Effect of mindfulness-based programmes on elite athlete mental health: a systematic review and meta-analysis

Objective To determine the effectiveness of mindfulness-based programmes (MBPs) on the mental health of elite athletes. Design Systematic review and meta-analysis. Data sources Eight online databases (Embase, PsycINFO, SPORTDiscus, MEDLINE, Scopus, Cochrane CENTRAL, ProQuest Dissertations & Theses and Google Scholar), plus forward and backward searching from included studies and previous systematic reviews. Eligibility criteria for selecting studies Studies were included if they were randomised controlled trials (RCTs) that compared an MBP against a control, in current or former elite athletes. Results Of 2386 articles identified, 12 RCTs were included in this systematic review and meta-analysis, comprising a total of 614 elite athletes (314 MBPs and 300 controls). Overall, MBPs improved mental health, with large significant pooled effect sizes for reducing symptoms of anxiety (hedges g=−0.87, number of studies (n)=6, p=0.017, I 2=90) and stress (g=−0.91, n=5, p=0.012, I 2=74) and increasing psychological well-being (g=0.96, n=5, p=0.039., I 2=89). Overall, the risk of bias and certainty of evidence was moderate, and all findings were subject to high estimated levels of heterogeneity. Conclusion MBPs improved several mental health outcomes. Given the moderate degree of evidence, high-quality, adequately powered trials are required in the future. These studies should emphasise intervention fidelity, teacher competence and scalability within elite sport. PROSPERO registration number CRD42020176654.