The Combined Effect of Mindfulness and Physical Activity on Stress: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Background: Interventions combining mindfulness and physical activity are increasingly used for stress management, but their average efficacy and incremental benefit over either component alone remain uncertain. Objective: This study aimed to evaluate combined mindfulness–physical activity interventions for stress or stress-related outcomes relative to passive or general control conditions, mindfulness alone, and physical activity alone, and to explore potential sources of heterogeneity. Methods: Following PRISMA 2020, eight electronic databases were searched through November 2025. Two reviewers independently screened records. Data extraction and the initial risk-of-bias assessment were performed by the first author and checked in full by a second reviewer. Risk of bias was assessed using RoB 1.0. Certainty of evidence was assessed using the GRADE approach. Hedges’ g values were synthesised in three separate comparator-specific meta-analyses using restricted maximum-likelihood random-effects models with Knapp–Hartung adjustment. Results: Fourteen randomised controlled trials involving 872 randomised participants were included in the systematic review, and 13 contributed to quantitative synthesis. Compared with passive or general control conditions, combined interventions produced a statistically significant average effect favouring the combined intervention (k = 12; Hedges’ g = −0.74, 95% CI −1.21 to −0.27; p = 0.006; I2 = 83.1%; 95% prediction interval −2.27 to 0.79). The combined intervention was not statistically superior to mindfulness alone (k = 2; Hedges’ g = 0.49, 95% CI −1.71 to 2.69) or physical activity alone (k = 3; Hedges’ g = 0.01, 95% CI −0.50 to 0.52), although both comparisons were imprecise. No formal subgroup test identified a statistically significant moderator. Excluding the most extreme estimate reduced the pooled control-comparison effect to −0.55 (95% CI −0.79 to −0.31) and I2 to 27.9%. Conclusions: Combined mindfulness and physical activity interventions may reduce stress or stress-related psychological outcomes relative to passive or general controls. The current evidence is insufficient to determine whether they provide additional benefit over well-delivered single-component interventions. Substantial heterogeneity and the small number of active-comparator trials warrant cautious interpretation.