Clint T Miller1, Patrick J Owen2, Christian A Than3, Jake Ball4, Kate Sadler2, Alessandro Piedimonte5, Fabrizio Benedetti5,6, Daniel L Belavy2,7. 1. Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia. c.miller@deakin.edu.au. 2. Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia. 3. School of Biomedical Sciences, The University of Queensland, St. Lucia, Brisbane, Australia. 4. School of Medicine and Public Health, University of Newcastle, Callaghan, Newcastle, Australia. 5. Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy. 6. Medicine and Physiology of Hypoxia, Plateau Rosà, Zermatt, Switzerland. 7. Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany.
Abstract
BACKGROUND: Pain is the most disabling characteristic of musculoskeletal disorders, and while exercise is promoted as an important treatment modality for chronic musculoskeletal conditions, the relative contribution of the specific effects of exercise training, placebo effects and non-specific effects such as natural history are not clear. The aim of this systematic review and meta-analysis was to determine the relative contribution of these factors to better understand the true effect of exercise training for reducing pain in chronic primary musculoskeletal pain conditions. DESIGN: Systematic review with meta-analysis DATA SOURCES: MEDLINE, CINAHL, SPORTDiscus, EMBASE and CENTRAL from inception to February 2021. Reference lists of prior systematic reviews. ELIGIBILITY CRITERIA: Randomised controlled trials of interventions that used exercise training compared to placebo, true control or usual care in adults with chronic primary musculoskeletal pain. The review was registered prospectively with PROSPERO (CRD42019141096). RESULTS: We identified 79 eligible trials for quantitative analysis. Pairwise meta-analysis showed very low-quality evidence (GRADE criteria) that exercise training was not more effective than placebo (g [95% CI]: 0.94 [- 0.17, 2.06], P = 0.098, I2 = 92.46%, studies: n = 4). Exercise training was more effective than true, no intervention controls (g [95% CI]: 0.99 [0.66, 1.32], P < 0.001, I2 = 92.43%, studies: n = 42), usual care controls (g [95% CI]: 0.64 [0.44, 0.83], P < 0.001, I2 = 76.52%, studies: n = 33), and when all controls combined (g [95% CI]: 0.84 [0.64, 1.04], P < 0.001, I2 = 90.02%, studies: n = 79). CONCLUSIONS: There is very low-quality evidence that exercise training is not more effective than non-exercise placebo treatments in chronic pain. Exercise training and the associated clinical encounter are more effective than true control or standard medical care for reductions in pain for adults with chronic musculoskeletal pain, with very low quality of evidence based on GRADE criteria.
BACKGROUND: Pain is the most disabling characteristic of musculoskeletal disorders, and while exercise is promoted as an important treatment modality for chronic musculoskeletal conditions, the relative contribution of the specific effects of exercise training, placebo effects and non-specific effects such as natural history are not clear. The aim of this systematic review and meta-analysis was to determine the relative contribution of these factors to better understand the true effect of exercise training for reducing pain in chronic primary musculoskeletal pain conditions. DESIGN: Systematic review with meta-analysis DATA SOURCES: MEDLINE, CINAHL, SPORTDiscus, EMBASE and CENTRAL from inception to February 2021. Reference lists of prior systematic reviews. ELIGIBILITY CRITERIA: Randomised controlled trials of interventions that used exercise training compared to placebo, true control or usual care in adults with chronic primary musculoskeletal pain. The review was registered prospectively with PROSPERO (CRD42019141096). RESULTS: We identified 79 eligible trials for quantitative analysis. Pairwise meta-analysis showed very low-quality evidence (GRADE criteria) that exercise training was not more effective than placebo (g [95% CI]: 0.94 [- 0.17, 2.06], P = 0.098, I2 = 92.46%, studies: n = 4). Exercise training was more effective than true, no intervention controls (g [95% CI]: 0.99 [0.66, 1.32], P < 0.001, I2 = 92.43%, studies: n = 42), usual care controls (g [95% CI]: 0.64 [0.44, 0.83], P < 0.001, I2 = 76.52%, studies: n = 33), and when all controls combined (g [95% CI]: 0.84 [0.64, 1.04], P < 0.001, I2 = 90.02%, studies: n = 79). CONCLUSIONS: There is very low-quality evidence that exercise training is not more effective than non-exercise placebo treatments in chronic pain. Exercise training and the associated clinical encounter are more effective than true control or standard medical care for reductions in pain for adults with chronic musculoskeletal pain, with very low quality of evidence based on GRADE criteria.
Authors: Bruce A Arnow; Enid M Hunkeler; Christine M Blasey; Janelle Lee; Michael J Constantino; Bruce Fireman; Helena C Kraemer; Robin Dea; Rebecca Robinson; Chris Hayward Journal: Psychosom Med Date: 2006 Mar-Apr Impact factor: 4.312
Authors: Rolf-Detlef Treede; Winfried Rief; Antonia Barke; Qasim Aziz; Michael I Bennett; Rafael Benoliel; Milton Cohen; Stefan Evers; Nanna B Finnerup; Michael B First; Maria Adele Giamberardino; Stein Kaasa; Beatrice Korwisi; Eva Kosek; Patricia Lavand'homme; Michael Nicholas; Serge Perrot; Joachim Scholz; Stephan Schug; Blair H Smith; Peter Svensson; Johan W S Vlaeyen; Shuu-Jiun Wang Journal: Pain Date: 2019-01 Impact factor: 6.961
Authors: Patrick J Owen; Tobias Saueressig; Daniel L Belavy; Christian A Than; Jake Ball; Kate Sadler; Alessandro Piedimonte; Fabrizio Benedetti; Clint T Miller Journal: Sports Med Date: 2022-04 Impact factor: 11.928
Authors: Casper G Nim; Aron Downie; Søren O'Neill; Gregory N Kawchuk; Stephen M Perle; Charlotte Leboeuf-Yde Journal: Sci Rep Date: 2021-12-03 Impact factor: 4.379
Authors: Patrick J Owen; Luana C Main; Clint T Miller; Jon J Ford; Andrew J Hahne; Daniel L Belavy Journal: BMJ Open Date: 2022-02-03 Impact factor: 2.692