PURPOSE: This study aimed to compare the effects of various exercise interventions on the 6-min walk distance (6MWD) in patients with stable chronic obstructive pulmonary disease (COPD) using network meta-analysis and to explore their optimal dosage configurations. METHODS: Randomized controlled trials (RCTs) on exercise interventions for patients with COPD published before January 1, 2025, were retrieved from CNKI, PubMed, PsycINFO, Web of Science, and the Cochrane Library. A total of 55 eligible RCTs were included. A meta-analysis and network meta-analysis (using R software) evaluated the effects of water-based exercise, traditional Chinese mind-body training, and general exercise on 6MWD. For the optimal intervention method, subgroup analysis of the conventional meta-analysis and nonlinear meta-regression were used to examine the dosage-efficacy relationship. RESULTS: Network meta-analysis showed water-based exercise (WBE) most favorably improved 6MWD (SUCRA 98.9, MD 83.91, 95% CI 55.98 to 111.83), significantly outperforming traditional Chinese mind-body training (CTMBT) and general exercise (GE). Nonlinear meta-regression linked efficacy to dosage, with optimal outcomes achieved with >= 3 sessions/week (5 sessions as ideal), >= 60 min/session (90 min as perfect), an 8-weeks duration, and a total of 270 min/week. Patients aged <= 61.67 years showed more pronounced improvements. CONCLUSION: Water-based exercise was the most effective intervention for improving the 6MWD of COPD patients. Optimal results required managing frequency (>= 3 times/week, ideally 5 times/week), session duration (>= 60 min, ideally 90 min), 8 weeks, and a total of 270 min/week. Older patients (<= 61.67 years) benefited more. This study supported individualized, evidence-based exercise rehabilitation strategies for COPD. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD42025636763, identifier CRD42025636763.

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