PILATES was the most effective mind-body exercise for short-term pain relief in people with low back pain.
Network Meta-Analysis of Mind-Body Exercise
Investigators conducted a systematic review and frequentist network meta-analysis of randomized controlled trials comparing commonly used mind-body exercise modalities with each other and with usual care or other control conditions. Thirty-two trials enrolling 2,480 people with clinically diagnosed low back pain were included. Studies involving postsurgical patients were excluded. Risk of bias was assessed using the Cochrane RoB2 tool and certainty of evidence was graded with the GRADE framework, which supports confidence in the overall findings.
Pilates, taiji, qigong and yoga were evaluated across the network. Pain outcomes were standardized and analyzed using standardized mean differences, which allowed comparison across diverse intervention protocols. Surface Under the Cumulative Ranking curve estimates were used to rank modalities according to their probability of providing the greatest pain relief.
Pilates Shows Greatest Pain Reduction
Pilates was associated with the largest reduction in pain compared with usual care, with a standardized mean difference of -1.56 and a 95 percent confidence interval from -2.10 to -1.02. The authors report moderate certainty in this estimate. Importantly, the degree of pain reduction achieved with Pilates exceeded the prespecified minimal clinically important difference, suggesting that benefits are likely to be meaningful for many patients in clinical practice.
Taiji and qigong also reduced pain compared with usual care, although to a lesser extent than Pilates. In contrast, yoga did not differ significantly from control conditions at follow-up in this analysis. Network rankings based on Surface Under the Cumulative Ranking curve further supported the superiority of Pilates over other mind-body exercise options for low back pain.
Mind-Body Exercise for Low Back Pain in Practice
The authors conclude that mind-body exercise represents an effective non-pharmacological strategy for managing low back pain, with Pilates offering the most meaningful short-term pain relief. Their findings support integrating structured mind-body exercise programs into standard low back pain care pathways. The work also highlights the need for further direct comparisons between Pilates, yoga, taiji and qigong to clarify relative benefits and inform shared decision making.
Reference: Tian Q et al. Comparative efficacy of different mind-body exercise modalities in low back pain: systematic review and network meta-analysis. Complement Ther Med. 2025;doi:10.1016/j.ctim.2025.103309.
