Evidence summary
Several meta-analyses have demonstrated a consistent positive effect of mindful exercises on anxiety symptoms in a non-clinical populations. One meta-analysis (1) looking at the benefits of Thai Chi Chuan (TCC) reviewed 14 studies, deemed as fair to high quality with a total of 1285 people (Thai Chi Chuan = 645, control = 640). This demonstrated TCC to significantly decrease anxiety as compared to the control groups (SMD = – 0.561, 95% CI: -0.714 – 0. 408, I2 = 0.000%, P=0.000). A further meta-analysis (2) reviewed 390 participants looking at the effect of Pilates (n=201) to non-active control groups (n = 189) found a large significant reduction in anxiety symptoms (Δ = 1.29, 95%CI: 0.24, 2.33; z = 2.40, p≤0.02; N=5, n=231). 8 studies all deemed to be fair or good on the PEDro scale for risk of bias. One further meta-analysis of 14 studies compared mindful (Yoga, Thai Chi and Qigong) to non-mindful exercises and found that mindful exercises were more effective at reducing anxiety symptoms, however this was only statistically when yoga was compared to non-mindful exercises alone (SMD = -0.45 (95% CI = – 0.81 to -0.09), p = 0.01, I2 = 82%) (3).

Quality of evidence
A – Consistent evidence from meta-analysis and systematic reviews.

Strength of recommendation
1 – significant benefit, low risk of PA.

References:
1) Zhang S, Zou L, Chen LZ, Yao Y, Loprinzi PD, Siu PM, Wei GX. The Effect of Tai Chi Chuan on Negative Emotions in Non-Clinical Populations: A Meta-Analysis and Systematic Review. Int J Environ Res Public Health. 2019 Aug 21;16(17):3033. doi:10.3390/ijerph16173033. PMID: 31438638; PMCID: PMC6747200.
2) Fleming KM, Herring MP. The effects of pilates on mental health outcomes: A meta-analysis of controlled trials. Complement Ther Med. 2018 Apr;37:80-95. doi: 10.1016/j.ctim.2018.02.003. Epub 2018 Feb 13. PMID: 29609943.
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