Comparative efficacy of traditional and modern mind-body exercises in middle-aged and older adults with knee osteoarthritis: a network meta-analysis of randomized controlled trials

Why clinicians should know about it

• Picked for Family Practice (top studies of the week, 19 July 2026).

Abstract

OBJECTIVE: Traditional and modern Mind-body exercise methods are widely used in the rehabilitation treatment of knee osteoarthritis (KOA), this network meta-analysis (NMA) compared the relative efficacy of various Mind-body exercise methods on KOA-related pain, function and stiffness, as well as psychological and physical outcomes. METHODS: PubMed, EMBASE, Cochrane Library, and Web of Science were searched up to December 1, 2025. The main outcome measures included WOMAC pain score, WOMAC physical function score and WOMAC stiffness score. Secondary outcome indicators included mental health status, 6-min walking test (6MWT) and timed up-and-go test (TUG). RoB 2 was used to evaluate the risk of bias, and CINeMA was used to evaluate the certainty of network evidence. This research scheme has been registered in PROSPERO (CRD420261281876). RESULTS: A total of 29 RCTs (n = 2,095) were included. The mean age of participants ranged from 58 to 79 years. Eight intervention measures were evaluated: Wuqinxi, Tai Chi, Pilates, Yijinjing, Baduanjin, yoga, conventional exercise, and no exercise intervention. Compared with no exercise intervention, Tai Chi and Wuqinxi significantly reduced WOMAC pain score. Pilates, Baduanjin, and Tai Chi significantly improved the WOMAC physical function score. Baduanjin significantly improved stiffness. Yijinjing, yoga, and Tai Chi significantly improved mental health. CONCLUSION: Different Mind-body exercises may provide outcome-specific benefits for KOA, particularly in middle-aged and older adults. Tai Chi and Wuqinxi appeared more favorable for pain relief, Pilates had the highest probability of improving physical function, Baduanjin appeared favorable for stiffness, and Yijinjing showed the highest ranking probability for mental health. Given the clinical diversity across trials and the low or very low certainty of several comparisons, SUCRA rankings should be interpreted cautiously. Specifically, TUG-related ranking results should be considered exploratory because the TUG network did not form a closed loop and inconsistency testing could not be performed; therefore, they should not be interpreted as definitive evidence. Further high-quality, long-term RCTs are needed to strengthen the evidence and support more precise exercise prescriptions.Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420261281876, identifier: CRD420261281876.

Abstract as published, via PubMed.