Abstract:Objective To assess the comparative impact of nine exercise training modalities on pulmonary rehabilitation in COPD patients. Methods We searched eight domestic and international electronic databases, from inception to 1 March 2022, to identify randomized controlled trails that compared the differences between different exercise training modalities in pulmonary rehabilitation for COPD patients. Two researchers independently screened the search results, extracted data and assessed risk of bias of included studies. Then, network meta-analysis was performed by R4.1 and ADDIS. Results A total of 34 studies, totaling 2,373 patients, with 9 exercise modalities were included. All exercise training modalities presented significant improvements in FEV1%pred, FEV1/FVC% and dyspnea (SGRQ symptom score) compared to usual treatment and care, however yoga showed no benefit than usual care in improving FEV1%pred. For improvement of FEV1%pred, resistance exercise, tai-chi, and combined aerobic and resistance exercise were superior to Baduanjin;and tai-chi was also better than breathing exercise and Liuzijue. The surface under the cumulative ranking curve confirmed that resistance training was most likely to result in improving pulmonary function while Liuzijue was more powerful in ameliorating dyspnea. Conclusion Exercise training can effectively improve pulmonary function and alleviate dyspnea in COPD patients. Appropriate exercise modality can be selected according to the goals of the intervention.