





































Feldenkrais Research Journal • volume 7 (2023)

Systematic Reviews

The effectiveness of the Feldenkrais Method:
A systematic review of the evidence

Susan Hillier
International Centre for Allied Health Evidence, Sansom Institute of Health Research, School of Health
Science, University of South Australia

Anthea Worley
School of Health Science, University of South Australia

Contact: susan.hillier@unisa.edu.au

This article was originally published in Evidence-Based Complementary and Alternative Medicine; 2015.
Volume 2015, Article ID 752160. The PDF version of the article follows. The HTML version can be found
at Hindawi: https://doi.org/10.1155/2015/752160

Abstract
The Feldenkrais Method (FM) has broad application in populations interested in improving awareness,
health, and ease of function. This review aimed to update the evidence for the benefits of FM, and for
which populations. A best practice systematic review protocol was devised. Included studies were
appraised using the Cochrane risk of bias approach and trial findings analysed individually and
collectively where possible. Twenty RCTs were included (an additional 14 to an earlier systematic review).
The population, outcome, and findings were highly heterogeneous. However, meta-analyses were able to
be performed with 7 studies, finding in favour of the FM for improving balance in ageing populations (e.g.,
timed up and go test MD −1.14 sec, 95% CI −1.78, −0.49; and functional reach test MD 6.08 cm, 95% CI
3.41, 8.74). Single studies reported significant positive effects for reduced perceived effort and increased
comfort, body image perception, and dexterity. Risk of bias was high, thus tempering some results.
Considered as a body of evidence, effects seem to be generic, supporting the proposal that FM works on
a learning paradigm rather than disease-based mechanisms. Further research is required; however, in the
meantime, clinicians and professionals may promote the use of FM in populations interested in efficient
physical performance and self-efficacy.

Keywords
Feldenkrais Method, Awareness Through Movement, Functional Integration, systematic review, Cochrane
approach, mechanisms of action, function, functional reach, balance training, dexterity, self-efficacy,
reduced perceived effort, body image perception

Copyright ©: The copyright for this paper remains with the author(s).

Published by the International Feldenkrais® Federation (IFF) https://feldenkrais-method.org
Available online at https://feldenkraisresearchjournal.org

mailto:susan.hillier@unisa.edu.au
https://doi.org/10.1155/2015/752160
https://feldenkrais-method.org/
https://feldenkraisresearchjournal.org


Please cite: Feldenkrais Research Journal, volume 7; 2023.

Service marks: The terms Feldenkrais®, Feldenkrais Method®, Awareness Through Movement®, ATM®,
Functional Integration®, and FI® are service marked terms of the International Feldenkrais® Federation
(IFF) and Feldenkrais professional guilds and associations in many countries. In keeping with academic
conventions, they will not be service marked in the entire text as may be required in nonacademic use,
but only for the first and most prominent use of the terms. In recognition that these phrases are formal
terms referring to specific practices within the Method, and to the Method as a whole, capitalization of all
the words in each term has been retained.



Review Article
The Effectiveness of the Feldenkrais Method: A Systematic
Review of the Evidence

Susan Hillier1 and Anthea Worley2

1International Centre for Allied Health Evidence, Sansom Institute of Health Research, School of Health Science,
University of South Australia, P.O. Box 2471, Adelaide, SA 5001, Australia
2School of Health Science, University of South Australia, P.O. Box 2471, Adelaide, SA 5001, Australia

Correspondence should be addressed to Susan Hillier; susan.hillier@unisa.edu.au

Received 16 December 2014; Revised 4March 2015; Accepted 9March 2015

Academic Editor: Cun-Zhi Liu

Copyright © 2015 S. Hillier and A. Worley. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.

The FeldenkraisMethod (FM) has broad application in populations interested in improving awareness, health, and ease of function.
This review aimed to update the evidence for the benefits of FM, and for which populations. A best practice systematic review
protocol was devised. Included studies were appraised using the Cochrane risk of bias approach and trial findings analysed
individually and collectively where possible. Twenty RCTs were included (an additional 14 to an earlier systematic review). The
population, outcome, and findings were highly heterogeneous. However, meta-analyses were able to be performed with 7 studies,
finding in favour of the FM for improving balance in ageing populations (e.g., timed up and go test MD −1.14 sec, 95% CI −1.78,−0.49; and functional reach test MD 6.08 cm, 95% CI 3.41, 8.74). Single studies reported significant positive effects for reduced
perceived effort and increased comfort, body image perception, and dexterity. Risk of bias was high, thus tempering some results.
Considered as a body of evidence, effects seem to be generic, supporting the proposal that FMworks on a learning paradigm rather
than disease-based mechanisms. Further research is required; however, in the meantime, clinicians and professionals may promote
the use of FM in populations interested in efficient physical performance and self-efficacy.

1. Introduction

The Feldenkrais Method (FM) was developed over a period
of decades in the last century by Dr. Moshe Feldenkrais.
He claimed the basis of the approach was founded in the
human potential for learning how to learn [1]. As such, he
operationalized an experiential process or set of processes,
whereby an individual or a group could be guided through
a series of movement- and sensation-based explorations.The
purpose of these explorations was to practise the nonlinear
process of sensing the difference between twoormore options
to achieve the stated movement task, and making a discern-
ment about which may feel easier, that is to say, performed
with less effort.These perceptual discernments are predicated
on a judgement that is positive (pleasurable, easy, and with
less effort) compared with experiencing a less favourable
feedback signal such as pain, strain, or discomfort. Further
to this, the participants are encouraged to generate many
alternative movement solutions to the guided task to increase

the opportunity for further distinctions and improvements
to be made. Thus the process of intention, action, gaining
feedback, making decisions, and reenacting with adaptations
constitutes the learning framework in a somatic context [2].

The two modes of delivery that are offered to the public
are either individual, manually directed lessons (functional
integration, FI) or group, verbally directed classes (aware-
ness through movement, ATM). The nomenclature for both
reflects the fundamentals of the approach—that movement
has to be based on a functional or meaningful intention
for the system to engage and that by becoming aware
of what and how we act (move) we become in a better
place to choose an alternative behaviour (movement pattern)
[3]. Both modes of delivery apply the same principles of
perceptual exploration through movement that is passively
and/or actively performed.

The method has been applied in varied domains across
countries, from general education or children with learning
issues to enhancing performance in sports and theatre.

Hindawi Publishing Corporation

Evidence-Based Complementary and Alternative Medicine

Volume 2015, Article ID 752160, 12 pages

http://dx.doi.org/10.1155/2015/752160

http://dx.doi.org/10.1155/2015/752160


2 Evidence-Based Complementary and Alternative Medicine

The clinical applications have received the most interest in
the published literature because of the intuitive appeal of
basing a health recovery process on a learning paradigm and
because of the inherent fostering of self-efficacy that occurs
particularly in a group setting.

In the climate of evidence-based practice in the health
domain, any approach being offered to the public is being
scrutinized for evidence of effectiveness and, if effective, for
what type of benefit and of what magnitude for any clinical
population. An earlier systematic review of the evidence for
the method was published in 2005 by Ernst and Canter [4].
This review included six randomised controlled trials (RCTs)
of low to moderate quality in populations such as people
with multiple sclerosis, chronic low back pain, and neck
issues. They concluded that there was promising evidence
but its credibility was tempered due to the low number of
studies, high level of clinical heterogeneity between studies,
and methodological flaws. The methods employed by Ernst
and Canter [4] were robust for the time; however, their risk
of bias assessment used a now discarded tool (the Jadad)
and their search covered until 2003. Therefore, it is timely
to systematically update the evidence for the Feldenkrais
Method with current review procedures.

