{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T20:59:58Z","timestamp":1792184398176,"version":"4.4.0"},"reference-count":46,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T00:00:00Z","timestamp":1768348800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Italian Ministry of Enterprises and Made in Italy","award":["F\/350225\/05\/X60"],"award-info":[{"award-number":["F\/350225\/05\/X60"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Chronic Obstructive Pulmonary Disease (COPD) is frequently associated with dyspnea, impaired health-related quality of life (HRQoL), and cognitive dysfunction. Although pulmonary rehabilitation (PR) is considered a core therapeutic strategy, its specific effects on cognitive function, dyspnea, and dysphonia remain unclear. This systematic review aimed to evaluate the impact of PR and respiratory or cognitive-focused rehabilitative interventions on dyspnea, quality of life, cognitive performance, and voice outcomes in adults with COPD. Methods: This review was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420251131325). A systematic search of PubMed, Scopus and Web of Science identified studies published between 2010 and 21 August 2025. Eligible designs included randomized and non-randomized controlled studies, cohort, and mixed-method studies involving adults with COPD undergoing rehabilitative interventions targeting dyspnea, cognition, dysphonia, or swallowing. Outcomes included cognitive measures, dyspnea scales, voice parameters, and HRQoL indices. Results: Twelve studies (n \u2248 810 participants) met inclusion criteria. Most PR and exercise-based programs showed improvements in global cognition and executive functions, particularly when combined with cognitive training or high-intensity exercise modalities. Dyspnea improved consistently following short- to medium-term PR or respiratory muscle training, whereas low-frequency long-term programs yielded limited benefit. HRQoL improved across structured PR programs, especially in multidimensional interventions. Only one study assessed dysphonia, reporting transient improvements in maximum phonation time following inspiratory muscle training. No included study evaluated dysphagia-related outcomes. Conclusions: PR and respiratory muscle training can enhance cognition, dyspnea, and HRQoL in COPD, although evidence for dysphonia remains scarce and dysphagia is entirely unaddressed. Future high-quality trials should adopt standardized outcome measures, include long-term follow-up, and integrate voice and swallowing assessments within PR pathways.<\/jats:p>","DOI":"10.3390\/jcm15020670","type":"journal-article","created":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T12:04:22Z","timestamp":1768392262000},"page":"670","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Effects of Pulmonary Rehabilitation on Dyspnea, Quality of Life and Cognitive Function in COPD: A Systematic Review"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8265-3037","authenticated-orcid":false,"given":"Alessandro","family":"Vatrella","sequence":"first","affiliation":[{"name":"Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1874-1686","authenticated-orcid":false,"given":"Angelantonio","family":"Maglio","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5443-8185","authenticated-orcid":false,"given":"Maria Pia","family":"Di Palo","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa Anna","family":"Contursi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo Francesco","family":"Buscetto","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noemi","family":"Caf\u00e0","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1600-4682","authenticated-orcid":false,"given":"Marina","family":"Garofano","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosaria","family":"Del Sorbo","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Placido","family":"Bramanti","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colomba","family":"Pessolano","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Marino","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5360-7530","authenticated-orcid":false,"given":"Mariaconsiglia","family":"Calabrese","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5247-9901","authenticated-orcid":false,"given":"Alessia","family":"Bramanti","sequence":"additional","affiliation":[{"name":"Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1164\/rccm.202204-0671PP","article-title":"Definition and Nomenclature of Chronic Obstructive Pulmonary Disease: Time for Its Revision","volume":"206","author":"Celli","year":"2022","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1590\/S1806-37132015000004424","article-title":"Cognitive impairment in COPD: A systematic review","volume":"41","author":"Valenza","year":"2015","journal-title":"J. Bras. Pneumol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2663","DOI":"10.2147\/COPD.S165657","article-title":"Oropharyngeal swallow physiology and swallowing-related quality of life in underweight patients with concomitant advanced chronic obstructive pulmonary disease","volume":"13","author":"Garand","year":"2018","journal-title":"Int. J. Chron. Obstruct. Pulmon. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"100120","DOI":"10.1016\/j.apjon.2022.100120","article-title":"Pathophysiology of cachexia and characteristics of dysphagia in chronic diseases","volume":"9","author":"Matsuo","year":"2022","journal-title":"Asia Pac. J. Oncol. Nurs."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"108012","DOI":"10.1016\/j.rmed.2025.108012","article-title":"Assessment of breathing patterns and voice of patients with COPD and dysphonia","volume":"240","author":"Blaut","year":"2025","journal-title":"Respir. