Effects of progressive muscle relaxation training on symptom burden and quality of life in clinical populations: a systematic review and meta-analysis

This systematic review and meta-analysis evaluated the effects of progressive muscle relaxation training (PMRT) on symptom burden and quality of life (QoL) across diverse clinical populations. We searched seven electronic databases for randomized controlled trials (RCTs) investigating PMRT from inception to May 4, 2026. Risk of bias was assessed with the Cochrane RoB 1.0 tool. Random-effects models were used for synthesis, with non-prespecified exploratory subgroup analyses by patient population, intervention composition, and comparator type. Twenty RCTs involving 1,354 participants were included. PMRT significantly improved QoL (standardized mean difference [SMD] = 0.79, P = 0.01), sleep quality (SMD = − 1.03, P = 0.03), depression (SMD = − 0.57, P < 0.01), anxiety (SMD = − 0.73, P = 0.04), and pain (SMD = − 0.42, P < 0.01). The pooled estimate for fatigue was not statistically significant and imprecise (SMD = 0.11, 95% CI: −0.62 to 0.84; P = 0.77); because all contributing studies involved non-cancer populations, this finding should be interpreted cautiously as hypothesis-generating rather than evidence of no effect. Non-prespecified subgroup analyses suggested effect estimates varied by intervention composition and comparator type for some outcomes, but these exploratory findings do not establish causal effect modification or the superiority of one format or comparator. PMRT may improve sleep quality, pain, anxiety, depression, and QoL, whereas the pooled estimate for fatigue was not significant and was limited to non-cancer populations. GRADE certainty was very low for five outcomes and low for pain, so the observed benefits should be interpreted as potentially beneficial but not definitive. Whether PMRT’s effects differ when delivered alone versus combined with other active components requires confirmation in adequately powered, head-to-head trials. Further high-quality RCTs are needed to confirm the magnitude, durability, and clinical importance of these effects. PROSPERO: CRD420261400445.