BACKGROUND: While motion-sensing game (MSG) platforms provide immersive, real-time feedback environments for rehabilitation, research findings on their effectiveness in chronic obstructive pulmonary disease (COPD) pulmonary rehabilitation remain heterogeneous. OBJECTIVE: This study aims to systematically evaluate the efficacy of MSG-assisted pulmonary rehabilitation for patients with COPD. METHODS: This meta-analysis was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 statement. Eight electronic databases (PubMed, Cochrane Library, Embase, CINAHL, Web of Science, Scopus, China National Knowledge Infrastructure, and Wanfang) were systematically searched from inception to March 2025. Randomized controlled trials (RCTs) comparing MSG-assisted versus conventional pulmonary rehabilitation in patients with COPD were included. Data analysis was performed using Review Manager 5.3 (Cochrane Collaboration) and Stata 17 (StataCorp LLC). Mean differences (MDs) and odds ratios (ORs) with 95% CIs were calculated. Risk of bias was assessed using the revised Cochrane Risk of Bias tool (Cochrane Collaboration), and evidence quality was evaluated using the Grading of Recommendations Assessment, Development, and Evaluations (GRADE) approach. RESULTS: Analysis of 12 RCTs (n = 776) demonstrated that MSG-assisted pulmonary rehabilitation, compared with conventional pulmonary rehabilitation, significantly improved 6-Minute Walk Distance (MD 23.23, 95% CI 14.47 to 31.99; p < 0.001), upper limb strength via 30-Second Arm Curl Test (MD 1.83, 95% CI 0.63 to 3.03; p = 0.003), balance performance (Balance Evaluation Systems Test; MD 2.34, 95% CI 1.52 to 3.17; p < 0.001), and exercise adherence (OR 3.00, 95% CI 1.38 to 6.52; p = 0.005). Additionally, significant improvements were observed in dyspnea severity (MD -0.25, 95% CI -0.48 to -0.02; p = 0.03), health-related quality of life (MD -6.00, 95% CI -10.96 to -1.04; p = 0.02), and psychological outcomes including anxiety (MD -2.41, 95% CI -3.42 to -1.39; p < 0.001) and depression (MD -1.40, 95% CI -2.69 to -0.42; p = 0.03). The overall methodological quality of the included studies was suboptimal with most evidence rated as low or very low quality. CONCLUSIONS: MSG-assisted pulmonary rehabilitation demonstrates significant improvements in exercise capacity, respiratory symptoms, quality of life, and psychological well-being among patients with COPD. Despite potential benefits, the predominance of low-quality evidence highlights the necessity for risk-benefit assessment before clinical implementation. Future research priorities should include larger, methodologically rigorous RCTs, standardized intervention protocols, investigation of sustained therapeutic effects, and cost-effectiveness analyses to establish definitive evidence for optimal implementation of gaming technology in pulmonary rehabilitation programs.

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