Table 1.
Study | Study Design | Participants that completed the study (n, male/female) |
Age (years, mean ± SD) |
Details of Exercise | Type of exercise | Intensity of exercise | Outcomes for pain | Assessment timing | Conclusion | MINORS Score |
---|---|---|---|---|---|---|---|---|---|---|
Ohlman et al. 2018 | Quasi-experiment | 20/32 | Male=67.6±5.3 Female=67.2±4.9 |
A submaximal isometric handgrip exercise at 25% of MVC by the left arm | Strength | Light | PPT 30-seconds of continuous heat pain test |
Before and immediately after exercise | Older adults did not exhibit EIH after submaximal isometric exercise. However, those who did more MVPA per week experienced a greater magnitude of pain inhibition after acute exercise. | 22 |
Persson et al. 2000 | Quasi-experiment | 0/25 | Younger: 44±10.18 | A weight belt of 1 kg was wrapped around the wrist of the subject’s hand. In the resting position, the subject held her forearms and hands on a pillow in her lap. During test contractions for EMG recording (each lasting 15 seconds) and during the endurance test, the subject’s right arm was abducted 90[degrees] in the scapular plane, with a slightly flexed (20[degrees]) elbow, pronated with the thumb pointing downward | Strength | Intense | PPT | Before and after the endurance test | The mechanisms of recovery from fatigue and nociception are independent of each other. The bilateral PPT increases might be explained by central antinociceptive mechanisms activated by static muscle work. | 16 |
Koltyn K. F. et al. 1998 | RCT | 7/6 | 23±5 | Exercise group:45 minutes of lifting three sets of 10 repetitions at 75% of the individual’s one repetition maximum. Control group: Quiet rest consisted of 45 minutes of sitting quietly in a room free from distractions. |
Strength | Moderate | PPT Pain ratings |
Before and after (5 and 15 mins) exercise and quiet rest | A single bout of resistance exercise is capable of modifying the sensation of experimentally induced pain. | 20 |
Koltyn K. F. et al. 2001 | Quasi-experiment | 15/16 | Male=22±5 Female=21.5±2 |
2 sessions: 1)Squeezed a hand dynamometer with their right hand (dominant hand) as hard as they could for 5 s, rested for 2 min, and then squeezed the hand dynamometer again for 5 s; 2) Submaximal isometric exercise consisted of squeezing the hand dynamometer with the right hand between 40% and 50% of maximum for 2 min. | Strength | Moderate and intense | PPT Pain ratings |
Before and immediately after exercise | It is concluded that: 1) men and women differed in PT, SBP, and DBP before ISO EX; and 2) analgesia after ISO EX is observed more consistently in women. | 17 |
Koltyn K. F. et al. 2007 | Quasi-experiment | 0/14 | 19.5±1 | 2 sets of submaximal (40% to 50% of max) isometric exercise consisting of squeezing a dynamometer for 2 minutes with the dominant hand. | Strength | Moderate | PPT Pain ratings |
Before and immediately after exercise | Submaximal isometric exercise performed for 2 minutes resulted in ipsilateral and contralateral hypoalgesia responses. | 17 |
Kruger S. 2016 | RCT | Healthy control group=29 No other demographic characteristics data provided |
Control group=48±13 | Walk for a maximum of 30 min with a self-chosen velocity. | Aerobic | Moderate | PPT | Before and immediately after exercise | Subjects were able to perform an endurance exercise with self-chosen velocity for 30 min as recommended, without increasing the acute pain condition. | 18 |
Focht B.C. et al. 2009 | Quasi-experiment | 21/0 | 21.4±2.5 | 2 RE sessions, each session consists of leg extension, torso-arm pull-down, chest press, and overhead press, 3 sets of 10 repetitions 75% of each individual’s 1-repetition maximum.1st session at 6:00–8:00am and repeat at 6:00–8:00 pm. | Strength | Moderate | PPT Pain ratings |
Before and after (1 and 15 mins) each bout of RE. | Acute RE results in alterations in the perception of experimentally induced pressure pain and that this hypoalgesic response is not influenced by the time of day that RE is performed. | 17 |
Bartholomew et al. 1996 | Quasi-experiment | 17/0 | Younger (no more details) | 20 min of self-selected exercise | Strength | Moderate | PPT Pain tolerance |
Before and immediately after exercise | The analgesic effect of exercise is not limited to controlled experimental conditions but generalizes to naturally occurring stimulations. | 11 |
