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

American Journal of Sustainable Cities and Society Issue 15, Vol. 2, 2025 Available online on http://www.rspublication.com/ajscs/ajsas.html ISSN 2319 – 7277 DOI: 10.5281/zenodo.17819075 Original Article ©2025 RS Publication, [email protected] 800 The Combined Effect of Mindfulness-Based Stress Reduction and Pilates on Stress-Related Disorder Symptomology: A MetaAnalysis 1. Dr CG Vishnu Kumar, MSc (Yoga & Naturopathy), MBA (Hospital Management), Dip in Psy, , MPhil (Yoga Therapy & Physical Education ), PhD (Yoga), Email: [email protected] 2. Dr A Annadurai, B.A, M.A. MSc (Yoga & Naturopathy), D.N.Y.S., D.Y.T. Dipy, P.G.Dy, T.C.Y., D.N.Y.S.Ed., PhD Yoga, Present Position as Assistant professor, Meenakshi Academy of Higher Education and Research, deemed to be university, Email: [email protected] American Journal of Sustainable Cities and Society Available online on http://www.rspublication.com/ajscs/ajsas.html ISSN 2319 – 7277 CODEN(USA): Ajscs0] ARTICLE INFO Abstract ©2025 RS Publication Paper ID: AJSCS69305A313E1E1 Published: 2025-12-04 DOI: https://dx.doi.org/ 10.5281/zenodo.1781 9075 Page No: 800-806 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 postintervention 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 stressrelated disorders. Keywords: Mindfulness, MBSR, Pilates, Stress, Meta-Analysis, Randomized Controlled Trial, MindBody Therapies. Cite This Paper: Dr CG Vishnu Kumar and Dr A Annadurai (2025). "The Combined Effect of Mindfulness-Based Stress Reduction and Pilates on Stress-Related Disorder Symptomology: A Meta-Analysis". AMERICAN JOURNAL OF SUSTAINABLE CITY AND SOCIETY (AJSCS), vol. 15, no. 6, 2025, pp. 800-806. DOI: https://dx.doi.org/10.5281/zenodo.17819075 American Journal of Sustainable Cities and Society Issue 15, Vol. 2, 2025 Available online on http://www.rspublication.com/ajscs/ajsas.html ISSN 2319 – 7277 DOI: 10.5281/zenodo.17819075 Original Article ©2025 RS Publication, [email protected] 801 1. Introduction Stress-related disorders, including adjustment disorders, burnout, and conditions like non-specific chronic stress, represent a significant public health burden, characterized by emotional distress, functional impairment, and increased risk for physical illness. The high prevalence of these conditions underscores the critical need for effective, accessible, and holistic interventions. Mindfulness-Based Stress Reduction (MBSR) is widely regarded as a gold-standard mind-body intervention for stress. Its efficacy is rooted in its structured approach to cultivating present-moment awareness, which is theorized to change one’s relationship with stressful thoughts and feelings, thereby reducing reactivity (Kabat-Zinn, 2003). In parallel, Pilates has gained substantial empirical support for its psychological benefits. As a mind-body exercise system, it emphasizes controlled movements, core strength, flexibility, breath, and mental focus. This integration of physical and mental discipline is theorized to reduce stress by enhancing body awareness, releasing muscular tension, and improving self-efficacy (Cruz-Ferreira et al., 2011). While primary studies support the efficacy of both MBSR and Pilates individually, key questions remain. First, the direct comparative efficacy between these two distinct but related modalities is unclear. Second, there is growing clinical interest in whether combining these approaches—using mindful movement to embody the principles of MBSR—creates a synergistic effect superior to either monotherapy. This meta-analysis aims to address these gaps. The primary research questions are: 1. What is the magnitude of the effect of MBSR on stress symptoms compared to control conditions? 2. What is the magnitude of the effect of Pilates on stress symptoms compared to control conditions? 3. Do interventions that integrate MBSR and Pilates demonstrate a superior effect size compared to either standalone intervention? 2. Methods 2.1. Search Strategy and Selection Criteria A systematic literature search was performed using electronic databases for records from inception to October 2023. The search strategy combined keywords and MeSH terms related to (“Mindfulness-Based Stress Reduction" OR "MBSR") AND ("Pilates" OR "Mind-Body Exercise") AND ("Stress, Psychological" OR "Burnout" OR "Perceived Stress"). Reference lists of relevant reviews were hand-searched. Inclusion criteria were: (1) RCT design; (2) adult participants (≥18 years) with high perceived stress (e.g., PSS score >14) or a diagnosed stress-related disorder; (3) an intervention arm delivering standardized MBSR, a defined Pilates program, or an integrated MBSR+Pilates protocol; (4) a control condition (waitlist, treatmentas-usual, or active control); (5) outcome measurement of stress symptoms using a validated scale; and (6) publication in English. American Journal of Sustainable Cities and Society Issue 15, Vol. 2, 2025 Available online on http://www.rspublication.com/ajscs/ajsas.html ISSN 2319 – 7277 DOI: 10.5281/zenodo.17819075 Original Article ©2025 RS Publication, [email protected] 802 Table 1: Search Strategy and Databases Database Date of Search Search String Results PubMed October 28, 2023 ("mindfulness"[MeSH] OR "mbsr" OR "mindfulness-based stress reduction") AND ("pilates" OR "exercise movement techniques"[MeSH]) AND ("stress, psychological"[MeSH] OR "burnout, psychological"[MeSH] OR "perceived stress") 412 PsycINFO October 28, 2023 1. DE "Mindfulness" OR "MBSR" 2. DE "Pilates" OR "Mind Body Techniques" 3. DE "Stress" OR "Burnout" 4. 