Virtual Reality for Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis

Purpose: Chronic obstructive pulmonary disease (COPD) limits exercise capacity and quality of life, and participation in pulmonary rehabilitation (PR) is often suboptimal. Virtual reality (VR) may enhance engagement and complement rehabilitation. We synthesized the effects of immersive and nonimmersive VR on functional capacity, dyspnea, lung function, quality of life, mental health, and adherence in people with COPD. Methods: PubMed, MEDLINE, and CINAHL were searched through June 2025 for experimental VR studies in COPD. Twelve studies met inclusion criteria. Risk of bias was assessed with RoB 2 (randomized trials) and ROBINS-I (nonrandomized studies). Random-effects meta-analyses were conducted for primary outcomes, with subgroup analyses by VR type. Results: Among randomized trials, four were rated as low risk of bias, 3 moderate, and one high. Among nonrandomized studies, two were rated moderate and two as high risk of bias. Pooled analyses comparing VR interventions with conventional or PR programs did not demonstrate statistically significant differences for the six-minute walk test (standardized mean difference [ SMD ] = 0.98, 95% CI [−1.89, 3.85]), the sit-to-stand test ( SMD = 1.49, 95% CI [−0.85, 3.83]), or dyspnea ( SMD = −0.41, 95% CI [−0.88, 0.07]). Subgroup analyses suggested immersive VR reduced dyspnea more than nonimmersive approaches. Individual studies often reported improvements in lung function and quality of life, but small samples and heterogeneity limited pooling. Conclusions: Virtual reality interventions show improvements comparable with conventional rehabilitation. However, pooled analyses did not demonstrate statistically significant advantages of VR for primary outcomes, which may be constrained by small, heterogeneous studies and short interventions. Subgroup analyses suggested larger dyspnea reductions in immersive VR studies. Larger, adequately powered trials with standardized VR dosage, core outcomes, and longer follow-up are needed to clarify VR's role as an adjunct to PR in COPD.