This review had the aims of

(1) systematically identifying and appraising the evi-
dence for the effectiveness of the Feldenkrais Method
across domains;

(2) determining what is the nature and order of magni-
tude of any beneficial effects and for which popula-
tion/s.

2. Materials and Methods

2.1. Criteria for Considering Studies for This Review. We
employed systematic review methods based on the PRISMA
guidelines [5].

2.2. Types of Studies. Weconsidered all types of primary stud-
ies in the first instance in order to fully explore the potential
populations and outcomes covered. In the final inclusion only
studies with a random allocation and a stated control group
were included. Any secondary researches (systematic and
semisystematic reviews) found were not included, but rather
their included studies were retrieved in full and added to the
potential pool in order for all primary studies to be appraised
with a consistent method.

2.3. Types of Participants and Outcomes. We included any
population where there was an outcome of interest related to
improvement in health and/or function.

2.4. Types of Interventions and Comparisons. Either form
of Feldenkrais Method (functional integration or awareness
through movement) was included as the sole approach for
the intervention group.The comparison group could include
placebo, inactive control, or an alternate method.

2.5. Search Methods for Identification of Studies. We searched
the databases of AMED (Allied and Complementary
Medicine), Embase Classic + Embase, Ovid MEDLINE(R),
Cochrane, PsycINFO, PubMed, and Google Scholar
from inception to July 2014. We considered all languages (the
search was open to all listed journals irrespective of language)
and publication status (we would include unpublished trials
wherever found, e.g., through experts in the field or grey
literature such as organizational websites).

The search terms included variations and combinations
of methodology terms (such as randomised, trial, clinical,
and controlled), with intervention terms such as Feldenkrais
Method, (awareness through movement and functional inte-
gration). An example of the terms employed in the electronic
search strategy is presented in Table 1.

From the generated lists from each database, duplicates
were removed and the first high level sift was performed by
one author based on title alone. The second level of review
was performed by both authors and required retrieval of the
abstract at theminimum.The retained studies were examined
in full to confirm inclusion. Those excluded were recorded
with reasons.

All retrieved studies were checked for additional refer-
ences, and experts in the field were contacted to assist in
identifying any further studies published or unpublished.
Experts were provided from the membership of peak FM
bodies (the Australian Feldenkrais Guild and the Interna-
tional Feldenkrais Federation) and were asked to supply
further papers by email.

2.6. Data Collection and Analysis. Relevant data were
extracted from each of the included studies using a standard
trial summary sheet by one author and checked by the second.
Data included author, date, study design, population sample,
intervention, comparison, outcome measures, results, and
comments. A risk of bias evaluation was also performed for
each study by one author using standard Cochrane tables
[26] with checking and data entry by the second author. Any
disagreements were resolved by consensus, with a third party
if necessary.

Where possible, data were extracted for meta-analyses.
We planned to extract and analyse data to calculate individual
and total effect sizes through odds ratios or mean differences
(fixed effect or random effect if the studies were small and/or
heterogeneous) and 95% confidence intervals. Statistical het-
erogeneity would be evaluated based on visual inspection
of forest plots and on the "2 statistic. It was not anticipated
that any other analyses would be possible (e.g., subgroup or
publication bias) due to a paucity of studies.

If we found that meta-analyses were not possible, then
results would be synthesized and reported narratively.

3. Results

3.1. Included Studies. The systematic search yielded over
1,300 initial titles for high pass screening. See Figure 1 for
the PRISMA Flow diagram. With duplicates and obviously
irrelevant titles removed, 124 records were considered at the



Evidence-Based Complementary and Alternative Medicine 3

Table 1: Example of search strategy.

Number Searches Results

1 (Clinical trial or randomised trial or controlled trial).mp. [mp = ab, hw, ti, sh, tn, ot,
dm, mf, dv, kw, nm, kf, ps, rs, an, ui] 1900972

2 (Feldenkrais or awareness through movement or functional integration).mp. [mp =
ab, hw, ti, sh, tn, ot, dm, mf, dv, kw, nm, kf, ps, rs, an, ui] 2239

3 1 and 2 47
4 Removing duplicates from 3 40

Table 2: List of papers excluded with reasons.

Studies Reason for exclusion
Kirkby (1994) Controlled trial
Bearman (1999) Pre/posttest (no control)
Seegert (1999) Controlled trial
Huntley (2000) Systematic review
Dunn (2000) Pre/posttest (no control)
Fialka-Moser (2000) Commentary
Malmgren-Ohlsen (2001,
2002, 2003) Controlled trial

Kerr (2002) Controlled trial
Emerich (2003) Review
Junker (2003) Posttest (no control)
Galantino (2003) Review
Gard (2005) Review
Mehling (2005) Review
Liptak (2005) Review
Batson (2005) Pre/posttest (no control)
Wennemer (2006) Pre/posttest (no control)
Porcino (2009) Descriptive
Mehling (2009) Review (assessment)
Connors (2010) Content analysis
Connors (2011a) Controlled trial
Connors (2011b) Pre/posttest (no control)
Mehling (2011) Inquiry (phenomenological)
Ohman (2011) Pre/posttest (no control)
Laird (2012) Review

Mehling (2013) Intervention (not exclusively
Feldenkrais)

Gross (2013) Review
Webb 2013 Pre/posttest (no control)

abstract level by both authors, with an additional two studies
provided from experts in the field (newly published, one RCT,
one non-RCT). Seventy-seven abstracts were excluded at this
stage because they were did not report an investigation of the
FM and/or did not involve a trial of effect. Forty-seven full-
text articles were reviewed against the criteria and further 27
excluded with reasons noted in Table 2.

Fourteen newRCTswere included alongwith the original
six studies from the Ernst and Canter [4] review. See Table 3
for details of all included studies. From this total of 20 studies,

there were seven studies sufficiently homogenous to allow for
meta-analyses.

3.2. Description of Studies. Publication dates ranged from
1991 [12] to 2014 [25]. Populations under investigation in the
included RCTs ranged from healthy volunteers [6, 12, 15–
17, 19, 24], healthy ageing [21–23], institutional ageing [25],
people withmultiple sclerosis [7–11, 13], eating disorders [14],
myocardial infarct [18], and sleep bruxism [20]. Studies gen-
erally had small sample sizes with a mean of 40.8 participants
(SD 23.5).

The nature of the Feldenkrais interventions also varied
in delivery mode, intensity, and frequency.The predominant
methods were single or multiple ATM lessons delivered
either in a group or individually using audio recording.
The comparison groups were most commonly an alternate
form of therapy. Fourteen trials had active controls (such
as relaxation classes or generic movement/balance classes)
and six had a passive or inactive control (usual activities/no
intervention).

Outcomes were also highly heterogeneous in keeping
with the needs of the diverse populations and are listed
in Table 3. The measures related to performance or activity
outcomes (e.g., balance or dexterity), symptoms (e.g., pain,
effort or mood) or were related to quality of life.

3.3. Excluded Studies. Table 2 summarises the list of studies
(27) that were retrieved but excluded. Reasons for exclusion
were predominantly around design: two were systematic
reviews; five were controlled trials (not randomly allocated);
eight had no control group; eightwere nonsystematic reviews;
onewas not exclusively Feldenkrais in the intervention group;
one was a content analysis of an intervention; one was a
phenomenological analysis; and one was a commentary.

