BACKGROUND: Music has been used as a distractive auditory stimulus (DAS) in patients with chronic obstructive pulmonary disease (COPD), but its effects are unclear. This systematic review aimed to establish the effect of DAS on exercise capacity, symptoms and health-related quality of life (HRQOL) under three conditions: (1) during exercise training; (2) during exercise testing, and (3) as a strategy for symptom management at rest. METHODS: Randomized controlled or cross-over trials as well as cohort studies of DAS during exercise training, formal exercise testing and for symptom management among individuals with COPD, were identified following the search of seven databases. Two reviewers independently assessed study quality. Weighted mean differences (WMD) with 95% CI were calculated using a random-effects model. RESULTS: A total of 13 studies were included, 12 of which were randomized controlled or cross-over trials, with a total of 415 participants. DAS increased exercise capacity when applied over at least two months of exercise training (WMD of 98m (95% CI 47 to 150m)). HRQOL improved only after a training duration of three months. Less dyspnea was noted with DAS during exercise training but this was not consistently observed in short term exercise testing or as a symptom management strategy at rest. CONCLUSIONS: DAS appears to reduce symptoms of dyspnea and fatigue when utilized during exercise training, with benefits observed in exercise capacity and HRQOL. When applied during exercise testing, the effects on exercise capacity and symptoms and as a strategy for symptom management at rest are inconsistent.

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