Meta-analysis finds balance training improves balance in COPD patients receiving pulmonary rehabilitation

BACKGROUND: COPD is associated with extrapulmonary manifestations, including balance impairment, which increases the fall risk and reduces functional independence and quality of life. Pulmonary rehabilitation (PR) rarely includes specific balance exercises. This systematic review evaluated the effectiveness of adding balance training (BT) to conventional PR in COPD patients. METHODS: This review was registered in PROSPERO (CRD42024523748) and conducted in accordance with PRISMA guidelines. Six databases were searched up to July 2025 for RCTs involving COPD patients aged ≥50 years that compared PR + BT with PR alone. The outcomes included static balance, dynamic balance, overall balance, balance confidence, functional exercise capacity, and health-related quality of life. The risk of bias was assessed using the Cochrane RoB-2 tool, and meta-analyses were performed using JAMOVI software 5.4. RESULTS: Seven trials with 548 participants were included. BT protocols involved static and dynamic exercises, dual-task activities, and progression from stable to unstable surfaces. Compared with PR alone, PR + BT significantly improved static balance (MD = 3.29 s; 95% CI: 2.76 to 3.82), dynamic balance (MD = -2.08 s; 95% CI: 2.48 to -1.69), overall balance (MD = 3.09 score; 95% CI: 1.11 to 5.06), balance confidence (MD = 6.48 score; 95% CI: 2.48 to 10.48), and health-related quality of life (SMD = -0.78; 95% CI: 1.45 to -0.11). No significant differences were found for functional exercise capacity. CONCLUSION: Incorporating BT into PR improves balance and health-related quality of life among individuals with COPD. Given the high prevalence of balance impairments in this population, these findings support balance training as a clinically relevant component of PR.