3.4. Risk of Bias in Included Studies. Risk of bias was high in
most studies. Less than a quarter of the studies had adequate
random allocation processes and only a third had blinding
of outcome assessments. It has to be acknowledged that for
trials requiring an intervention like Feldenkrais it may be
difficult or inappropriate to expect blinding of therapists or
even participants, though participants can be blinded to the
intervention of interest if there is a plausible comparison
group (such as a relaxation or other forms of movement-
based class). Figures 2 and 3 summarize the risk of bias
analysis. It can be seen that a definitive judgement could not
be made in many cases as it could not be confirmed whether



4 Evidence-Based Complementary and Alternative Medicine

Sc
re

en
in

g
In

clu
de

d
El

ig
ib

ili
ty

Id
en

tifi
ca

tio
n Records identified through

database searching (after high level
title screening) (n = 176)

Additional records identified
through other sources (n = 2)

Records after duplicates removed
(n = 124)

Records screened (n = 124) Records excluded (n = 77)

Full-text articles assessed
for eligibility (n = 47)

Full-text articles excluded,
with reasons (n = 27)

Studies included in
qualitative synthesis (n = 20)

Studies included in
quantitative synthesis

(meta-analysis) (n = 7)

Figure 1: PRISMA flow diagram.

Random sequence generation (selection bias)

Allocation concealment (selection bias)

Blinding of participants and personnel (performance bias)

Blinding of outcome assessment (detection bias)

Incomplete outcome data (attrition bias)

Selective reporting (reporting bias)

Other biases

0 25 50 75 100

Low risk of bias
Unclear risk of bias

High risk of bias

(%)

Figure 2: Risk of bias graph: review authors’ judgements about each risk of bias item presented as percentages across all included studies.



Evidence-Based Complementary and Alternative Medicine 5

Ta
bl
e
3:
Ra

nd
om

ise
d
co
nt
ro
lle
d
tri
als

of
FM

(E
rn
st
an
d
Ca

nt
er
,2
00
5[

4]
,#=6)

wi
th

up
da
te
d
RC

Ts
#=14.

Au
th
or

(y
ea
r)

St
ud

yd
es
ig
n

Sa
m
pl
e

In
te
rv
en
tio

n
Co

nt
ro
l

O
ut
co
m
e

Re
su
lts

Co
m
m
en
ts

Ru
th

an
d

Ke
ge
rr
eis

(19
92
)

[6
]

RC
T

2p
ar
all
el
gr
ou

ps
30

he
alt
hy

vo
lu
nt
ee
rs

Si
ng

le
FM

se
qu

en
ce

Pa
rti
cip

at
io
n
in

ot
he
r

ra
nd

om
ac
tiv

iti
es

D
eg
re
eo

fn
ec
k
fle
xi
on

(g
on

io
m
et
er
);
pe
rc
eiv

ed
eff
or
t

du
rin

gfl
ex
io
n

G
re
at
er

de
gr
ee

of
ne
ck

fle
xi
on

(g
on

io
m
et
er
)(
!<0.01

);
les

s
pe
rc
eiv

ed
eff
or
td

ur
in
gfl

ex
io
n

(!<0.0
5)

St
ud

yh
as

pi
lo
tc
ha
ra
ct
er

Jo
hn

so
n
et
al.

(19
99
)[
7]

RC
T

2-
gr
ou

p
cr
os
so
ve
r(
2p

ha
se
s)

20
pe
op

le
wi
th

M
S

FM
:8×45

m
in

se
ss
io
ns

at
we

ek
ly

in
te
rv
als

8w
ee
ks

sh
am

no
nt
he
ra
pe
ut
ic
bo

dy
wo

rk

L
an
d
R
ha
nd

de
xt
er
ity

(p
eg
bo

ar
d
te
st)

;
8s

ym
pt
om

/p
er
fo
rm

an
ce

sc
or
es
;

5m
oo

d
sc
ale

s

N
SD

Le
ss
pe
rc
eiv

ed
str

es
sf
ol
lo
wi
ng

FM
(!=0.0

1)
Po

sit
iv
er

es
ul
tc
ou

ld
be

du
e

to
m
ul
tip

le
te
sti
ng

fo
r

sig
ni
fic
an
ce

Lu
nd

bl
ad

et
al.

(19
99
)[
8]

RC
T

3p
ar
all
el
gr
ou

ps

97
fe
m
ale

sw
ith

ne
ck

an
d

sh
ou

ld
er

pr
ob

lem
s

FM
:4

in
di
vi
du

al
se
ss
io
ns
,1
2g

ro
up

se
ss
io
ns

of
50

m
in
s

pw
,f
or

16
we

ek
s,

ho
m
ea

ud
io

ta
pe
s

(C
1)
ph

ys
io
th
er
ap
y2
×

50
m
in
sp

er
we

ek
fo
r1
6

we
ek
s;
ho

m
ee

xe
rc
ise

s
(C

2)
no

in
te
rv
en
tio

n

Cl
in
ica

la
ss
es
sm

en
ts
(4

m
ea
su
re
s)
;

ph
ys
io
lo
gi
ca
lt
es
ts
(18

m
ea
su
re
s)

co
m
pl
ain

ti
nd

ice
s(
5m

ea
su
re
s)
;

VA
Sp

ain
ra
tin

gs
(2

m
ea
su
re
s)
;

di
sa
bi
lit
ya

nd
sic

k
lea

ve
m
ea
su
re
s(
4
m
ea
su
re
s)

Pr
ev
ale

nc
eo

fn
ec
k
pa
in

an
d

di
sa
bi
lit
yd

ur
in
gl
eis

ur
ed

ec
re
as
ed

in
FM

ve
rs
us

C1
or

C2
(!<0.0

5)
31

of
33

m
ea
su
re
sN

SD

Im
po

rta
nt

ba
se
lin

e
di
ffe
re
nc
es
,p
os
sib

le
re
gr
es
sio

n
to

th
em

ea
n.

H
ig
h

dr
op

ou
tr
at
ea

nd
pe
r

pr
ot
oc
ol
an
aly

sis
.M

ul
tip

le
te
sti
ng

fo
rs
ig
ni
fic
an
ce

St
ep
he
ns

et
al.

(2
00
1)
[9
]

RC
T

2p
ar
all
el
gr
ou

ps
12

pe
op

le
wi
th

M
S

FM
:8
×2–4h

ou
rs

se
ss
io
ns

ov
er

10
we

ek
s

Ed
uc
at
io
na
ls
es
sio

ns
ov
er

10
we

ek
s

3c
lin

ica
lt
es
ts
of

ba
lan

ce
;

3s
ym

pt
om

sc
ale

s

Si
gn

ifi
ca
nt

im
pr
ov
em

en
ti
n
FM

co
m
pa
re
d
to

C
fo
rm

CT
SI
B
an
d

Ba
lan

ce
Co

nfi
de
nc
eS

ca
le;

ot
he
r4

ou
tc
om

es
N
SD

Ve
ry

sm
all

sa
m
pl
es

ize
.N

o
ba
se
lin

ed
at
ao

rs
ta
tis
tic

al
an
aly

sis
av
ail
ab
le

Sm
ith

et
al.