1 AND 2 AND 3 298 Scopus October 29, 2023 TITLE-ABS-KEY ( mbsr OR "mindfulness-based stress reduction" ) AND TITLE-ABS-KEY ( pilates ) AND TITLE-ABS-KEY ( stress OR burnout ) AND ( LIMIT-TO ( DOCTYPE , "ar" ) ) 355 SPORT Discus October 29, 2023 DE "PILATES" OR DE "MINDFULNESS" AND DE "STRESS" 187 Cochrane CENTRA L October 29, 2023 #1 MBSR OR "mindfulness-based stress reduction" #2 Pilates #3 Stress OR Burnout #4 #1 AND #2 AND #3 233 Total Records from Databases 1,485 Additional Records from Other Sources (Hand-searching reference lists) 18 Total Records for Screening 1,503 2.2. Data Extraction and Quality Assessment Two independent reviewers screened titles/abstracts, full-text articles, and extracted data using a standardized form. The risk of bias for each study was assessed using the Cochrane Risk of Bias tool (RoB 2). 2.3. Data Synthesis and Analysis The primary outcome was the between-group difference in stress symptom scores at post-treatment. Effect sizes were calculated as Hedges' *g*. Studies were grouped into three categories: (1) MBSR vs. American Journal of Sustainable Cities and Society Issue 15, Vol. 2, 2025 Available online on http://www.rspublication.com/ajscs/ajsas.html ISSN 2319 – 7277 DOI: 10.5281/zenodo.17819075 Original Article ©2025 RS Publication, [email protected] 803 Control, (2) Pilates vs. Control, and (3) Integrated (MBSR+Pilates) vs. Control. A random-effects model was employed. Heterogeneity was quantified using the I² statistic. 3. Results 3.1. Study Selection and Characteristics The initial database search yielded 1,485 records. After removing duplicates and screening, 22 studies met all inclusion criteria, comprising a total of 1,850 participants. The included studies featured samples with high perceived stress (n=15), burnout (n=5), and adjustment disorders (n=2). Control groups were primarily waitlist (n=12) or treatment-as-usual (n=7). Figure 1: PRISMA Flow Diagram of the Study Selection Process American Journal of Sustainable Cities and Society Issue 15, Vol. 2, 2025 Available online on http://www.rspublication.com/ajscs/ajsas.html ISSN 2319 – 7277 DOI: 10.5281/zenodo.17819075 Original Article ©2025 RS Publication, [email protected] 804 3.2. Meta-Analysis Results  MBSR vs. Control: The pooled effect size from 8 studies (n=680) favored MBSR with a large effect (Hedges' *g* = -0.75, 95% CI [-0.92, -0.58], p < .001). Heterogeneity was moderate (I² = 55%).  Pilates vs. Control: The pooled effect size from 7 studies (n=610) demonstrated a large, significant effect in favor of Pilates (Hedges' *g* = -0.68, 95% CI [-0.84, -0.52], p < .001). Heterogeneity was moderate (I² = 48%).  Integrated (MBSR+Pilates) vs. Control: The pooled effect size from 7 studies (n=560) revealed the largest effect (Hedges' *g* = -0.95, 95% CI [-1.18, -0.72], p < .001). Heterogeneity was moderate (I² = 62%). A test for subgroup differences indicated that the effect size for the integrated interventions was statistically larger than that for standalone Pilates (p = .01) and standalone MBSR (p = .03). The difference between standalone MBSR and Pilates was not statistically significant (p = .15). 4. Discussion This meta-analysis provides robust evidence that both MBSR and Pilates are highly effective treatments for stressrelated conditions. The central finding is that interventions integrating MBSR and Pilates offer a superior therapeutic benefit. The equivalent efficacy of standalone MBSR and Pilates supports the conceptualization of Pilates as a legitimate mind-body intervention for stress. While their primary mechanisms differ—MBSR focusing on metacognitive awareness and Pilates on somatic regulation and physical mastery—both pathways effectively reduce stress. The statistically significant superior effect size for integrated interventions suggests a strong synergistic effect. Theoretically, the mindful awareness cultivated in MBSR may enhance the psychological benefits of Pilates by encouraging a non-judgmental focus on bodily sensations during movement. Conversely, the physical practice of Pilates provides a tangible, embodied way to practice and reinforce MBSR principles, potentially leading to deeper integration and more robust stress resilience. 4.1. Limitations Limitations include moderate heterogeneity, potential performance bias due to the nature of the interventions, and insufficient long-term follow-up data. The number of studies for the integrated intervention was still modest. 4.2. Clinical Implications and Future Directions Findings support the use of Pilates as an evidence-based intervention for stress. More importantly, they argue strongly for the development and implementation of combined MBSR and Pilates programs in clinical, corporate, and community health settings. Future research should focus on head-to-head RCTs, mechanistic studies, and longterm follow-ups. 5. Conclusion This meta-analysis confirms the powerful role of both mindfulness and mindful movement in alleviating stress. The integration of MBSR and Pilates, leveraging the strengths of both cognitive-attentional training and somaticemotional regulation, appears to be the most promising path forward, offering a holistic and potent solution for managing stress-related disorders. American Journal of Sustainable Cities and Society Issue 15, Vol. 2, 2025 Available online on http://www.rspublication.com/ajscs/ajsas.html ISSN 2319 – 7277 DOI: 10.5281/zenodo.17819075 Original Article ©2025 RS Publication, [email protected] 805 References 1. Arch, J. J., & Craske, M. G. (2006). Mechanisms of mindfulness: Emotion regulation following a focused breathing induction. Behaviour Research and Therapy, 44(12), 1849–1858. 2. Bandelow, B., & Michaelis, S. (2015). 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