Context: Considering current models that highlight the role of psychological components in pain management, mindfulness practice may be an effective strategy in the management of pain.

Objective: To examine the effects of adding an eight-week mindfulness program to exercise therapy on the perceptions of pain severity, knee function, fear of movement, and pain catastrophizing of female recreational runners with patellofemoral pain (PFP).

Design: Parallel randomized control clinical trial.

Setting: University Lab.

Patients or Other Participants: Thirty female runners (age 28.3±7.08 years) with PFP were randomly assigned to the two intervention groups: exercise group and mindfulness-exercise group.

Intervention(s): The Ex group received 18 weeks (3 sessions per week) of an exercise program for symptoms control and training modifications. The mindfulness-exercise group received an 8-week mindfulness intervention in addition to the exercise program. The mindfulness component started 4 weeks before the exercise component; therefore, the two components overlapped during the first 4 weeks of the intervention.

Main Outcome Measure(s): Usual pain, pain during stepping, and pain during running were assessed through visual analog scales (VAS). Functional limitations of the knee were assessed using the knee outcome survey. Fear of movement, pain catastrophizing, and coping strategies were measured with the Tampa Scale for Kinesiophobia, the Pain Catastrophizing Scale, and the Coping Strategies Questionnaire, respectively. These outcomes were assessed at baseline, at week 9, and after 18 weeks.

Results: Pain during running, pain during stepping, and functional limitations of the knee were significantly lower for the mindfulness-exercise group than for the exercise group (p<.05). mindfulness-exercise participants reported higher perceived treatment effects than exercise group participants (p<.05). Pain catastrophizing was lower and coping strategies were more favorable for mindfulness-exercise participants than for exercise participants (p<.05).

Conclusions: Mindfulness practice can be an effective adjunct to exercise therapy in the rehabilitation of PFP in recreational female runners.

Trial Registry: Trial was registered with the (blind).

Key Points:
  • Adding an 8-week mindfulness intervention to an exercise therapy program facilitated a quicker onset of perceived therapeutic effectiveness in the terms of clinical and psychological outcomes in runners with PFP.

  • After 18 weeks exercise therapy, participants who received an 8-week mindfulness program showed greater improvements in the clinical and psychological outcomes than those who didn't receive program, indicating better long-term effectiveness.

  • Addition of 8-week mindfulness practice to the PFP exercise therapy program led to more long-lasting effects two months after the completion of the interventions.

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Author notes

Trial registration: this trial is registered at the university hospital medical information network of Japan (UMIN-CTR) with address https://rctportal.niph.go.jp/en/detail?trial_id=UMIN000035347 and current controlled trials UMIN000035347.

Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Conflict of interests: The authors declare that they have no competing interest.