(2
00
1)
[10

]
RC

T
2p

ar
all
el
gr
ou

ps
26

pa
tie

nt
sw

ith
ch
ro
ni
cl
ow

ba
ck

pa
in

FM
:o
ne

30
-m

in
ut
e

se
ss
io
n

At
te
nt
io
n
co
nt
ro
l

Pa
in

(M
cG

ill
);

an
xi
et
y(

ST
AI

)

FM
no

tC
re
du

ce
d
aff
ec
tiv

e
di
m
en
sio

n
of

pa
in

pr
e-
po

st
(!=0.0

4)Cnot
FM

im
pr
ov
ed

se
ns
or
yd

im
en
sio

n
of

pa
in

pr
e/
po

stt
es
t(
!=0.03

)
N
SD

fo
re

va
lu
at
iv
ed

im
en
sio

n
of

pa
in

or
an
xi
et
y

O
nl
ya

cu
te
eff
ec
ts
we

re
m
ea
su
re
d.
Ba

se
lin

e
di
ffe
re
nc
es

be
tw
ee
n
FM

an
d

C
in

du
ra
tio

n
of

ba
ck

pa
in

m
ay

be
im

po
rta

nt

G
rü
be
le
ta
l.

(2
00
3)

[11
]

RC
T

2p
ar
all
el
gr
ou

ps
66

pa
tie

nt
sw

ith
ca
nc
er

FM
:5×50

m
in
ut
es

se
ss
io
ns

of
fu
nc
tio

na
l

in
te
gr
at
io
n
in

ad
di
tio

n
to

co
nv
en
tio

na
l

th
er
ap
ies

C:
no

ad
ju
nc
tt
he
ra
py

Bo
dy

im
ag
eq

ue
sti
on

na
ire

;
Fr
an
kf
ur
te
rb

od
yc

on
ce
pt

sc
ale

s;
qu

ali
ty
of

lif
e;

se
ns
eo

fm
ov
em

en
t;
an
d
bo

dy
aw

ar
en
es
s

Bo
th

gr
ou

ps
im

pr
ov
ed

in
all

ou
tc
om

em
ea
su
re
s

N
on

sig
ni
fic
an
tt
re
nd

fa
vo
ur
ed

FM

Ad
di
tio

na
lR

CT
s

Br
ow

n
an
d

Ke
ge
rr
eis

(19
91
)

[12
]

RC
T

2p
ar
all
el
gr
ou

ps

21
(12

m
en

an
d
9

wo
m
en
)

vo
lu
nt
ee
rs

pa
in
-fr

ee

FM
:4
5m

in
au
di
o

ta
pe

“a
ct
iv
at
in
gt

he
fle
xo
rs”

les
so
n

C:
lis
te
ne
d
to

th
es

am
e

45
m
in

au
di
o
ta
pe

m
od

ifi
ed

to
in
clu

de
on

ly
in
str

uc
tio

ns
pe
rta

in
in
g

to
ex
er
cis

em
ov
em

en
ts

EM
G
ac
tiv

ity
of

fle
xo
rs
an
d

ex
te
ns
or
s(
U
L)

Pe
rc
ep
tio

n
of

eff
or
td

ur
in
g

fle
xi
on

m
ov
em

en
t

N
SD

Th
er
ew

as
an

ov
er
all

de
cr
ea
se

in
m
ea
n
fle
xo
ra

ct
iv
ity

wi
th

no
ch
an
ge

in
m
ea
n
ex
te
ns
or

ac
tiv

ity
fo
rb

ot
h
gr
ou

ps
.

Ch
in
n
et
al.

(19
94
)[
13
]

RC
T

2p
ar
all
el
gr
ou

ps

23
su
bj
ec
ts
wi
th

up
pe
rb

ac
k,
ne
ck
,

or
sh
ou

ld
er

di
sc
om

fo
rt

FM
:s
in
gl
eA

TM
les

so
n;

22
m
in

au
di
o

ta
pe

C:
sin

gl
es

ha
m

tre
at
m
en
t;
30

m
in
s

ge
nt
le
ne
ck

an
d

sh
ou

ld
er

ex
er
cis

es

Fu
nc
tio

na
lr
ea
ch

ta
sk
;

pe
rc
eiv

ed
eff
or
td

ur
in
gt

he
ta
sk

N
SD

Re
du

ce
d
pe
rc
eiv

ed
eff
or
ti
n
FM

gr
ou

p
(!<0.0

5)
Sm

all
sa
m
pl
es

ize



6 Evidence-Based Complementary and Alternative Medicine

Ta
bl
e
3:
Co

nt
in
ue
d.

Au
th
or

(y
ea
r)

St
ud

yd
es
ig
n

Sa
m
pl
e

In
te
rv
en
tio

n
Co

nt
ro
l

O
ut
co
m
e

Re
su
lts

Co
m
m
en
ts

La
um

er
et
al.

(19
97
)[
14
]

RC
T

2p
ar
all
el
gr
ou

ps
30

pa
tie

nt
sw

ith
ea
tin

gd
iso

rd
er

FM
:9
-h
ou

rc
ou

rs
e

C:
di
d
no

tp
ar
tic

ip
at
ei
n

FM

Bo
dy

Ca
th
ex
is
Sc
ale

;
Bo

dy
Pa
rts

Sa
tis
fa
ct
io
n
Sc
ale

;
Bo

dy
pe
rc
ep
tio

n;
em

ot
io
n

in
ve
nt
or
y;
An

or
ex
ia
-

N
er
vo
sa
-In

ve
nt
or
yf
or

Se
lf-
Ra

tin
g;

ea
tin

gd
iso

rd
er

in
ve
nt
or
y-
2

FM
pa
rti
cip

an
ts
sh
ow

ed
in
cr
ea
sin

gc
on

te
nt
m
en
tw

ith
re
ga
rd

to
pr
ob

lem
at
ic
zo
ne
so

f
th
eir

bo
dy

an
d
th
eir

ow
n
he
alt
h

an
d
ac
ce
pt
an
ce

an
d
fa
m
ili
ar
ity

wi
th

th
eir

bo
dy

Fu
ll
ar
tic
le
in

G
er
m
an

Ja
m
es

et
al.

(19
98
)[
15
]

RC
T

3p
ar
all
el
gr
ou

ps
48

he
alt
hy

un
de
rg
ra
du

at
e

stu
de
nt
s

FM
:4×45-

m
in
ut
e

se
ss
io
ns

ov
er

2w
ee
ks

of
4
di
ffe
re
nt

AT
M

les
so
ns

re
co
rd
ed

on
au
di
oc
as
se
tte

Re
lax

at
io
n:
4×45m

in
se
ss
io
ns

ov
er

2w
ee
ks

lis
te
ne
d
to

re
lax

at
io
n

tra
in
in
ga

ud
io
ca
ss
et
te

C:
no

su
pe
rv
ise

d
les

so
ns

H
am

str
in
gl
en
gt
h
(m

od
ifi
ed

AK
E
te
st)

N
SD

In
su
ffi
cie

nt
ex
po

su
re
,l
ow

sta
tis
tic

al
po

we
r

H
op

pe
re

ta
l.

