BACKGROUND: Elderly patients with Chronic Obstructive Pulmonary Disease (COPD) commonly suffer from anxiety, depression, and impaired health-related quality of life (HRQOL). This review evaluated the effects of mind-body exercises on these outcomes and exercise tolerance in COPD patients aged >= 60 years. METHODS: Following PRISMA guidelines, we systematically searched PubMed, Embase, PsycINFO, Cochrane Library, and Web of Science (inception-January 2025) for randomized controlled trials (RCTs) comparing mind-body exercise versus usual care. Outcomes were anxiety, depression, HRQOL (St. George's Respiratory Questionnaire or Chronic Respiratory Questionnaire), and exercise tolerance (6-minute walk test). Meta-analyses used random-effects models, reporting Standardized Mean Differences (SMDs) or Mean Differences (MDs) with 95% confidence intervals (CIs). Evidence certainty was assessed (GRADE framework). Seventeen RCTs were included. RESULTS: Mind-body exercise reduced anxiety (SMD -0.59, 95% CI -0.84 to -0.34; high certainty) and depression (SMD -0.34, 95% CI -0.54 to -0.14; high certainty). HRQOL improved significantly (SMD -0.79, 95% CI -1.14 to -0.44; low certainty), with exploratory findings showing greater improvement in Southeast Asian patients (SMD -3.41). Exercise tolerance increased (MD 44.23m, 95% CI 26.12 to 62.34), exceeding minimal clinically important differences. Intervention duration for depression was a key moderator, with greater benefits in patients with interventions lasting >= 3080min. CONCLUSION: Mind-body exercise reduces anxiety and depression, improves health-related quality of life, and increases exercise tolerance in elderly patients with COPD. For anxiety and depression, benefits are significantly enhanced with intervention durations >= 3080minutes. Incorporating mind-body exercise into comprehensive COPD management for older adults is recommended.

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