Moving for relief: a meta-analysis on traditional Chinese exercise and nonspecific low back pain

Objective: A meta-analysis was conducted to evaluate the efficacy of Traditional Chinese Exercise in reducing pain intensity, improving dysfunction and quality of life, and increasing the overall treatment effectiveness rate in patients with nonspecific low back pain (NLBP), so as to provide evidence for its clinical application. Methods: Following the PRISMA guidelines, this study systematically searched eight databases-CNKI, Wanfang, VIP, Sinomed, PubMed, Embase, the Cochrane Library, and Web of Science-for randomized controlled trials published up to January 19, 2026. A total of 38 studies involving, 3,054 patients were included. The Cochrane Risk of Bias Tool was used to evaluate the quality of the included studies. Based on heterogeneity, either a fixed-effects or random-effects model was selected to synthesize the standardized mean difference (SMD) or weighted mean difference (WMD), Subgroup analysis and meta-regression were performed to explore the sources of heterogeneity. Results: The meta-analysis demonstrated that traditional Chinese exercise significantly reduced pain intensity [WMD = -1.21; 95% CI (-1.66, -0.76)], improved dysfunction [WMD = -6.80; 95% CI (-10.18, -3.41)], and enhanced quality of life [SMD = 1.64; 95% CI (0.33, 2.96)] in patients with nonspecific low back pain (NLBP). The overall treatment response rate was increased by 17% [RR = 1.17; 95% CI (1.10, 1.24)]. Subgroup analysis indicated that Liu Zi Jue (a specific Qigong breathing exercise) demonstrated the greatest analgesic effect (SMD = -1.71) and the most significant improvement in functional disability (WMD = -13.35). Additionally, patients younger than 45 years of age showed a more favorable response to treatment (SMD = -1.52). Substantial heterogeneity was observed across studies, attributed primarily to the diversity of intervention protocols, including variations in exercise types, treatment durations, and differences in the measurement instruments used. Conclusion: Traditional Chinese exercise is an effective, low-cost, and safe intervention for NLBP patients and may be recommended as a complementary approach in clinical management. Future research should include large-sample, standardized studies incorporating biomechanical and imaging techniques to elucidate underlying mechanisms, and develop evidence-based practice guidelines. Systematic Review Registration: identifier: CRD42025649466 (https://www.crd.york.ac.uk/PROSPERO/).