(19
99
)[
16
]

St
ud

y1
:R

CT
2p

ar
all
el
gr
ou

ps
St
ud

y2
:s
ub

sa
m
pl
eo

fS
tu
dy

1

St
ud

y1
:7
5

un
de
rg
ra
d
ph

ys
io

stu
de
nt
s

St
ud

y2
:3
9

pa
rti
cip

an
ts
fro

m
St
ud

y1

St
ud

y1
:F
M
:s
in
gl
e

AT
M
,4
5m

in
au
di
o

ca
ss
et
te
les

so
n
(n
o

pr
io
rF

M
ex
pe
rie

nc
e)

St
ud

y2
:4

di
ffe
re
nt

AT
M

les
so
ns

ov
er

2
we

ek
s

St
ud

y1
:C

:l
ist
en
ed

to
so
ft
no

nv
er
ba
lm

us
ic

St
ud

y2
:s
am

eA
TM

les
so
ns

ov
er

4
se
ss
io
ns

in
2w

ee
ks

wh
en

su
bj
ec
ts
ha
d
pr
io
rF

M
ex
pe
rie

nc
e

M
od

ifi
ed

AK
E
te
st
(h
am

str
in
g

len
gt
h)
;

Si
ta
nd

Re
ac
h
te
st;

Bo
rg
’s
6–

20
ra
tin

go
fp

er
ce
iv
ed

ex
er
tio

n
(d
ur
in
gs

it
an
d
re
ac
h
te
st)

St
ud

y1
:N

SD
St
ud

y2
:f
or

pe
rc
eiv

ed
ex
er
tio

n
sig

ni
fic
an
tm

ain
eff
ec
t

!=0.00
03.

N
SD

ot
he
rs

In
bo

th
stu

di
es

th
er
ew

as
a

sig
ni
fic
an
td

iff
er
en
ce

in
ex
er
tio

n
lev

els
be
tw
ee
n

m
ale

sa
nd

fe
m
ale

sw
ith

m
ale

se
xe
rti
ng

m
or
e

irr
es
pe
ct
iv
eo

fg
ro
up

Ko
lt
an
d

M
cC

on
vi
lle

(2
00

0)
[17

]
RC

T
2p

ar
all
el
gr
ou

ps

54
un

de
rg
ra
d

ph
ys
io
th
er
ap
y

stu
de
nt
sw

ith
no

pr
io
rF

M
ex
pe
rie

nc
e

FM
:4×45

m
in

AT
M

les
so
ns

vi
a

au
di
oc
as
se
tte

ov
er

a
2-
we

ek
pe
rio

d

Re
lax

at
io
n:
4×45m

in
re
lax

at
io
n
se
ss
io
ns

vi
a

au
di
oc
as
se
tte

ov
er

a
2-
we

ek
pe
rio

d
C:

no
sp
ec
ifi
ct
as
ks

ov
er

2-
we

ek
pe
rio

d

Bi
po

lar
fo
rm

of
th
ep

ro
fil
eo

f
m
oo

d
sta

te
s(
PO

M
S-
BI
)

N
SD

Co
m
po

se
d-
an
xi
ou

ss
co
re
so

ft
he

PO
M
S-
BI

di
d
va
ry

sig
ni
fic
an
tly

ov
er

tim
e(
!=0.00

1)foral
l

pa
rti
cip

an
ts.

Fe
m
ale

si
n
FM

an
d

re
lax

at
io
n
gr
ou

ps
re
po

rte
d

sig
ni
fic
an
tly

lo
we

ra
nx

iet
ys

co
re
s

at
co
m
pl
et
io
n
co
m
pa
re
d
wi
th

co
nt
ro
l

N
o
di
ffe
re
nc
es

be
tw
ee
n
FM

an
d
re
lax

at
io
n
gr
ou

ps

Lö
we

et
al.

(2
00
2)

[18
]

Ps
eu
do

ra
nd

om
ize

d,
co
ns
ec
ut
iv
ea

llo
ca
tio

n

60
pa
tie

nt
s

tra
ns
fe
rr
ed

to
no

rm
al
wa

rd
aft

er
ac
ut
e

tre
at
m
en
tf
or

M
I

FM
:2×30

m
in

in
di
vi
du

al
se
ss
io
ns

Re
lax

at
io
n:
2×30m

in
in
di
vi
du

al
PM

R
C:

no
bo

dy
-o
rie

nt
ed

in
te
rv
en
tio

ns

Bo
dy

im
ag
eq

ue
sti
on

na
ire

(F
KB

-2
0,
G
er
m
an

ve
rs
io
n)
;

H
os
pi
ta
lA

nx
iet

ya
nd

D
ep
re
ss
io
n
Sc
ale

-G
er
m
an

ve
rs
io
n
(H

AD
S-
D
);

M
un

ich
Q
ua
lit
yo

fL
ife

D
im

en
sio

ns
Li
st
(M

LD
L)
;

G
er
m
an

ve
rs
io
n
G
en
er
ali
ze
d

Se
lf-
Effi

ca
cy

Sc
ale

(G
SE

S)

N
SD

O
ve
ra
ll
im

pr
ov
em

en
ts
we

re
se
en

in
M
LD

L,
G
SE

S,
an
d

FK
B-
20

St
ep
he
ns

et
al.

(2
00

6)
[19

]
RC

T
2p

ar
all
el
gr
ou

ps
38

gr
ad
ua
te

stu
de
nt
s

FM
:5×15

m
in

AT
M

se
ss
io
ns
/w

k,
au
di
ot
ap
eo

ve
r

3-
we

ek
pe
rio

d

C:
re
gu

lar
da
ily

ac
tiv

iti
es

AK
E
(h
am

str
in
gm

us
cle

len
gt
h)

Si
gn

ifi
ca
nt

in
cr
ea
se

in
ha
m
str

in
g

m
us
cle

len
gt
h
(!=0.0

05)in
AT

M
gr
ou

p
co
m
pa
re
d
wi
th

co
nt
ro
l

Pa
rti
cip

an
ts
va
rie

d
gr
ea
tly

in
th
ed

ur
at
io
n
an
d
nu

m
be
ro

f
ho

m
es

es
sio

ns
co
m
pl
et
ed

Q
ui
nt
er
o
et
al.

(2
00

9)
[2
0]

RC
T

2g
ro
up

(c
ro
ss
ov
er

de
sig

n
fo
r

co
nt
ro
l)

3-
to

6-
ye
ar
-o
ld

ch
ild

re
n
wi
th

sle
ep

br
ux

ism

FM
:3

hr
se
ss
io
ns
×

10
du

rin
g1

0-
we

ek
pe
rio

d
ba
se
d
on

AT
M

C:
no

de
ta
ils

Va
rio

us
m
ea
su
re
so

fj
oi
nt

fu
nc
tio

n;
no

ct
ur
na
lb
ru
xi
sm

St
at
ist
ica

lly
sig

ni
fic
an
ti
nc
re
as
eo

f
CV

A
an
gl
e(
!=0.0)

fo
rF

M
c.f
.C

.
Aft

er
in
te
rv
en
tio

n
77
%
pa
re
nt
si
n

FM
re
po

rte
d
no

no
ct
ur
na
l

br
ux

ism
c.f
.1
5.3

8%
fo
rC

At
ba
se
lin

et
wo

gr
ou

ps
we

re
co
m
pa
ra
bl
e



Evidence-Based Complementary and Alternative Medicine 7

Ta
bl
e
3:
Co

nt
in
ue
d.

Au
th
or

(y
ea
r)

St
ud

yd
es
ig
n

Sa
m
pl
e

In
te
rv
en
tio

n
Co

nt
ro
l

O
ut
co
m
e

Re
su
lts

Co
m
m
en
ts

Vr
an
tsi
di
se

ta
l.

