Is yoga more beneficial than exercise-based interventions for patients with chronic low back pain? A systematic review and meta-analysis.

BACKGROUND

Chronic low back pain (CLBP) is a prevalent condition associated with persistent pain, functional limitations, and psychological distress. Yoga is frequently recommended as an active, mind body intervention, yet it remains uncertain whether yoga provides added benefit compared with other exercise based programs.

OBJECTIVE

To compare the effects of yoga versus active exercise interventions on pain intensity, physical function or disability, and emotional wellbeing in adults with CLBP.

METHODS

A systematic review and meta-analysis was conducted in line with PRISMA 2020 and the Cochrane Handbook, and registered in PROSPERO. PubMed, Embase, Cochrane Library, Web of Science, and PEDro were searched from inception to November 23, 2025. Parallel-group randomized controlled trials enrolling adults with non-specific CLBP were included when they compared yoga with exercise based interventions and reported extractable continuous outcomes. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were pooled using fixed or random effects models based on heterogeneity. Risk of bias was assessed with the Cochrane tool.

RESULTS

Seven randomized controlled trials were included. For pain, yoga was not statistically superior to exercise comparators (SMD = -0.52, 95% CI -1.38-0.35; I 2 = 95%). For physical function, yoga showed a significant improvement compared to exercise controls (SMD = -1.20, 95% CI -1.64 to -0.77; I 2 = 31%); however, this specific finding is based on a limited evidence pool of only two studies. For disability, no clear between-group difference was observed (SMD = -0.19, 95% CI -1.11-0.73; I 2 = 92%). For emotional outcomes, yoga improved emotional wellbeing compared with exercise controls (SMD = -0.71, 95% CI -1.26 to -0.16; I 2 = 75%), and this effect became more consistent after removing one influential study (I 2 = 0%).

CONCLUSION

Based on the results of the current meta-analysis, yoga demonstrated statistically significant improvements in physical function and emotional wellbeing compared to active exercise interventions, while no consistent advantage was observed for pain or disability. These findings are specific to the limited evidence base and high heterogeneity identified in this study; therefore, while the data indicates positive trends, yoga's comparative superiority should be viewed as a preliminary observation from this synthesis rather than a definitive clinical conclusion.