Journal of pain research · 2026
Effects of Mind-Body Exercises on Pain Intensity in Individuals with Chronic Nonspecific Low Back Pain: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.
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Xiang Yi, Lu Zengao, Li Liang, Fan Tonggang
Аннотация
OBJECTIVE: To synthesize the effects of mind-body exercises (MBEs) on pain in adults with chronic nonspecific low back pain (CNLBP) and assess whether comparative and study-level dose evidence can inform exercise selection.
METHODS: We searched 10 databases from inception to 11 July 2026 for randomized controlled trials. Random-effects pairwise meta-analysis compared MBEs with control conditions. Network meta-analysis (NMA) compared yoga, Pilates, Tai Chi (TC), and qigong. Exploratory subgroup analyses and meta-regression evaluated intervention duration, frequency, session duration, weekly exercise volume, and comparator type. Risk of bias and certainty of evidence were assessed using the Cochrane Risk of Bias 2 tool (RoB 2) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, respectively.
RESULTS: Twenty-five randomized controlled trials were included. MBEs reduced pain on a 0-10-cm visual analog scale compared with control conditions (mean difference, -1.56 cm; 95% confidence interval, -1.98 to -1.15). Heterogeneity was substantial, with an I-squared statistic of 92.7%, and the 95% prediction interval ranged from -3.69 to 0.56 cm. No statistically significant subgroup differences were identified for intervention duration, frequency, session duration, or weekly exercise volume. Comparator type was associated with study-level effect estimates (P = 0.0036). In the NMA, all four MBEs had lower estimated pain scores than the control node, but no between-modality differences were detected. TC had the highest surface under the cumulative ranking curve (SUCRA) value (85.4%). The certainty of evidence was low for all network comparisons assessed.
CONCLUSION: MBEs may reduce pain intensity in adults with CNLBP. However, substantial heterogeneity, uncertainty in transitivity, and low certainty of evidence limit confidence in comparative estimates. The available evidence does not establish a preferred MBE modality or an optimal exercise dose.
METHODS: We searched 10 databases from inception to 11 July 2026 for randomized controlled trials. Random-effects pairwise meta-analysis compared MBEs with control conditions. Network meta-analysis (NMA) compared yoga, Pilates, Tai Chi (TC), and qigong. Exploratory subgroup analyses and meta-regression evaluated intervention duration, frequency, session duration, weekly exercise volume, and comparator type. Risk of bias and certainty of evidence were assessed using the Cochrane Risk of Bias 2 tool (RoB 2) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, respectively.
RESULTS: Twenty-five randomized controlled trials were included. MBEs reduced pain on a 0-10-cm visual analog scale compared with control conditions (mean difference, -1.56 cm; 95% confidence interval, -1.98 to -1.15). Heterogeneity was substantial, with an I-squared statistic of 92.7%, and the 95% prediction interval ranged from -3.69 to 0.56 cm. No statistically significant subgroup differences were identified for intervention duration, frequency, session duration, or weekly exercise volume. Comparator type was associated with study-level effect estimates (P = 0.0036). In the NMA, all four MBEs had lower estimated pain scores than the control node, but no between-modality differences were detected. TC had the highest surface under the cumulative ranking curve (SUCRA) value (85.4%). The certainty of evidence was low for all network comparisons assessed.
CONCLUSION: MBEs may reduce pain intensity in adults with CNLBP. However, substantial heterogeneity, uncertainty in transitivity, and low certainty of evidence limit confidence in comparative estimates. The available evidence does not establish a preferred MBE modality or an optimal exercise dose.