Can active mind-body movement therapies alone or combined with pulmonary rehabilitation be effective in the management of chronic obstructive pulmonary disease?

Chronic obstructive pulmonary disease (COPD) is a major cause of illness and the fourth leading cause of death worldwide. COPD is generally characterized by shortness of breath, tiredness, and exercise intolerance. It is usually caused by long-term exposure to lung irritants, such as cigarette smoke, second-hand smoke, air pollution, chemicals, and dust particles from workplace environments.
Pulmonary rehabilitation is defined as a comprehensive intervention generally consisting in exercise training, education, and behaviour change. Its aim is to improve the physical and psychological condition of patients and promote long-term adherence to health-enhancing behaviours. 
Active mind-body movement therapies include mind-body therapies as controlled breathing and/or focused meditation/attention interventions like yoga, tai chi, or qigong where participants actively move their joints and muscles. When applied to people with COPD, they have been found to be more effective than usual care. However, it is not clear whether if they should be applied as an adjunct to or alternatively to pulmonary rehabilitation. 
This Cochrane review examined both RCTs comparing active mind-body movement therapies (for at least 4 weeks with no minimum intervention frequency) versus pulmonary rehabilitation (in any setting for at least 4 weeks, with no minimum intervention frequency, that included conventional exercise training with or without education or psychological support) and RCTs comparing active mind-body movement therapies added to pulmonary rehabilitation versus pulmonary rehabilitation alone in people with COPD. 
Given the low quality of available evidence, the effects of active mind-body movement therapies versus pulmonary rehabilitation or of active mind-body movement therapies added to pulmonary rehabilitation in comparison with pulmonary rehabilitation alone remain inconclusive. 
In most of the RCTs pulmonary rehabilitation programmes included only unstructured walking training. This, together with the poor quality of evidence, limited the authors confidence in the observed effects. 
Available evidence suggests that active mind-body movement therapies were more effective than pulmonary rehabilitation in improving disease-specific quality of life and that when added to pulmonary rehabilitation it was more effective in improving generic quality of life. On the other hand, active mind-body movement therapies were not superior to pulmonary rehabilitation with regard to dyspnoea. 
Future research studies comparing active mind-body movement therapies to pulmonary rehabilitation are needed to draw stronger conclusions. 

Comment by Francesco Agostini