Falla D. et al. 2014 | RCT | Control group:9/8 | Control group:29.4±7.4 | Subjects were asked to repetitively move a box with hole-shaped handles, loaded with a weight of 5 kg. | Strength | Light | PPT | Before and immediately after exercise | LBP alters the normal adaptation of lumbar erector spinae muscle activity to exercise, which occurs in the presence of exercise-induced hyperalgesia. Reduced variability of muscle activity may have important implications for the provocation and recurrence of LBP due to repetitive tasks. | 15 |
Kosek E. et al. 1995 | Quasi-experiment | 0/14 | 36.8±9.96 | The maximum isometric knee extensor strength at a 90° of knee flexion was determined 3 times with I min of rest between trials. The best value was used for calculating 25% of MVC. | Strength | Moderate | PPT | Before, during rest, during contraction and following contraction. | The results suggest that input from cutaneous and deeper tissues interacts with nociceptive activity set up by the pressure stimulus. Determining the degree of sensory modulation in muscle and skin in different chronic pain syndromes could become a functional method of patient assessment important for differential diagnosis, treatment evaluation, and follow-up. | 18 |
Arroyo-Morales M. et al. 2012 | Quasi-experiment | 25/25 | 22.4±3.42 | A standardized light warm-up protocol, followed by three 30-s Wingate tests on an ergometer cycle separated by 3-min recovery periods. | Aerobic | Intense | PPT | Before and immediately after exercise | High-intensity interval exercise induces a worse psychoneuroimmunological state in males than in females. | 13 |
Agnew J. W. et al. 2018 | Quasi-experiment | 25 miles group=5/1 50 miles group =9/13 100 miles group =9/8 |
25 miles group =37.2±12.9 50 miles group =42.1±6.9 100 miles group =41.8±7.8 |
Complete 25 miles, 50 miles or 100 miles marathon | Aerobic | Intense | PPT CPM |
Before and immediately after completion of 25°miles, 50°miles and 100°miles. | An increased peripheral and/or central pain sensitization starting at 25° miles and continuing throughout an ultra-marathon competition run in these conditions. | 21 |
Burrows N. J. et al. 2018 | RCT | Old group=5/6 Young group=4/7 |
Old group=61.3±8.2 Young group=25±4.9 |
Three sets of 10 repetitions were performed at 60% of the individuals’ 1RM. One-minute rest was given between sets. | Strength | Intense | PPT Pressure pain tolerance |
Before and immediately after exercise | An acute bout of upper or lower body exercise evoked a systemic decrease in pain sensitivity in healthy individuals irrespective of age. The decreased pain sensitivity following resistance exercise can be attributed to changes in pain thresholds, not pain tolerance. | 22 |
Lee H. S. et al. 2014 | RCT | Aerobic exercise group(AG)=5 Strengthening exercise group(SG)=5 Control group(CG)=5 No other demographic characteristics data provided |
AG=25.2±0.8 SG=71.2±5.3 CG=24.3±0.5 |
AG=walked on a treadmill for 10 and 40 min at 6.5 km/h; SG= performed 10 and 40 min of circulate training exercises that included a bench press, lateral pulldown, biceps curl, triceps extension, and shoulder press based on the perceived exertion. CG= rested in a quiet room without exercising for 10 and 40 min. |
Aerobic Strength |
Light Light |
PPT | Before and immediately after 10 and 40 min of exercise | 40 min is a more appropriate exercise time, although the efficacy of controlling pain did not differ be-tween strengthening exercise and aerobic exercise. | 20 |
Lemley K. J.et al. 2016 | Quasi-experiment | 33/31 | Young women=20.6 ±1.5 Young men=21.7 ±3.7 Old women=71.3±7.6 Old men=71.3 ±5.1 |
Before and after maximal velocity concentric contractions of knee extensors or elbow flexors (separate days). | Strength | Intense | PPT | Before and immediately after exercise | Under controlled conditions where muscle fatigue is similar, sex differences in EIH occur in young and older adults that is site specific (upper extremity). Only women experience EIH following acute single limb high-velocity contractions. | 11 |
Lofgren M. et al. 2018 | RCT | Control group=4/16 | Control group=60±6 | A right-leg isometric knee extension contraction and to maintain it until they were unable to sustain 30% of their MVC. | Strength | Moderate | PPT EIH |
Before and immediately after exercise | A generally increased pain sensitivity but normal function of EIH among persons with RA and offer one possible explanation for pain reduction observed in this group of patients following clinical exercise programs. | 19 |
Micalos P. S. et al. 2016 | Quasi-experiment | 10/0 | 21.2±3.4 | Aerobic cycling exercise performed at 70 and 30°% of VO2peak on two separate visitations in a counterbalanced order. | Aerobic | Light/Moderate | PPT | Before and 5 min after exercise | Aerobic activity attenuates pressure pain sensitivity locally at the exercise muscle site following cycling exercise at 70% of peak oxygen uptake, however, may facilitate pain sensitivity following exercise at 30% of VO2peak. | 14 |
