Comparative efficacy of different mind-body exercise modalities in low back pain: Systematic review and network meta‑analysis
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.
