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

Background: Physical activity and mindfulness practice both have established psychological benefits, yet research into their interaction and combined use is sparse. This systematic review aimed to pool the evidence examining the impact of interventions that combined physical activity and mindfulness on mental health and wellbeing outcomes, and their potential mechanisms of action. Methods: Six databases (PubMed, Scopus, EMBASE, PsychINFO, Web of Science, Cochrane Library) were searched for trials reporting interventions that included 1) physical activity and mindfulness as primary treatments, 2) comparative control condition(s), 3) an adult sample, and 4) at least one mental health or wellbeing outcome. Screening, data extraction and quality assessment were conducted by two researchers. Findings are presented narratively due to clinical and methodological heterogeneity. Results: Out of 7682 search results, 35 trials were included. Most eligible studies had pilot or feasibility designs (n = 19, 54%) or small sample sizes. Combined interventions were feasible to deliver and improved psychological health relative to passive controls (25/33 outcome comparisons reported across trials). Effects on psychological health outcomes compared to active controls were mixed (12/38 comparisons favoured combination over physical activity only, 5/18 favoured combination over mindfulness only), as were results regarding physical activity engagement. Conclusions: Interventions combining physical activity with mindfulness are effective for improving mental health and wellbeing, possibly more so than either approach alone. Further research, including larger randomised controlled trials, is required to determine effectiveness and optimal intervention parameters. Exploring mechanisms of change will clarify their effects on mental health, wellbeing, and potential for behaviour change.