ObjectiveTo systematically evaluate the effect of pulmonary rehabilitation training on moderate-to-severe chronic obstructive pulmonary disease (COPD). MethodsRandomized controlled trials on pulmonary rehabilitation for patients with moderate-to-severe COPD were retrieved from CNKI, VIP, Wanfang data, SinoMed, PubMed, Cochrane Library, Embase and Web of Science, from inception to January 30, 2026. The Cochrane risk-of-bias tool and the PEDro scale were used to assess the quality of the included literatures, and RevMan 5.4 was used for meta-analysis. ResultsA total of 15 studies involving 1 259 patients were included. The PEDro scores of the included studies ranged from seven to ten. Meta-analysis showed that pulmonary rehabilitation training improved the distance of 6 Minute Walk Test (6MWT) (MD = 39.48, 95%CI 32.65 to 46.32, P < 0.001) and forced vital capacity (MD = 0.16, 95%CI 0.00 to 0.31, P = 0.04), reduced the scores of modified Medical Research Council (MD = -0.36, 95%CI -0.48 to -0.23, P < 0.001), COPD Assessment Test (MD = -4.72, 95%CI -6.71 to -2.74, P < 0.001) and St. Georges Respiratory Questionnaire (MD = -4.34, 95%CI -6.73 to -1.94, P < 0.001). Subgroup analysis showed that pulmonary rehabilitation training lasting ≥ 3 months and < 3 months both increased the distance of 6MWT, and the pulmonary rehabilitation group improved the percentage of forced expiratory volume in the first second to forced vital capacity. ConclusionPulmonary rehabilitation training can improve exercise capacity and quality of life, and alleviate dyspnea and improve pulmonary function in patients with moderate-to-severe COPD.