Adding mindfulness practice to exercise therapy for female recreational runners with patellofemoral pain: A randomized controlled trial

Bagheri S, Naderi A, Mirali S, Calmeiro L, Brewer BW. J Athl Train. 2020 Nov 25. doi: 10.4085/1062-6050-0214.20. Online ahead of print.
Full Article Freely Available

Take-Home Message

Athletes with patellofemoral pain experienced better and longer-lasting patient-reported outcomes after completing an 8-week mindfulness program with an exercise program than those performing the exercise program alone. 


Psychological characteristics play a role in prolonging pain and patellofemoral recovery. Practicing mindfulness (deliberately sustaining attention to sensory and cognition) could lead someone to recognize and accept their patellofemoral pain, allowing them to focus on their rehabilitation more fully. However, it is unclear whether mindfulness practice leads to positive outcomes in this patient population.

Study Goal

The authors conducted a randomized controlled trial to assess if pairing an 8-week mindfulness intervention with an 18-week exercise program would improve patient-reported outcomes more than the exercise program alone among female recreational runners with patellofemoral pain.


The authors included 30 female participants that ran at least twice a week for 45 minutes. Furthermore, each participant needed to report signs and symptoms of patellofemoral pain in one or both knees for at least 3 months and score negatively (85 or less/100) on the Activities of Daily Living Scale of the Knee Outcome Survey (KOS). Participants who completed the mindfulness exercise program performed 8 weeks of breathing meditation, body scan meditation, gentle yoga, sitting meditation, and walking meditation. The mindfulness program began 4 weeks before the participant started the exercise program. The authors evaluated the participants at baseline, 5 weeks into the rehabilitation program, at the end of the exercise intervention (week 18), and then 2 months after the intervention. The authors assessed pain intensity, scores on the KOS, perceived treatment effecting using the global rate of change scale, fear of reinjury with the Tampa Scale for Kinesiophobia, scores on the Pain Catastrophizing Scale, and Coping Strategies Questionnaire scores.


Participants completing the mindfulness exercises perceived more treatment effect and reported less pain during stepping, less functional limitations, less pain catastrophizing, and less fear of movement than the exercise-only group. These benefits typically occurred at the end of the exercise intervention and lasted up to 2 months after the intervention.


Overall, the authors found that adding mindfulness exercises to an exercise program can have both short- and medium-term positive outcomes. Athletes may benefit from mindfulness techniques because they can concentrate on exercise performance and proper biomechanics instead of the pain and fear of reinjury. The authors also noted that fewer runners with mindfulness training used medication for pain than those performing the exercise program alone (5 vs. 9 people). It would be interesting to see future studies explore this further.

A sport psychologist delivered the mindfulness training; however, they did so in a group setting, making this training more feasible. Future research should test mindfulness training in a larger population with more diversity (e.g., different sexes, conditions) to ascertain these mindfulness practices’ versatility. Furthermore, it would be interesting to know if mindfulness training could be delivered remotely or via mobile applications. These options may allow patients to benefit from mindfulness training, even if they lack access to a sport psychologist.

Clinical Implications

Medical professionals should encourage mindfulness practices with traditional exercises to maximize patient outcomes following their rehabilitation.

Questions for Discussion

Have you ever implemented mindfulness techniques into your rehabilitation? If so, what is your experience? What exercises did you implement, and what were your outcomes?

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Written by: Jane McDevitt
Reviewed by: Jeffrey Driban

7 evidence-based practice courses