Meeus M. et al. 2010 | RCT | Control group=10/21 | Control group=39.88±12.63 | A submaximal aerobic exercise protocol on a bicycle ergometer: each plateau phase at a certain workload lasted for 60 s. Each exercise bout consisted of 2 plateau phases at incremental workloads. | Aerobic | Moderate | PPT VAS |
Before and immediately after exercise | Hyperalgesia and abnormal central pain processing during submaximal aerobic exercise in chronic fatigue syndrome, but not in chronic low back pain. Nitric oxide appeared to be unrelated to pain processing. | 20 |
Lewis Z. et al. 2018 | Quasi-experiment | 24/9 | 22.75±3.98 | Rowed two 20-min time trials under two counterbalanced conditions-paired and large group | Aerobic | Moderate | PPT | Before, immediately post, 5-min post, and 10-min post each session. | Pain threshold were affected by a wide variety of synchronous activities. There was a significantly higher pain threshold in the large group than in the paired condition after 10 min of exercise. | 13 |
Lemley K. J. et al. 2014 | Quasi-experiment | 24 No other demographic characteristics data provided |
72.2±6.2 | Isometric contractions of the left elbow flexor muscles of the following doses: 1) three brief MVC; 2) 25% MVC held for 2 min; 3) 25% MVC held to task failure. | Strength | Moderate and intense | PPT | Before and immediately after exercise | Older adults experienced similar reductions in pain after several different intensities and durations of isometric contractions. Both older men and women experienced increases in pain threshold, but only older women experienced reductions in pain ratings. | 16 |
Fingleton C. et al. 2017 | RCT | Control group=11/9 | Control group=62±7.9 | Aerobic exercise in a sitting position on a cycle ergometer and doing the Aerobic Power Index test. Isometric exercise: extend knee as far as could be achieved without pain >3/10. And then hold an isometric knee extension contraction until exhaustion. |
Aerobic and strength | Intense | PPT CPM EIH |
Before and immediately after exercise | Dysfunctional EIH in response to aerobic and isometric exercise in knee OA patients with abnormal CPM, and normal function of EIH in knee OA patients with an efficient CPM response. | 18 |
Alsouhibani et al. 2018 | RCT | 15/15 | 19.3±1.5 | Isometric exercise group: a submaximal (30% MVIC) iso-metric contraction of the right knee extensor muscles that was held for three minutes while seated upright on the edge of a plinth table. Control group: quiet rest |
Strength | Moderate | CPM PPT |
Before, during, and after ice water immersions. | Isometric exercise decreased CPM in individuals who reported systemic EIH, suggesting activation of shared mechanisms between CPM and systemic EIH responses. | 21 |
Harris S. et al. 2018 | Quasi-experiment | 19/16 | 23.6±6.6 | 5 min knee extension isometric contraction at 20–25% MVC | Strength | Moderate | PPT OffA |
Before and immediately after exercise | Five minutes of 20–25% MVC lower limb isometric exercise provided non-pharmacological pain modulation in young, active adults. | 16 |
Gajsar H. et al. 2016 | Quasi-experiment | 12/17 | 29.97±6.06 | 120 seconds of the isometric Biering-Soerensen back extension test | Strength | Moderate | PPT | Before and immediately after exercise | Isometric back exercise produces local and remote hypoalgesia. | 15 |
Naugle K. M. et al. 2014 | Quasi-experiment | 12/15 | 21.78±4.14 | Vigorous aerobic exercise: 5-minute warm-up period and then cycled for 20 minutes at an intensity of 70% HRR. Moderate intensity aerobic exercise: 5-minute warm-up period and then cycled for 20 minutes at an intensity of 50–55% HRR. |
Aerobic | Moderate and intense | PPT Suprathreshold pressure pain test. Static continuous heat test. Repetitive pulse heat pain test |
Before and immediately after exercise | MAE is capable of producing a hypoalgesic effect using continuous and repetitive pulse heat stimuli. However, a dose-response effect was evident as VAE produced larger effects than MAE. | 23 |
Naugle K. M. et al. 2014 | Quasi-experiment | 12/15 | Younger (no more details) | A 3-minute trial of submaximal isometric handgrip exercise at 25% of MVC. | Strength | Moderate | PPT Suprathreshold pressure pain test. Static prolonged heat test. Temporal summation of heat pain |
