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Doctor, I have musculoskeletal pain. Is doing aerobic exercise helpful or harmful?

For many people with musculoskeletal pain, aerobic exercise reduces sensitivity to pain.

What is the evidence?


Sensitivity to pain after aerobic exercise in people with musculoskeletal pain

OutcomeEffectQuality of Evidence
Sensivity to painReduced by an average of 11% (ranging from as little as 2% reduction to as high as 24% reduction)

8 out of 11 studies

low risk of bias

*low risk of bias = low risk the study has method or design errors that would affect the accuracy of the results

What kind of study was this?

This was a systematic review of 11 studies published up to March 26, 2021.

Who? This review included 590 people (average age 34 to 56 years) who had low back, neck, shoulder, elbow or knee pain lasting for 30 days to years. People with complex regional pain syndrome, fibromyalgia, rheumatoid arthritis, chronic fatigue syndrome, headache, migraine, temporomandibular joint disorders, myofascial pain, whiplash and inflammatory arthritis were excluded.

What? The reviewers included studies that compared sensitivity to pain after aerobic exercise in people with MSK pain with healthy people.

Aerobic exercise

Aerobic exercise: cycling, walking, stepping

Intensity: aiming for 66 to 85% of maximal heart rate response

Duration: 4 to 60 minutes

Frequency: single session to 3 to 5 times per week for 2 to 12 weeks.

Why was this research done?

Musculoskeletal (MSK) pain is pain that comes from muscles, bones, joints, tendons or ligaments. Sometimes people with MSK pain are afraid to exercise. Research has shown that some types of exercise interfere with the signals that increase sensitivity to pain. The reviewers wanted to know if aerobic exercise (cycling, walking, stepping) in people with MSK pain decreases sensitivity to pain. They found that for most people, sensitivity to pain is reduced by about 11%. The people who did not benefit were ones who typically experience increasing back or leg pain with walking. This review shows that for many people with MSK pain, controlled aerobic exercise is not harmful and may reduce sensitivity to pain, in general. It is important to note that the exercise did not specifically target the painful joint. The main concern about this study is that it included some studies that were of low quality.

This Evidence Summary is based on the following article:

Tan L, Cicuttini FM, Fairley J, et al. Does aerobic exercise effect pain sensitisation in individuals with musculoskeletal pain? A systematic review. BMC Musculoskelet Disord. 2022 Feb 3;23(1):113. doi: 10.1186/s12891-022-05047-9. PubMed

Published: Friday, March 25, 2022
Last Updated: Wednesday, October 19, 2022

Please note that the information contained herein is not to be interpreted as an alternative to medical advice from a professional healthcare provider. If you have any questions about any medical matter, you should consult your professional healthcare providers, and should never delay seeking medical advice, disregard medical advice or discontinue medication based on information provided here.