Comparative efficacy of different mind-body exercise modalities in low back pain: Systematic review and network
Qingsong Tian1, Dijun Li1, Huihui Xiong1
1Department of Orthopedics, Affiliated Renhe Hospital of China Three Gorges University, 410 Yiling Road, Yichang City, Hubei Province, China.
Objective:
To assess and compare the effectiveness of commonly used mind-body exercise modalities for the treatment of low back pain (LBP), and to provide evidence to inform clinical decision-making and policy development.
Design:
Systematic review and network meta-analysis.
Literature Searchs:
PubMed, Embase, Cochrane Library, and Web of Science were searched from inception to May 2025.
Study Selection Criteria:
Randomised controlled trials comparing mind-body exercise interventions with each other or with control groups in patients with clinically diagnosed low back pain. Studies involving postsurgical patients were excluded.
Data Synthesis:
Two reviewers independently screened studies, extracted data, and assessed the risk of bias using the Cochrane Risk of Bias 2 tool (RoB2). Certainty of evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. A frequentist network meta-analysis was conducted using standardised mean differences (SMD) for pain outcomes.
Results:
Thirty-two randomized controlled trials (RCTs) involving 2480 participants were included. Pilates was associated with the greatest reduction in pain compared with usual care (SMD -1.56; 95 % CI -2.10 to -1.02; moderate certainty evidence), followed by taiji and qigong. The pain reduction associated with Pilates exceeded the prespecified minimal clinically important difference. Yoga did not significantly differ from control in follow-up. Surface Under the Cumulative Ranking curve (SUCRA) supported the superiority of Pilates.
Conclusions:
Mind-body exercises-particularly Pilates-are effective non-pharmacological options for managing low back pain. Pilates may offer the most meaningful short-term pain relief. These findings support the integration of structured mind-body programmes into standard LBP care pathways and highlight the need for further direct comparisons between modalities.
