Effects of combining physical activity with mindfulness on mental health and wellbeing: Systematic review of complex interventions

This systematic review examined interventions that combined two primary components:

1. **Physical Activity (PA):** Any form of bodily movement that requires energy expenditure. The specific types of physical activity varied across the included studies, ranging from structured exercise programs to mindful movement practices like yoga or Tai Chi.

2. **Mindfulness:** Practices designed to promote greater awareness and acceptance of one's thoughts, feelings, and experiences in the present moment. This often involved formal meditation techniques but could also be integrated into movement.

The review aimed to understand the impact of these combined interventions on two main types of outcomes:

**Primary Outcomes:** Mental health and wellbeing. This broadly included measures of mood, stress, anxiety, depression, and overall psychological flourishing.

**Secondary Outcomes:** Physical activity engagement. This looked at whether the combined interventions influenced how much or how consistently people participated in physical activity.

The effectiveness of these combined interventions was compared against various control conditions:

**Passive Controls:** These groups typically received no intervention, were on a waitlist for treatment, or received "treatment as usual" (which often meant no specific mental health or physical activity intervention). This comparison helps determine if the combined intervention has *any* effect beyond doing nothing.

**Active Controls:** These groups received either physical activity *only* or mindfulness *only*. This comparison is crucial for determining if combining the two approaches offers an *additive* or *synergistic* benefit beyond what each component could achieve on its own.

The systematic review included a total of **35 individual trials**. These trials collectively studied **adult populations**, specifically individuals with a mean age between **18 and 65 years**. The review did not impose restrictions on the participants' baseline mental health status, meaning the included studies could involve healthy individuals, those with subclinical symptoms, or those diagnosed with specific mental health conditions.

It's important to note that the review highlighted that a significant proportion of the included studies were either **pilot or feasibility designs (19 out of 35 trials, or 54%)** or had **small sample sizes**. This means that while the participants were adults, the individual studies often weren't designed to definitively prove effectiveness across a large, diverse population. The setting for these studies was not specified in the abstract, but typically, such interventions are conducted in research settings, community centers, or clinical environments.

As a systematic review, this paper did not directly measure outcomes but rather synthesized findings from the 35 individual studies it included. Therefore, the specific instruments and scales used varied widely across those studies. However, the review focused on studies that reported on:

**Psychological Health Outcomes:** This category encompasses a broad range of mental health and wellbeing indicators. Common examples of scales used in such research (though not explicitly listed in this review's abstract) include:

* **Depression:** Beck Depression Inventory (BDI), Patient Health Questionnaire-9 (PHQ-9).

* **Anxiety:** Generalized Anxiety Disorder 7-item scale (GAD-7), State-Trait Anxiety Inventory (STAI).

* **Stress:** Perceived Stress Scale (PSS).

* **Wellbeing:** World Health Organization-5 Wellbeing Index (WHO-5), Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS).

* **Mood:** Positive and Negative Affect Schedule (PANAS), Profile of Mood States (POMS).

* **Mindfulness:** Five Facet Mindfulness Questionnaire (FFMQ), Mindful Attention Awareness Scale (MAAS).

**Physical Activity Engagement:** This was typically measured through:

* **Self-report questionnaires:** Such as the International Physical Activity Questionnaire (IPAQ) or Godin Leisure-Time Exercise Questionnaire.

* **Objective measures:** Like accelerometers or pedometers, though self-report is more common in many studies.

* **Intervention adherence data:** Tracking attendance at sessions or self-reported home practice.

The review's methodology involved extracting data on these outcomes from the original studies. The decision to conduct a narrative synthesis (rather than a meta-analysis) implies that the specific instruments and their scoring might have been too diverse to combine statistically into a single pooled effect size. This means that while the *types* of outcomes were consistent, the *ways* they were measured likely varied considerably from study to study.

This paper is a **Systematic Review**, which is a high-level research design that aims to identify, appraise, and synthesize all the available evidence on a particular research question. It does not involve conducting new experiments but rather rigorously compiling and evaluating existing studies.

Here's how this systematic review was conducted and what its design implies:

**1. Search Strategy and Inclusion Criteria:**

**Databases Searched:** The researchers conducted a comprehensive search across six major electronic databases: PubMed, Scopus, EMBASE, PsychINFO, Web of Science, and Cochrane Library. This broad search minimizes the risk of missing relevant studies and enhances the comprehensiveness of the review.

**Search Terms:** They used a structured search strategy, requiring at least one keyword from each of four categories: (i) physical activity, (ii) mindfulness, (iii) psychological health, and (iv) controlled trial methodology. This specificity ensures that the identified studies directly address the review's core question.

**Inclusion Criteria for Individual Studies:** To be included, studies had to meet strict criteria:

* They had to be **peer-reviewed primary controlled studies** published in English. This ensures a baseline level of quality and scientific rigor.

* They focused on **longitudinal interventions** in **adult populations** (mean age 18–65 years). Longitudinal studies track changes over time, which is essential for assessing intervention effects.

* The intervention itself had to consist of **physical activity and mindfulness as primary treatments**, with these two components making up **over 50% of the total intervention time**. This ensures that the combined nature of the intervention was central, not just an incidental add-on.

* Studies needed to include **comparative control condition(s)** (either passive or active controls). This is crucial for determining if the intervention has an effect beyond natural progression or other factors.

* They had to report on **at least one mental health or wellbeing outcome**.

**Exclusion Criteria:** Review articles, commentaries, letters to the editor, and graduate theses were excluded, as the focus was on original primary research.

**Why this design matters:** A systematic review is considered one of the highest levels of evidence in