Feasibility of a Mind-Body Program for Chronic Pain: A Randomized Clinical Trial.

The short version

This feasibility randomized clinical trial with 92 sedentary adults experiencing chronic musculoskeletal pain explored whether a mind-body walking program could be delivered successfully across three geographically and racially diverse U.S. academic medical centers, compared with a health education program. The mind-body walking program combined quota-based pacing — increasing step-count goals gradually based on what participants could sustain, rather than tying goals to whether pain was present — with mind-body skills such as breathing exercises and body scans, and cognitive skills aimed at identifying and reframing unhelpful pain-related thoughts. The trial measured physical function in three complementary ways (self-reported, performance-based, and step-count-based), addressing a gap identified in pain-trial reporting guidelines. Participants were randomized 1:1 to the 10-week, 60-minute weekly group mind-body walking program (47 participants) or a matched health-education control (45 participants), recruited between April 2023 and January 2024. The mind-body group received a Fitbit Inspire 3 tracker with individualized weekly step goals. Physical function was measured with the 6-Minute Walk Test, a wrist-worn accelerometer worn for one week, and the World Health Organization Disability Assessment Schedule. Pain, mood, and psychological mechanisms — pain catastrophizing, fear of movement, adaptive coping, and mindfulness — were measured with validated questionnaires before and after the program. Both programs met most feasibility benchmarks, including attendance (95.7% mind-body walking vs 82.2% health education), delivery fidelity, and participant retention (93.6% vs 86.7%). Racial and ethnic diversity exceeded its target (54.3% of participants from minority groups, against a 38% benchmark), though overall recruitment fell short (69.7% of eligible patients enrolled, against an 80% target). Within the mind-body walking group, participants showed large pre-to-post improvements in walking distance (48.6 meters over six minutes, P<.001), self-reported physical function (P<.001), and pain catastrophizing (P<.001), plus medium improvements in pain intensity (P=.002) and fear of movement (P<.001), and smaller but significant improvements in adaptive coping and mindfulness (both P<.05). The health education group improved only on walking distance and pain intensity. Because the trial was not statistically powered to compare the two programs against each other, these within-group changes describe what happened in each arm rather than a demonstrated advantage of one program over the other. The trial establishes that a mind-body walking program can be delivered with strong attendance and participant satisfaction across diverse academic medical centers, supporting a future, fully powered efficacy trial. The findings do not establish that the mind-body walking program produces greater benefit than health education, since the study was designed to test feasibility rather than comparative outcomes. The gap between eligible and enrolled participants (69.7% versus an 80% target) points to recruitment timing as an area for refinement in future trial designs.

Key findings

• A 10-week, weekly, group-based walking program that combined gradually increasing step-count goals (called quota-based pacing) with relaxation and thought-reframing skills was found to be practical to deliver to 92 adults with chronic pain lasting three months or longer, across three U.S. medical centers with a racially and ethnically diverse mix of participants.
• Participants in the walking program attended sessions reliably (96% attended at least 7 of 10 sessions), stayed in the study through the end (94%), and rated the program as satisfying (98%) and credible (100%).
• From before to after the program, participants in the walking program walked farther in a 6-minute walking test, reported better day-to-day physical function, and reported less catastrophic thinking about their pain (a pattern of worry and helplessness around pain), with the largest changes seen in these three measures.
• The comparison health-education program (covering topics like nutrition and sleep) only showed improvement in walking distance and pain intensity, not in the psychological measures.
• Because the study was built to test whether the program could be run successfully rather than to directly compare it against the health-education program, these results cannot yet show that the walking program works better than the comparison program — a larger, fully powered trial is needed to test that question directly.

Common questions