Chronic Obstructive Pulmonary Disease (COPD) impairs lung function, limits exercise capacity, and reduces quality of life. Pulmonary rehabilitation (PR) is a well-established intervention, yet comparative effectiveness of its core components remains under discussion. This systematic review evaluates the therapeutic impact of Inspiratory Muscle Training (IMT) versus aerobic exercise within PR programs for COPD patients.
A systematic search was conducted across PubMed, Cochrane CENTRAL, SportDiscus, and Google Scholar for randomized controlled trials published between 2017 and 2023. The review followed PRISMA guidelines and utilized the SPIDER model for inclusion/exclusion. Methodological quality was assessed using the PEDro scale.
Five RCTs involving 745 COPD patients met inclusion criteria. IMT showed significant improvements in inspiratory strength and six-minute walk distance (6MWD), while aerobic exercise demonstrated superior gains in VO₂max and health-related quality of life (HRQoL) as measured by the St. George's Respiratory Questionnaire (SGRQ). High-intensity IMT was effective in increasing 6MWD but showed variable results on FEV₁. No adverse effects were reported. Findings indicate that combining IMT with aerobic training may enhance overall outcomes.
Both IMT and aerobic training provide unique and complementary benefits for COPD rehabilitation. Integration of these modalities is recommended for optimizing patient-centered outcomes. This review supports evidence-based protocol development for international clinical practice. Currently, this protocol is being adapted and expanded in collaboration with NHS partners for future clinical implementation and publication. 

Kubra Aydin is a specialist physiotherapist and clinical lead at Metin Sabancı Baltalimani Bone Diseases Training and Research Hospital – Türkiye’s only single-branch hospital dedicated exclusively to orthopaedics. She holds a Master’s degree in Applied Sport and Exercise Physiology from the University of East London and has extensive postgraduate training in osteopathy. Her clinical and research interests include scoliosis rehabilitation, respiratory care, and musculoskeletal exercise therapy. She recently presented her systematic review on COPD at an international congress in London and is currently collaborating with NHS professionals to develop clinical protocols and upcoming publications in the field.