Before and immediately after exercise | The hypoalgesic response to submaximal isometric exercise is partially a function of sex and experimental pain test. | 23 |
Naugle. K. M. et al. 2016 | Quasi-experiment | Young adults=11/14 Old adults=9/9 |
Young adults: 21.7±4.1 Old adults: 63.7±6.6 |
Vigorous aerobic exercise: 5-minute warm-up period and then cycled for 20 minutes at an intensity of 70% HRR. Moderate intensity aerobic exercise: 5-minute warm-up period and then cycled for 20 minutes at an intensity of 50–55% HRR. Submaximal isometric exercise: the dominant arm contract at 25% of their MVC. |
Strength Strength Aerobic Aerobic |
Light Moderate Moderate Moderate |
PPT Pain rating Temporal summation of heat pain |
Before and immediately after exercise | Age differences in EIH following isometric and aerobic exercise, with younger adults experiencing greater EIH compared to older adults. | 23 |
Gomolka S. et al. 2019 | Quasi-experiment | 15/15 | 24.4±1.8 | 15 minutes of heart rate–controlled aerobic cycling in two sessions. | Aerobic | Moderate | PPT | Before, immediately after, and 15 min after exercise. | Fair test–retest reliability of EIH after aerobic cycling for local and semi local body parts, but only in men. | 16 |
Slater et al. 2009 | RCT | 6/7 | 27.1±1.4 | Eccentric-only exercise: 5 sets of 20 arm contractions at 30% maximal wrist extension force for 4 weeks. Concentric–eccentric exercise: 5 sets of 10 eccentric/10 concentric contractions at 30% maximal wrist extension force for 4 weeks. |
Strength | Intense | PPT | Before and immediately after exercise at each session | Mechanical hypoalgesia is induced by repeated low load exercises regardless of exercise mode, and this may prove beneficial if replicated clinically. | 21 |
Vaegter et al. 2015 | Quasi-experiment | 28/28 | 23.5±2.19 | 2 min warm-up and then 3 min to achieve the ATHR and then continued bicycling for additional 10 minutes. | Aerobic | Moderate | PPT | Before, immediately after, and 15 min after conditioning and exercise | Cold pressor stimulation and aerobic exercise caused comparable multisegmental increases in PPT in active and inactive men and women. | 20 |
Vaegter et al. 2016 | Quasi-experiment | 20/0 | 24.4±2.0 | Session 1: 15 min quiet rest Session 2 and 3: 12 min rest and then 3 min submaximal isometric knee extension at 30% of MVC with the dominant leg. |
Strength | Moderate | PPT PTT HPT |
Before and immediately after exercise and rest | Hypoalgesia after submaximal isometric exercise is primarily affecting tolerance of pressure pain compared with the pain threshold. | 21 |
Treseler et al. 2016 | Quasi-experiment | 0/19 | 20±1 | Two 5-km performance time trials with CS or regular socks in a counterbalanced order separated by 1 week. | Aerobic | Moderate | PPT Muscle soreness |
Before and immediately after exercise at each session | There were no significant improvements in average 5-km running time, heart rate, or perceived calf MS. | 20 |
Staud et al. 2010 | RCT | Control group=0/36 | Control group: 44.7±11.0 | Rotate the 1 kp flywheel consistently at 60 rpm until exhaustion, repeat twice alternating with 15-minute rest periods. | Aerobic | Moderate | VAS PPT |
Before and after each rest-and-exercise period | Alternating strenuous exercise with brief rest periods not only decreased overall clinical pain of FM subjects but also their mechanical hyperalgesia. | 20 |
Vaegter et al. 2018 | RCT | 21/13 | 25.8±3.4 | 2 sessions, each session consist of 15 min rest and 15 min bicycling | Strength | Moderate | PPT | Before and immediately after exercise and rest | Incremental bicycling exercise in-creased PPTs with fair relative and absolute reliability of the EIH response. | 19 |
Van Weerdenburg et al. 2017 | RCT | 9/6 | 25±6.5 | 3 interventions consisting of 20 min of aerobic cycling, 12 minutes of isometric knee extension and a deep breathing procedure | Aerobic and strength | Moderate | PPT. Cold pressor test |
Before and after each intervention | No hypoalgesic effect of aerobic and isometric exercise was found. | 20 |
PPT: pressure pain threshold; CPM: Conditioned Pain Modulation; EIH: Exercise-induced analgesia; CPP: cold pressor pain; VAS: Visual Analogue Scale; MVC: maximum voluntary contraction; PTT: pain tolerance; HPT: Heat pain threshold; HRR: heart rate reserve; RM: repetition maximum; CS: compression stockings; OffA: offset analgesia; MVIC: maximal voluntary isometric contractions; ATHR: age-related target heart rate; PwH: patients with hemophilia; LBP: low back pain; SBP: Systolic blood pressure ; DBP: diastolic blood pressure; ISO EX: isometric handgrip exercise; RA: Rheumatoid arthritis.