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

Abstract

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.

Keywords: Qigong; Tai Chi; Yoga; exercise; low back pain; mind-body medicine; mind-body therapy.

Figure 1

Flow chart of study searching.

Figure 2

Funnel plot of publication bias for pain intensity.

Figure 3

Effects of mindful exercises on pain intensity (YG = Yoga, WL = waitlist, TC = Tai Chi, CT = core training, QG = Qigong; PT = physical therapy, SB = self-care book; SE = stretching exercise). The red symbol represents the overall effect size in favor of mindful exercises.

Figure 4

Funnel plot of publication bias for disability.

Figure 5

The effect of mindful exercises on disability (YG = Yoga, ASE = Aerobic and strength exercise, SB = self-care book, SE = stretching exercise).The red symbol below represents the overall effect size in favor of mindful exercises.