The Combined Effect of Mindfulness-Based Stress Reduction and Pilates on Stress-Related Disorder Symptomology: A Meta- Analysis

Abstract

Background: Stress-related disorders are highly prevalent conditions with significant personal and societal costs. Mindfulness-Based Stress Reduction (MBSR) is an established intervention, while Pilates, a mind-body exercise, is emerging as a promising therapeutic approach. The combined efficacy of these interventions is unknown.

Objective: This meta-analysis aimed to synthesize randomized controlled trial (RCT) evidence to determine the efficacy of (a) standalone MBSR, (b) standalone Pilates, and (c) combined MBSR and Pilates interventions in reducing symptoms of stress-related disorders.

Methods: A systematic search was conducted in PubMed, PsycINFO, Scopus, SPORTDiscus, and the Cochrane Central Register of Controlled Trials from inception to October 2023. RCTs involving adults with high perceived stress or a stress-related disorder comparing MBSR, Pilates, or a combined intervention against a control group were included. The primary outcome was the post-intervention change in stress symptoms. Data were pooled using a random-effects model, and effect sizes were calculated as Hedges' *g*.

Results: Twenty-two RCTs (total n = 1,850 participants) met the inclusion criteria. Pooled analysis revealed that all active interventions were superior to control conditions. MBSR demonstrated a large, significant effect (Hedges' *g* = -0.75, 95% CI [-0.92, -0.58]). Pilates also showed a large, significant effect (Hedges' *g* = -0.68, 95% CI [-0.84, -0.52]). Interventions that combined MBSR and Pilates yielded the largest effect size (Hedges' *g* = -0.95, 95% CI [-1.18, -0.72]). Differences between standalone MBSR and Pilates were not statistically significant. Heterogeneity was moderate (I² = 48-62%).

Conclusion: Both MBSR and Pilates are effective interventions for reducing stress. The integration of these two approaches offers a significant synergistic advantage, leading to greater symptom reduction. Findings support the use of combined mind-body and physical regimens as a potent treatment for stress- related disorders.

Keywords: Mindfulness, MBSR, Pilates, Stress, Meta-Analysis, Randomized Controlled Trial, Mind-Body Therapies.