A foundational framework for high-intensity interval training in chronic obstructive pulmonary disease: a systematic review and meta-analysis of randomized controlled trials

Purpose: This study aimed to evaluate the effects of high-intensity interval training on patients with chronic obstructive pulmonary disease and to synthesize the evidence into a Frequency, Intensity, Time, and Type framework for clinical application. Materials and methods: We conducted a systematic review and meta-analysis of randomized controlled trials from PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) within the Cochrane Library through 14 July 2025. Trials evaluating structured high-intensity interval training programs in patients with chronic obstructive pulmonary disease were included. Two reviewers independently extracted data and assessed methodological quality. Results: Sixteen trials were included, with data from 11 pooled for meta-analysis. Compared to moderate-intensity continuous training, high-intensity interval training significantly improved walking distance, peak workload, and quality of life. High-intensity interval training combined with resistance training also yielded greater improvements in exercise capacity than usual care. No serious adverse events were directly attributed to the training. Conclusions: High-intensity interval training is a safe and superior strategy compared to continuous training for enhancing outcomes in patients with chronic obstructive pulmonary disease. This review successfully translates these findings into a practical Frequency, Intensity, Time, and Type framework, providing a scientific model to standardize clinical practice and guide future research.