Objective:To assess the effect of exercise prescription on patients with chronic obstructive pulmonary disease (COPD) and respiratory failure through meta-analysis.Methods:A comprehensive search was conducted in PubMed, The Cochrane Library, EMbase, CNKI, Wanfang, VIP, and China National Knowledge Infrastructure from the database establishment date to February 1, 2023. The search included randomized controlled trials that involved exercise prescription for patients with COPD and respiratory failure. Two independent researchers conducted literature searches, data extraction, and methodological quality evaluation. Meta-analysis was performed using Review Manager 5.3.Results:A total of 11 studies with 862 patients were included in the analysis. The meta-analysis revealed that the exercise prescription was beneficial in improving lung function [forced expiratory volume in one second (FEV 1): standardized mean difference ( SMD)=1.53(95% CI: 1.28, 1.78), P<0.001; forced vital capacity (FVC): SMD=1.55(95% CI: 0.25, 2.84), P=0.020; FEV 1/FVC: SMD=1.68(95% CI: 0.81, 2.55), P<0.001], gas exchange ability [arterial partial pressure of oxygen (PaO 2): SMD=1.13(95% CI: 0.92, 1.34), P<0.001; arterial partial pressure of carbon dioxide (PaCO 2): SMD=-1.23(95% CI:-1.60, -0.85), P<0.001], improving 6 minutes walking distance test (6MWT) [ SMD=2.20(95% CI: 1.13, 3.27), P<0.001], relieving dyspnea [Borg score: SMD=-1.74(95% CI:-3.26, -0.22), P=0.020; St George′ respiratory questionnaire (SGRQ) score: SMD=-1.10(95% CI:-1.53, 0.66), P<0.001], and reducing mechanical ventilation time [ SMD=-2.08(95% CI:-3.33, -0.83), P=0.001]. Conclusion:Exercise prescription can improve the pulmonary function, gas exchange ability, cardiorespiratory endurance, quality of life, dyspnea and reduce the duration of mechanical ventilation and negative outcomes for patients with COPD and respiratory failure.