OBJECTIVES: To evaluate the effects of a 2-week graded exercise rehabilitation program on respiratory function, exercise capacity, inflammatory markers, and immune function in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). METHODS: This is a prospective randomized controlled trial aimed at evaluating the efficacy of the graded exercise rehabilitation therapy based on the GOLD guidelines in patients with AECOPD. We divided the patients into the intervention group and the control group using the random number table method, with 35 patients in each group. The control group received conventional symptomatic treatment and exercise rehabilitation, while the intervention group underwent graded exercise rehabilitation according to the GOLD guidelines, twice a day, each session lasting 30 to 45min, for a total duration of 2 weeks. After the treatment, the main indicators included serum inflammatory factors and T lymphocyte subsets. Secondary indicators included exercise endurance (6MWT), disease symptom burden (CAT), dyspnea (mMRC), self-care ability (ADL), and psychological state (HADS). The hospitalization time, duration of non-invasive mechanical ventilation, and the overall incidence of related complications were also evaluated. All evaluations were conducted 2weeks before and after the rehabilitation treatment. RESULTS: Baseline characteristics were comparable between groups. Post-intervention, both groups showed significant improvements in all measured parameters (p < 0.05 versus baseline), with superior outcomes in the intervention group: greater reductions in inflammatory markers (IL-6, IL-8, TNF-alpha, CRP; p < 0.05); more favorable immune profile (higher CD3+, CD4+, CD4+/CD8+ ratio; lower CD8+; p < 0.05); better functional outcomes (6MWT, mMRC, CAT, ADL, HADS; p < 0.05). The duration of non-invasive ventilation, the length of hospital stay, and the incidence of complications were all reduced. CONCLUSIONS: The GOLD-based graded exercise rehabilitation demonstrates superior clinical efficacy compared to conventional rehabilitation for AECOPD patients, showing significant benefits in reducing systemic inflammation, improving immune function, and enhancing physical and psychological outcomes.

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