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1056\/NEJMra1900500","article-title":"Update on Clinical Aspects of Chronic Obstructive Pulmonary Disease","volume":"381","author":"Celli","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1080\/07853890.2021.1999494","article-title":"Effect of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis of randomized controlled trials","volume":"54","author":"Zhang","year":"2022","journal-title":"Ann. Med."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Eastus, C.C., Baez, D.E., Buckley, M.L., Lee, J., and Adami, A. (2022). The role of structured exercise interventions on cognitive function in older individuals with stable Chronic Obstructive Pulmonary Disease: A scoping review. Front. Rehabil. Sci., 3.","DOI":"10.3389\/fresc.2022.987356"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1055\/s-0041-1735846","article-title":"Clinical Practice Patterns of Speech-Language Pathologists Delivering Dysphagia Services to Persons with COPD: Analysis of Survey Outcomes","volume":"42","author":"Drulia","year":"2021","journal-title":"Semin. Speech Lang"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Gracioli, M., Pasqualoto, A.S., Feltrin, T.D., Mezzalira, R.M., Souza, J.A., Moraes, D.A.O., and Cielo, C.A. (2025). Immediate and Late Effects of a Single, Low-Intensity Inspiratory Muscle Intervention on Voice and Breathing in Chronic Obstructive Pulmonary Disease. J. Voice, in press.","DOI":"10.1016\/j.jvoice.2025.04.007"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Schardt, C., Adams, M.B., Owens, T., Keitz, S., and Fontelo, P. (2007). Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Med. Inform. Decis. Mak., 7.","DOI":"10.1186\/1472-6947-7-16"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"106478","DOI":"10.1016\/j.rmed.2021.106478","article-title":"Benefits of pulmonary rehabilitation in COPD patients with mild cognitive impairment\u2014A pilot study","volume":"185","author":"Andrianopoulos","year":"2021","journal-title":"Respir. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"711","DOI":"10.2147\/COPD.S96663","article-title":"Effects of combined training vs aerobic training on cognitive functions in COPD: A randomized controlled trial","volume":"11","author":"Aquino","year":"2016","journal-title":"Int. J. Chron. Obstruct. Pulmon. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Cheng, Y.Y., Lin, S.Y., Hsu, C.Y., and Fu, P.K. (2022). Respiratory Muscle Training Can Improve Cognition, Lung Function, and Diaphragmatic Thickness Fraction in Male and Non-Obese Patients with Chronic Obstructive Pulmonary Disease: A Prospective Study. J. Pers. Med., 12.","DOI":"10.3390\/jpm12030475"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"106249","DOI":"10.1016\/j.rmed.2020.106249","article-title":"Cognitive function following pulmonary rehabilitation and post-discharge recovery from exacerbation in people with COPD","volume":"176","author":"France","year":"2021","journal-title":"Respir. Med."},{"key":"ref_17","first-page":"e81413","article-title":"Changes in Clinical Parameters During Low-Frequency Outpatient Pulmonary Rehabilitation for Male Patients with Chronic Obstructive Pulmonary Disease","volume":"17","author":"Kotani","year":"2025","journal-title":"Cureus"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"00013-2019","DOI":"10.1183\/23120541.00013-2019","article-title":"Behavioural interventions targeting physical activity improve psychocognitive outcomes in COPD","volume":"5","author":"Lavoie","year":"2019","journal-title":"ERJ Open Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e12932","DOI":"10.1111\/ijn.12932","article-title":"Effects of a cognitive rehabilitation programme on cognitive function, self-management and quality of life in patients with chronic obstructive pulmonary disease","volume":"27","author":"Park","year":"2021","journal-title":"Int. J. Nurs. Pract."},{"key":"ref_20","first-page":"300","article-title":"Short- and long-term changes in cognitive function after exercise-based rehabilitation in people with COPD: A pilot study","volume":"5","author":"Rosenstein","year":"2021","journal-title":"Can. J. Respir. Crit. Care Sleep Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.2147\/COPD.S514766","article-title":"Effects of 12 weeks of Head-Down Strong Abdominal Breathing Training on Gait and Cognitive Function in Patients with Chronic Obstructive Pulmonary Disease","volume":"20","author":"Song","year":"2025","journal-title":"Int. J. Chron. Obstruct. Pulmon. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"14799731231201643","DOI":"10.1177\/14799731231201643","article-title":"Effect of a pulmonary rehabilitation program combined with cognitive training on exercise tolerance and cognitive functions among Tunisian male patients with chronic obstructive pulmonary disease: A randomized controlled trial","volume":"20","author":"Tabka","year":"2023","journal-title":"Chron. Respir. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"00475-2021","DOI":"10.1183\/23120541.00475-2021","article-title":"Working memory training efficacy in COPD: The randomised, double-blind, placebo-controlled Cogtrain trial","volume":"7","author":"Mount","year":"2021","journal-title":"ERJ Open Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"i4919","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: A tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne","year":"2016","journal-title":"BMJ"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e001709","DOI":"10.1136\/bmjresp-2023-001709","article-title":"Chronic obstructive pulmonary disease as a risk factor for cognitive impairment: A systematic review and meta-analysis","volume":"11","author":"Chen","year":"2024","journal-title":"BMJ Open Respir. Res."