{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T01:11:05Z","timestamp":1790557865148,"version":"4.1.0"},"reference-count":31,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,6,8]],"date-time":"2025-06-08T00:00:00Z","timestamp":1749340800000},"content-version":"unspecified","delay-in-days":68,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"AEIRC Pakistan","award":["0719\/KHI\/AG\/R&D\/2025"],"award-info":[{"award-number":["0719\/KHI\/AG\/R&D\/2025"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Sport Exerc Med"],"accepted":{"date-parts":[[2025,5,15]]},"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:p>Chronic low back pain (CLBP) presents as a widespread medical issue which severely affects personal health status while generating substantial economic expenses. Traditional treatment methods often have limited efficacy, necessitating the exploration of alternative therapies such as yoga and mindfulness-based stress reduction (MBSR). This study aims to compare the efficacy of Sphinx pose yoga and MBSR in managing CLBP. The focus is on evaluating improvements in pain intensity, functional disability, quality of life, heart rate variability and physiological markers associated with CLBP. This multicentre parallel-arm randomised controlled trial will compare the efficacy of yoga to MBSR for CLBP in healthcare providers. Participants will be randomly assigned to one of four groups: Sphinx pose yoga therapy (Group A), MBSR (Group B), usual care (Group C) and a combined yoga-MBSR intervention (Group D). Each intervention will last 12 weeks. Primary outcomes include pain intensity, functional disability (Oswestry Questionnaire) and physiological markers (cortisol, \u03b2-endorphins, substance-P, interleukin-6, C reactive protein). Secondary outcomes encompass quality of life (WHO Quality of Life), stress (Sadaf Stress Scale), depression (Beck Depression Inventory), anxiety (Generalised Anxiety Disorder-7) and heart rate variability. Data will be collected at baseline (week 0), at the end of the intervention (week 12) and 12 weeks after the intervention (week 24). Trial registration number <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT06910982\">NCT06910982<\/jats:ext-link>.<\/jats:p>","DOI":"10.1136\/bmjsem-2025-002697","type":"journal-article","created":{"date-parts":[[2025,6,8]],"date-time":"2025-06-08T15:50:21Z","timestamp":1749397821000},"page":"e002697","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Chronic low back pain management: clinical and psychophysiological outcomes of multimodal approaches\u2014a randomised controlled trial on yoga and mindfulness"],"prefix":"10.1136","volume":"11","clinical-trial-number":[{"clinical-trial-number":"nct06910982","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7605-1304","authenticated-orcid":false,"given":"Yusra","family":"Saleem","sequence":"first","affiliation":[{"name":"Department of Health, Physical Education and Sports Sciences, University of Karachi, Karachi, Pakistan"},{"name":"Advance Educational Institute and Research Centre, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shamoon","family":"Noushad","sequence":"additional","affiliation":[{"name":"Advance Educational Institute and Research Centre, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sadaf","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Health, Physical Education and Sports Sciences, University of Karachi, Karachi, Pakistan"},{"name":"Psychophysiology Research Unit, Department of Physiology, University of Karachi, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basit","family":"Ansari","sequence":"additional","affiliation":[{"name":"Department of Health, Physical Education and Sports Sciences, University of Karachi, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,6,8]]},"reference":[{"key":"2025083110094610000_11.2.e002697.1","doi-asserted-by":"crossref","unstructured":"Ozen S , Cakmak E . 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