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Are Mindful Exercises Safe and Beneficial for Treating Chronic Lower Back Pain? A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Lifestyle (Mind-Body Movement) Research Center, College of Sports Science, Shenzhen University, Shenzhen 518060, China
Health and Exercise Science Laboratory, Institute of Sports Science, Seoul National University, Seoul 08826, Korea
Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, AB T2S 3C3, Canada
Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4Z6, Canada
Department of Health, Exercise Science and Recreation Management School of Applied Sciences, The University of Mississippi, Oxford, MS 36877, USA
Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
Institute on Aging, Seoul National University, Seoul 08826, Korea
College of Mathematics and Statistics, Shenzhen University, Shenzhen 518060, China
Shenzhen Key Laboratory of Affective and Social Cognitive Science, College of Psychology and Sociology, Shenzhen University, Shenzhen 518060, China
Shenzhen Institute of Neuroscience, Shenzhen 518057, China
Authors to whom correspondence should be addressed.
These authors contributed equally to this work.
J. Clin. Med. 2019, 8(5), 628;
Received: 28 March 2019 / Revised: 4 May 2019 / Accepted: 6 May 2019 / Published: 8 May 2019
(This article belongs to the Special Issue Rehabilitation for Persistent Pain Across the Lifespan)
PDF [2785 KB, uploaded 8 May 2019]


Background: Chronic low back pain (CLBP) is a common health issue worldwide. Tai Chi, Qigong, and Yoga, as the most widely practiced mindful exercises, have promising effects for CLBP-specific symptoms. Objective: We therefore conducted a comprehensive review investigating the effects of mindful exercises versus active and/or non-active controls while evaluating the safety and pain-related effects of mindful exercises in adults with CLBP. Methods: We searched five databases (MEDLINE, EMBASE, SCOPUS, Web of Science, and Cochrane Library) from inception to February 2019. Two investigators independently selected 17 eligible randomized controlled trials (RCT) against inclusion and exclusion criteria, followed by data extraction and study quality assessment. Standardized mean difference (SMD) was used to determine the magnitude of mindful exercises versus controls on pain- and disease-specific outcome measures. Results: As compared to control groups, we observed significantly favorable effects of mindful exercises on reducing pain intensity (SMD = −0.37, 95% CI −0.5 to −0.23, p < 0.001, I2 = 45.9 %) and disability (SMD = −0.39, 95% CI −0.49 to −0.28, p < 0.001, I2 = 0 %). When compared with active control alone, mindful exercises showed significantly reduced pain intensity (SMD = −0.40, p < 0.001). Furthermore, of the three mindful exercises, Tai Chi has a significantly superior effect on pain management (SMD= −0.75, 95% CI −1.05 to −0.46, p < 0.001), whereas Yoga-related adverse events were reported in five studies. Conclusion: Findings of our systematic review suggest that mindful exercises (Tai Chi and Qigong) may be beneficial for CLBP symptomatic management. In particular, Tai Chi appears to have a superior effect in reducing pain intensity irrespective of non-control comparison or active control comparison (conventional exercises, core training, and physical therapy programs). Importantly, training in these mindful exercises should be implemented with certified instructors to ensure quality of movement and injury prevention. View Full-Text
Keywords: Tai Chi; Yoga; Qigong; mind-body therapy; exercise; mind-body medicine; low back pain Tai Chi; Yoga; Qigong; mind-body therapy; exercise; mind-body medicine; low back pain

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Zou, L.; Zhang, Y.; Yang, L.; Loprinzi, P.D.; Yeung, A.S.; Kong, J.; Chen, K.W.; Song, W.; Xiao, T.; Li, H. Are Mindful Exercises Safe and Beneficial for Treating Chronic Lower Back Pain? A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J. Clin. Med. 2019, 8, 628.

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