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Siraj, R.A. (2023). Comorbid Cognitive Impairment in Chronic Obstructive Pulmonary Disease (COPD): Current Understanding, Risk Factors, Implications for Clinical Practice, and Suggested Interventions. Medicina, 59.","DOI":"10.3390\/medicina59040732"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1183\/09031936.00125109","article-title":"Cognitive function in COPD","volume":"35","author":"Dodd","year":"2010","journal-title":"Eur. Respir. J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"897327","DOI":"10.1155\/2015\/897327","article-title":"Sirtuin 1 and aging theory for chronic obstructive pulmonary disease","volume":"2015","author":"Conti","year":"2015","journal-title":"Anal. Cell. Pathol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2065","DOI":"10.2147\/COPD.S426897","article-title":"The Association Between Cognitive Functions and Psychological Factors in Patients with Severe COPD","volume":"18","author":"Hansen","year":"2023","journal-title":"Int. J. Chron. Obstruct. Pulmon. Dis."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2791","DOI":"10.21037\/jtd.2020.03.60","article-title":"Management of cardiovascular comorbidities in chronic obstructive pulmonary disease patients","volume":"12","author":"Aisanov","year":"2020","journal-title":"J. Thorac. Dis."},{"key":"ref_32","first-page":"95","article-title":"Managing comorbidities in COPD","volume":"10","author":"Hillas","year":"2015","journal-title":"Int. J. Chron. Obstruct. Pulm. Dis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1007\/s00408-015-9838-z","article-title":"Muscular dysfunction in COPD: Systemic effect or deconditioning?","volume":"194","author":"Pleguezuelos","year":"2016","journal-title":"Lung"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1111\/ggi.13146","article-title":"Interdependence of physical inactivity, loss of muscle mass and low dietary intake: Extrapulmonary manifestations in older chronic obstructive pulmonary disease patients","volume":"18","author":"Yoshimura","year":"2018","journal-title":"Geriatr. Gerontol. Int."},{"key":"ref_35","first-page":"154","article-title":"Voice Problems in Patients with Chronic Obstructive Pulmonary Disease","volume":"30","author":"Mohamed","year":"2019","journal-title":"Minia J. Med. Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1016\/j.anl.2017.12.002","article-title":"Is insufficient pulmonary air support the cause of dysphonia in chronic obstructive pulmonary disease?","volume":"45","author":"Hassan","year":"2018","journal-title":"Auris Nasus Larynx"},{"key":"ref_37","unstructured":"Khatun, N. (2024). Impact on Voice Among Chronic Obstructive Pulmonary Disease (COPD) Patients in BANGLADESH. [Bachelor\u2019s Thesis, Bangladesh Health Professions Institute, Faculty of Medicine, The University of Dhaka]."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1159\/000319553","article-title":"Dyspnea during speech in chronic obstructive pulmonary disease patients: Effects of pulmonary rehabilitation","volume":"81","author":"Binazzi","year":"2011","journal-title":"Respiration"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1007\/s12325-019-01128-9","article-title":"Dyspnea in COPD: New Mechanistic Insights and Management Implications","volume":"37","author":"Milne","year":"2020","journal-title":"Adv. Ther."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"62","DOI":"10.23838\/pfm.2020.00212","article-title":"Evaluating dyspnoea in chronic obstructive pulmonary disease","volume":"5","author":"Ong","year":"2021","journal-title":"Precis. Future Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e15","DOI":"10.1164\/rccm.201402-0373ST","article-title":"An official American Thoracic Society\/European Respiratory Society statement: Update on limb muscle dysfunction in chronic obstructive pulmonary disease","volume":"189","author":"Maltais","year":"2014","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1378\/chest.10-3257","article-title":"Dyspnea perception in COPD: Association between anxiety, dyspnea-related fear, and dyspnea in a pulmonary rehabilitation program","volume":"140","author":"Janssens","year":"2011","journal-title":"Chest"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.maturitas.2013.06.005","article-title":"Understanding dyspnea as a complex individual experience","volume":"76","author":"Hayen","year":"2013","journal-title":"Maturitas"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"00181-2021","DOI":"10.1183\/23120541.00181-2021","article-title":"Changes in health-related quality of life as a marker in the prognosis in COPD patients","volume":"8","author":"Esteban","year":"2022","journal-title":"ERJ Open Res."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Jarab, A.S., Al-Qerem, W., Alzoubi, K.H., Abu Heshmeh, S., Mukattash, T.L., Naser, A.Y., and Al Hamarneh, Y.N. (2023). Health-related quality of life and its associated factors in patients with chronic obstructive pulmonary disease. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0293342"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"8687","DOI":"10.1038\/s41598-024-59289-9","article-title":"Influencing factors of good quality of life among chronic obstructive pulmonary disease patients living in Zhejiang Province, China","volume":"14","author":"Ying","year":"2024","journal-title":"Sci. Rep."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/2\/670\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T12:08:23Z","timestamp":1768392503000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/2\/670"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,14]]},"references-count":46,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["jcm15020670"],"URL":"https:\/\/doi.org\/10.3390\/jcm15020670","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,14]]}}}