(2
00

9)
[2
1]

RC
T

2g
ro
up

s(
cr
os
so
ve
rd

es
ig
n
fo
r

co
nt
ro
l)

55
pa
rti
cip

an
ts

ag
ed
≥55year

s

FM
:g
et
tin

g
gr
ou

nd
ed

gr
ac
ef
ul
ly

pr
og
ra
m

(b
as
ed

on
AT

M
)2×40–

60
m
in

se
ss
io
ns
/w

k
ov
er

8
we

ek
s

C:
co
nt
in
ue

wi
th

us
ua
l

ac
tiv

ity

Fr
en
ch
ay

Ac
tiv

ity
In
de
x;

H
um

an
Ac

tiv
ity

Pr
ofi

le;
As

se
ss
m
en
to

fQ
ua
lit
yo

fL
ife
;

M
od

ifi
ed

Fa
lls

Effi
ca
cy

Sc
ale

;
Ab

br
ev
iat
ed

M
en
ta
lT

es
tS

co
re
;

fo
ur
-s
qu

ar
es

te
p
te
st;

tim
ed

up
an
d
go

te
st;

th
eS

te
p
Te
st;

Ti
m
ed

Si
t-T

o-
St
an
d
Te
st;

Cl
in
ica

lS
tri
de

An
aly

ze
r;

fo
rc
e-
pl
at
fo
rm

m
ea
su
re
so

fg
ait
,

m
ob

ili
ty,

an
d
fu
nc
tio

n;
sa
tis
fa
ct
io
n
su
rv
ey

Si
gn

ifi
ca
nt

eff
ec
ts
fo
rg

ait
sp
ee
d

(!=0.0
28)and

M
od

ifi
ed

Fa
lls

Effi
ca
cy

Sc
ale

(!=0.0
03)forF

M
gr
ou

p;
ne
ar

sig
ni
fic
an
te
ffe
ct
fo
r

tim
ed

up
an
d
go

te
st
(!=0.0

56)
Po

sit
iv
ef
ee
db

ac
k
fro

m
su
rv
ey

N
o
sig

ni
fic
an
tb

as
eli
ne

di
ffe
re
nc
es

be
tw
ee
n
gr
ou

ps
.

H
ig
h
cla

ss
at
te
nd

an
ce

U
llm

an
n
et
al.

(2
01
0)

[2
2]

RC
T

2g
ro
up

s

47
re
lat
iv
ely

he
alt
hy

in
de
pe
nd

en
tly

liv
in
g ≥65-yea

r-o
ld
s

FM
:1

ho
ur

AT
M

se
ss
io
ns

3x
/w

ee
k
fo
r

5w
ee
ks

(p
ro
vi
de
d
by

in
str

uc
to
r)

C:
wa

itl
ist

Fa
lls

Effi
ca
cy

Sc
ale

;
Ac

tiv
iti
es

Sp
ec
ifi
cB

ala
nc
e

Co
nfi

de
nc
eS

ca
le;

tim
ed

up
an
d
go

an
d
TU

G
wi
th

ad
de
d
co
gn

iti
ve

ta
sk
;G

AI
TR

ite
W
alk

wa
yS

ys
te
m
;

ta
nd

em
sta

nc
e

Ba
lan

ce
(!=0.0

30)and
m
ob

ili
ty

(!=0.0
42)incr

ea
se
d
fo
rF

M
,

wh
ils
tf
ea
ro

ff
all
in
gd

ec
re
as
ed

(!=0.0
42).

At
ba
se
lin

eg
ro
up

s
co
m
pa
ra
bl
ee

xc
ep
tf
or

hi
gh

er
BM

Ii
n
in
te
rv
en
tio

n
gr
ou

p

H
ill
ier

et
al.

(2
01
0)

[2
3]

Ps
eu
do

ra
nd

om
ize

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co
nt
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l

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-3
6;

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tie

nt
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ifi
cF

un
ct
io
na
lS
ca
le

(P
SF
S)
;t
im

ed
up

an
d
go

te
st;

fu
nc
tio

na
lr
ea
ch

te
st
(F
RT

);
Si
ng

le
Le
gS

ta
nc
eT

im
e(
SL

S)
;

W
alk

on
Fl
oo

rE
ye
sc

lo
se
d

(W
O
FE

C)

Si
gn

ifi
ca
nt

tim
ee

ffe
ct
fo
ra

ll
m
ea
su
re
se

xc
ep
tf
or

W
O
FE

C
Si
gn

ifi
ca
nt

im
pr
ov
em

en
ts
fo
rb

ot
h

gr
ou

ps
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rS

F-
36
,P

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S,
an
d
FR

T.
SL

Si
m
pr
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ed

FM
(!=0.0

16)
Po

st
ho

ci
nd

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ua
la
na
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co
m
pa
ris

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tte

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ta
l.

(2
01
1)
[2
4]

RC
T

3a
rm

s
29

he
alt
hy

un
iv
er
sit
y

stu
de
nt
s

FM
1:
AT

M
les

so
n

1×40m
in
,

do
m
in
an
th

an
d;

FM
2:
sa
m
eb

ut
no

nd
om

in
an
th

an
d

C:
re
lax

at
io
n
les

so
n

1×40m
in

Pu
rd
ue

Pe
gb
oa
rd

Te
st;

G
rip

-li
ft

te
st;

su
bj
ec
tiv

ec
ha
ng

es

FM
1s
ig
ni
fic
an
tg

ro
up

by
tim

e
in
te
rv
en
tio

n
eff
ec
tw

he
n

co
m
pa
re
d
to

co
nt
ro
lg
ro
up

fo
r

de
xt
er
ity

N
am

bi
et
al.

(2
01
4)

[2
5]

RC
T

3a
rm

s
60 in
sti
tu
tio

na
liz
ed

ag
ein

gp
eo
pl
e

FM
:A

TM
cla

ss
es

3×6we
ek
s

PI
:P

ila
te
sc

las
se
s3×6

we
ek
s

C:
sh
am

wa
lk
in
g3×6

we
ek
s.

Fu
nc
tio

na
lr
ea
ch

te
st;

tim
ed

up
an
d
go

te
st;

D
yn

am
ic

ga
it
in
de
x;
RA

N
D
-3
6
fo
rq

ua
lit
y

of
lif
e

Bo
th

FM
an
d
PI

im
pr
ov
ed

all
m
ea
su
re
s(
!<0.00

0);C
im

pr
ov
ed

TU
G
an
d
D
G
Io

nl
y

RC
T:

ra
nd

om
ise

d
co
nt
ro
lle
d
tri
al;

FM
:F
eld

en
kr
ais

M
et
ho

d;
M
S:
m
ul
tip

le
sc
ler

os
is;

L:
left

;R
:r
ig
ht
;C

:c
on

tro
l;p

w
:p
er

we
ek
;V

AS
:v
isu

al
an
alo

gu
es

ca
le;

m
CT

SI
B:

M
od

ifi
ed

Cl
in
ica

lT
es
to

fS
en
so
ry

In
te
gr
at
io
n
an
d

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lan

ce
;N

SD
:n
o
sig

ni
fic
an
td

iff
er
en
ce
;S
TA

I:
St
at
e/
Tr
ait

An
xi
et
yI
nd

ex
;E

M
G
:e
lec

tro
m
yo
gr
ap
hy

;U
L:
up

pe
rl
im

b;
AT

M
:a
wa

re
ne
ss
th
ro
ug

h
m
ov
em

en
t(
les

so
n)
;m

in
:m

in
ut
es
;A

KE
:a
ct
iv
ek

ne
ee

xt
en
sio

n
te
st;

M
I:

m
yo
ca
rd
ia
li
nf
ar
ct
;P

M
R:

pr
og
re
ss
iv
em

us
cle

re
lax

at
io
n;

c.f
.:c

om
pa
re
d
wi
th
;S
F-
36
:s
ho

rt
fo
rm

36
;P

I:
Pi
lat
es
.



