12.80, 95 %CI (-22.96, -2.57), P < 0.05], pulmonary rehabilitation [SMD = -20.07, 95 %CI (-32.61, -6.98), P < 0.05], and progressive muscle relaxation [SMD = -16.99, 95 %CI (-28.83, -5.57), P < 0.05] were significantly effective in alleviating COPD-related fatigue. Ranking probability analysis further suggested that acupressure (0.25) was the most effective intervention, followed by pulmonary rehabilitation (0.19) and progressive muscle relaxation (0.15). The sensitivity analysis indicated that the ranking probability of acupressure was influenced by the quasi-experimental studies.

Pulmonary rehabilitation and progressive muscle relaxation therapy provide significant therapeutic advantages and should be prioritized as key non-pharmacological strategies for managing fatigue in patients with COPD.

INPLASY registration number: 202290072.