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 < 0.05). mindfulness-exercise participants reported higher perceived treatment effects than exercise group participants (p < 0.05). Pain catastrophizing was lower and coping strategies were more favorable for mindfulness-exercise participants than for exercise participants (p < 0.05). 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 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.

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