8 Evidence-Based Complementary and Alternative Medicine

Ra
nd

om
 se

qu
en

ce
 ge

ne
ra

tio
n 

(s
ele

ct
io

n 
bi

as
)

Bitter et al. 2011

Brown and Kegerreis 1991

Chinn et al. 1994

Hillier et al. 2010

Hopper et al. 1999

James et al. 1998

Johnson et al. 1999

Kolt et al. 2000

Laumer et al. 1997

Lundblad et al. 1999

Nambi et al. 2014

Quintero et al. 2009

Ruth and Kegerreis 1992

Smith et al. 2001

Stephens et al. 2001

Stephens et al. 2006

Ullman et al. 2010

Vrantsidis et al. 2009

Al
lo

ca
tio

n 
co

nc
ea

lm
en

t (
se

lec
tio

n 
bi

as
)

Bl
in

di
ng

 o
f p

ar
tic

ip
an

ts 
an

d 
pe

rs
on

ne
l (

pe
rfo

rm
an

ce
 b

ia
s)

Bl
in

di
ng

 o
f o

ut
co

m
e a

ss
es

sm
en

t (
de

te
ct

io
n 

bi
as

)

In
co

m
pl

et
e o

ut
co

m
e d

at
a (

at
tri

tio
n 

bi
as

)

Se
lec

tiv
e r

ep
or

tin
g (

re
po

rti
ng

 b
ia

s)

O
th

er
 b

ia
se

s
+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

+

−

−

−

−

Löwe et al. 2002

Grübel et al. 2003

Figure 3: Risk of bias summary: review authors’ judgements about
each risk of bias item for each included study.

therewas a clear risk of bias (given a red status) orwhether the
authors had simply not stated the process in sufficient detail
for a judgement to be made; hence the risk of bias indicator
was left blank.

3.5. Effects of Interventions. Sufficiently homogenous data
(same population, intervention, comparator, and outcome
measure) were able to be extracted to performmeta-analyses
in the areas of balance training in ageing populations.

Four studies [21–23, 25] reported on the timed up and
go assessment for balance and mobility, just failing to find in
favour of Feldenkrais classes (Figure 4(a)); pooling postinter-
vention measures gave a mean difference of −0.78 s (95% CI−1.69, 0.13), $ = 0.09. However, heterogeneity was high ("2 =49%). Therefore, a sensitivity analysis was performed as one
study by Hillier et al. [23] compared Feldenkrais to another
balance class whereas the other three studies compared the
FM class to wait list control or no class. Removal of Hillier
et al. [23] (Figure 4(b)) revealed a larger effect size with a
mean difference of −1.13 (95% CI −1.7, −0.56), $ = 0.0001,
and heterogeneity reduced to a negligible level ("2 = 5%). It
was also noted that Nambi et al. [25] had narrow outcome
variability which led to a heavier weighting in the meta-
analysis.

Two studies [21, 22] evaluated balance confidence using
the Falls Efficacy Scale after FM classes (Figure 5). Pooled
results trended in favour of the FM, however, failed to reach
significance (MD 0.59, 95% CI −0.08, 1.26; $ = 0.08).

Two studies [23, 25] evaluated balance using the func-
tional reach test after FM classes (Figure 6)—pooled results
found in favour of the FM classes (compared to nothing
or another generic balance class) with a mean difference of
6.08 cm (95% CI 3.41,8.74), $ < 0.00001.

Meta-analysis was also able to be performed using three
studies measuring the influence of FM classes on hamstring
length in healthy populations [15, 16, 19]. The authors all
reported the measure as an active knee extension test; how-
ever, on visual inspection, the results appeared heterogeneous
in terms of magnitude and range; therefore, a standardized
mean difference (rather than MD) was calculated. No sig-
nificant effect was found after the intervention compared
to control (SMD 0.15, 95% CI −0.49, 0.79; $ = 0.65) and
statistical heterogeneity was unacceptably high ("2 = 73%)
(Figure 7).

Single randomised controlled studies reported statisti-
cally significant, positive benefits compared to control inter-
ventions and included the following:

(i) greater neck flexion and less perceived effort after
a single FM lesson for neck comfort [6]; reduced
prevalence of neck pain and disability in symptomatic
women after FM (individual and group sessions
compared to conventional care or home exercises) [8];
reduced perceived effort in FM group for people with
upper torso/limb discomfort [13];

(ii) improved balance in people with MS after eight FM
sessions [9];

(iii) improved body image parameters in people with
eating disorders after a nine-hour FM course [14];

(iv) reduction in nocturnal bruxism in young children
after 10-week course of FM lessons [20];

(v) improved dexterity in healthy young adults after a
single session of FM class [24].

Seven of the 20 studies failed to show any superior posi-
tive effects of FM compared to other comparison modalities.
See Table 3 for details. No studies reported adverse events.



Evidence-Based Complementary and Alternative Medicine 9

Study or subgroup

Total (95% CI)

Mean

7.06
15

11.53
12.15

SD

1.72
1

4.06
2.9

Total

11
20
25
26

82

Mean

6.92
16.1

11.51
14.34

SD

0.88
1

4.13
4.3

Total

11
20
22
29

82

Weight

29.2%
43.1%
11.8%
15.9%

100.0%

IV, random, 95% CI
Feldenkrais Control Mean difference Mean difference

IV, random, 95% CI

0 5 10
Favours Feldenkrais Favours control

−10 −5
Heterogeneity: "2 = 0.40; #2 = 5.90, df = 3 (P = 0.12); I2 = 49%
Test for overall effect: Z = 1.67 (P = 0.09)

0.14 [−1.00, 1.28]
−1.10 [−1.72, −0.48]
0.02 [−2.33, 2.37]

−2.19 [−4.11, −0.27]

−0.78 [−1.69, 0.13]

Hillier et al. 2010
Nambi et al. 2014
Ullman et al. 2010
Vrantsidis et al. 2009

(a)

Study or subgroup

Total (95% CI)

Mean

7.06
15

11.53
12.15

SD

1.72
1

4.06
2.9

Total

11
20
25
26

71

Mean

6.92
16.1

11.51
14.34

SD

0.88
1

4.13
4.3

Total

11
20
22
29

71

Weight

81.7%
7.4%

10.9%

100.0%

IV, random, 95% CI

Not estimable

Feldenkrais Control Mean difference Mean difference
IV, random, 95% CI

Favours Feldenkrais Favours control
0 5 10−10 −5

−1.10 [−1.72, −0.48]
0.02 [−2.33, 2.37]

−2.19 [−4.11, −0.27]

−1.14 [−1.78, −0.49]
Heterogeneity: "2 = 0.03; #2 = 2.10, df = 2 (P = 0.35); I2 = 5%
Test for overall effect: Z = 3.45 (P = 0.0006)

Hillier et al. 2010
Nambi et al. 2014
Ullman et al. 2010
Vrantsidis et al. 2009

(b)

Figure 4: (a) Effect sizes of Feldenkrais versus control for the timed up and go test (measured in seconds; balance and mobility). (b) Effect
sizes of Feldenkrais versus control for the timed up and go test (measured in seconds; balance andmobility) withHillier 2010 removed (control
group was alternate balance class).

