BACKGROUND: Pulmonary rehabilitation (PR) improves exercise capacity and quality of life in people with chronic obstructive pulmonary disease (COPD), yet its effect upon anxiety and depression symptoms is less clear. Existing data is difficult to apply to clinical PR due to diverse interventions and comparators. This review evaluated the effectiveness of PR on anxiety and depression symptoms in people with COPD. METHODS: A systematic review and meta-analysis (PROSPERO CRD42018094172) was conducted according to PRISMA guidelines on randomised controlled trials comparing PR (>= 4 weeks duration) to usual care. Four electronic databases were searched to February 2018 using terms related to COPD, PR, anxiety and depression. Data were extracted by two assessors using standardised templates. Study quality was appraised via PEDro scale and evidence rated according to GRADE. Data were analysed in RevMan 5.3, with pooled effect estimates reported as standardized mean differences (SMD). The effect of program duration (<= 8 versus > 8 weeks) was explored via subgroup analysis. RESULTS: 11 studies comprising 734 participants (median PEDro score 4/10) were included. Compared to usual care, PR conferred significant benefits of a moderate magnitude for anxiety symptoms (SMD -0.53; 95%CI -0.82 to -0.23) and large magnitude for depression symptoms (SMD -0.70; 95%CI -0.87 to -0.53). The certainty of evidence for each outcome was 'moderate'. Effects were not moderated by program duration. CONCLUSION: PR confers significant, clinically relevant benefits upon anxiety and depression symptoms. As further studies involving 'no treatment' control groups are not indicated, these robust estimates of treatment effects are likely to endure.

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