Study or subgroup

Total (95% CI)

Mean
9.6

8.63

SD
1.7
1.6

Total
25
26

51

Mean
9.35
7.73

SD
1.7
1.9

Total
22
29

51

Weight

47.4%
52.6%

100.0%

IV, random, 95% CI
Feldenkrais Control Mean difference Mean difference

IV, random, 95% CI

Favours control Favours Feldenkrais

0.25 [−0.72, 1.22]
0.90 [−0.03, 1.83]

0.59 [−0.08, 1.26]

0 5 10−10 −5
Heterogeneity: "2 = 0.00; #2 = 0.90, df = 1 (P = 0.34); I2 = 0%
Test for overall effect: Z = 1.73 (P = 0.08)

Ullman et al. 2010
Vrantsidis et al. 2009

Figure 5: Effect sizes of Feldenkrais versus control for the Falls Efficacy Scale (balance confidence).

Study or subgroup

Total (95% CI)

Mean
31.89
36.7

SD
3.98
2.7

Total
11
20

31

Mean
27.62
29.6

SD
4.97
4.7

Total
11
20

31

Weight

36.2%
63.8%

100.0%

IV, random, 95% CI
4.27 [0.51, 8.03]
7.10 [4.72, 9.48]

6.08 [3.41, 8.74]

Feldenkrais Control Mean difference Mean difference
IV, random, 95% CI

Favours control Favours Feldenkrais
0 5 10−10 −5

Heterogeneity: "2 = 1.43; #2 = 1.55, df = 1 (P = 0.21); I2 = 36%
Test for overall effect: Z = 4.47 (P < 0.00001)

Hillier et al. 2010
Nambi et al. 2014

Figure 6: Effect sizes of Feldenkrais versus control for the functional reach test (measured in cm; balance).



10 Evidence-Based Complementary and Alternative Medicine

Study or subgroup

Total (95% CI)

Mean
20.9
33.5
149

SD
11.1
2.41
7.4

Total
75
14
18

107

Mean
21.5
34.4

141.8

SD
13.7
2.56
7.6

Total
75
17
15

107

Weight

41.6%
29.4%
29.0%

100.0%

IV, random, 95% CI
Feldenkrais Control Std. mean difference Std. mean difference

IV, random, 95% CI

0 1 2
Favours control Favours Feldenkrais

−0.05 [−0.37, 0.27]
−0.35 [−1.07, 0.36]
0.94 [0.21, 1.66]

0.15 [−0.49, 0.79]

−2 −1
Heterogeneity: "2 = 0.23; #2 = 7.31, df = 2 (P = 0.03); I2 = 73%
Test for overall effect: Z = 0.46 (P = 0.65)

James et al. 1998
Stephens et al. 2006

Hopper et al. 1999

Figure 7: Effect sizes of the Feldenkrais Method on the active knee extension test.

4. Discussion

4.1. Summary of Main Results. The majority of the 20
included studies reported significant positive effects of FM in
a variety of populations and outcomes of interest. A high risk
of bias/poor methods reporting does temper the interpreta-
tion of these findings.The low amount of confirmed/reported
adherence to best practice conduct of RCTs may be partially
attributable to the age of the studies when knowledge in the
area of trial conduct was less.

Neverthelessmeta-analyses in the area of balance training
in ageing populations were found in favour of the FM classes
for clinical measures such as the timed up and go and
functional reach tests. Both of these measures are predictive
of falls risk. Whilst the TUG effect size was probably not
clinically significant (1- to 2-second change), the functional
reach test effect size would arguably indicate a clinically
meaningful change (able to reach further 6 cm).

Given the positive effects in particular outcome domains
it is interesting to speculate on themechanism of action of the
FM; however, it is to be noted that this was not the purpose of
the review. The favourable evidence for reduced perceptions
of effort, improved dexterity, improved comfort and reduced
bruxism all support the proposed mechanism of action via
promotion of awareness, relaxation andmore efficient action.
Inconsistent results were found for improving hamstrings
length indicating that a “relaxation” effect may be variable.

The populations varied in age and diagnosis indicating
that a beneficial effect is possible across different domains;
again this is consistent with the use of the FM in diverse
populations and also consistent with the notion that it is not
a healing or disease-specific mechanism of action but rather
one based on more generic learning and self-improvement.

The findings of this updated review have strengthened
since the 2005 review by Ernst and Canter [4]. We were also
able to locate studies prior to 2005 that were not found by the
original SR authors, presumably due to improved database
access. As the previous authors reported, the studies are
still highly varied and of often questionable quality. There
is an ongoing issue of poor reporting, resulting in risks
being judged “unclear”; it is unknown whether this hides
undeclared risk or is simply an omission of reporting.

This review is not without its own limitations.This review
includes all trials aimed at improving health and/or function

so we have trials of healthy individuals as well as people
with a clinical presentation.We have not included an analysis
of publication bias, though we are confident that by using
experts in the field and checking grey literature (organi-
zational websites) we have made every effort to capture
unpublished (negative) trials. We attempted to account for
statistical heterogeneity and can conclude that the analysis for
the timed up and go ismore robust with the removal ofHillier
et al. [23] (Figure 4(b)) because the comparator group differs
from the other studies (alternate balance class versus no
intervention) and secondly this studywas pseudorandomized
(allocation based on enrolment day).The question of inactive
controls is vexed and permissible when proof of concept
or pilot/phase 1 trials are being conducted. We encourage
readers to take the stage of research and the design into
account in their interpretation.

4.2. Implications for Practice. There is promising evidence
that FM may be considered for balance classes in ageing
populations, both as a preventative approach and for people
at risk of falls.There is also some evidence for the use of FM
where reduced effort, efficiency of movement, and awareness
can play a part in reducing pain or discomfort.

4.3. Implications for Research. Further high quality research
is required comparing FM to other modalities. Investigations
should focus on the impact on self-efficacy, functional inde-
pendence, and ease and efficiency of functioning, both as
strategies for promotion of wellness and wellbeing and also
for people with impairment who wish to improve their sense
of ease. Mechanisms of effect also need to be investigated.
Particular attention needs to be paid to the reporting of best
practice trial design and to controlling for a potential placebo
effect.

5. Conclusions

There is further promising evidence that the FM may be
effective for a varied population interested in improving
functions such as balance. Careful monitoring of individual
impact is required given the varied evidence at a group level
and the relatively poor quality of studies to date.



Evidence-Based Complementary and Alternative Medicine 11

Disclosure

Funding was from professional bodies involved in promoting
FM but the bodies were not involved in the conduct of the
review other than to identify experts within their member-
ship to identify any missed/unpublished trials.

Conflict of Interests

The authors declare that there is no conflict of interests
regarding the publication of this paper.

Authors’ Contribution

Anthea Worley conducted the search and preliminary inclu-
sions. Both authors contributed to the review of all papers
and constructed the final report. One of the authors (Susan
Hillier) was also author for two included studies; these were
independently scrutinized.

Acknowledgments

The authors wish to acknowledge the financial assistance
of the Australian Feldenkrais Guild and the International
Feldenkrais Federation in supporting the costs of the search
and appraisal.

References

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[2] K. A. Connors, M. P. Galea, C. M. Said, and L. J. Remedios,
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[3] P. A. Buchanan and B. D. Ulrich, “The Feldenkrais Method:
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[4] E. Ernst and P. H. Canter, “The feldenkrais method—a system-
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[10] A. Smith, G. Kolt, and J. McConville, “The effect of the
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[13] J. Chinn, D. Trujilo, S. Kegerreis, and T. Worrel, “Effect of a
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