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Cited by 1,222Musculoskeletal pain and rehabilitationPhysical Activity and HealthPain Mechanisms and Treatments

Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews

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Geneen, Louise J, Moore, R Andrew, Clarke, Clare, Martin, Denis, Colvin, Lesley A, Smith, Blair H·2017·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd011279.pub3PMC PMC5461882
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Abstract

BACKGROUND: Chronic pain is defined as pain lasting beyond normal tissue healing time, generally taken to be 12 weeks. It contributes to disability, anxiety, depression, sleep disturbances, poor quality of life, and healthcare costs. Chronic pain has a weighted mean prevalence in adults of 20%.For many years, the treatment choice for chronic pain included recommendations for rest and inactivity. However, exercise may have specific benefits in reducing the severity of chronic pain, as well as more general benefits associated with improved overall physical and mental health, and physical functioning.Physical activity and exercise programmes are increasingly being promoted and offered in various healthcare systems, and for a variety of chronic pain conditions. It is therefore important at this stage to establish the efficacy and safety of these programmes, and furthermore to address the critical factors that determine their success or failure. OBJECTIVES: To provide an overview of Cochrane Reviews of adults with chronic pain to determine (1) the effectiveness of different physical activity and exercise interventions in reducing pain severity and its impact on function, quality of life, and healthcare use; and (2) the evidence for any adverse effects or harm associated with physical activity and exercise interventions. METHODS: We searched theCochrane Database of Systematic Reviews (CDSR) on the Cochrane Library (CDSR 2016, Issue 1) for systematic reviews of randomised controlled trials (RCTs), after which we tracked any included reviews for updates, and tracked protocols in case of full review publication until an arbitrary cut-off date of 21 March 2016 (CDSR 2016, Issue 3). We assessed the methodological quality of the reviews using the AMSTAR tool, and also planned to analyse data for each painful condition based on quality of the evidence.We extracted data for (1) self-reported pain severity, (2) physical function (objectively or subjectively measured), (3) psychological function, (4) quality of life, (5) adherence to the prescribed intervention, (6) healthcare use/attendance, (7) adverse events, and (8) death.Due to the limited data available, we were unable to directly compare and analyse interventions, and have instead reported the evidence qualitatively. MAIN RESULTS: We included 21 reviews with 381 included studies and 37,143 participants. Of these, 264 studies (19,642 participants) examined exercise versus no exercise/minimal intervention in adults with chronic pain and were used in the qualitative analysis.Pain conditions included rheumatoid arthritis, osteoarthritis, fibromyalgia, low back pain, intermittent claudication, dysmenorrhoea, mechanical neck disorder, spinal cord injury, postpolio syndrome, and patellofemoral pain. None of the reviews assessed 'chronic pain' or 'chronic widespread pain' as a general term or specific condition. Interventions included aerobic, strength, flexibility, range of motion, and core or balance training programmes, as well as yoga, Pilates, and tai chi.Reviews were well performed and reported (based on AMSTAR), and included studies had acceptable risk of bias (with inadequate reporting of attrition and reporting biases). However the quality of evidence was low due to participant numbers (most included studies had fewer than 50 participants in total), length of intervention and follow-up (rarely assessed beyond three to six months). We pooled the results from relevant reviews where appropriate, though results should be interpreted with caution due to the low quality evidence. Pain severity: several reviews noted favourable results from exercise: only three reviews that reported pain severity found no statistically significant changes in usual or mean pain from any intervention. However, results were inconsistent across interventions and follow-up, as exercise did not consistently bring about a change (positive or negative) in self-reported pain scores at any single point. Physical function: was the most commonly reported outcome measure. Physical function was significantly improved as a result of the intervention in 14 reviews, though even these statistically significant results had only small-to-moderate effect sizes (only one review reported large effect sizes). Psychological function and quality of life: had variable results: results were either favourable to exercise (generally small and moderate effect size, with two reviews reporting significant, large effect sizes for quality of life), or showed no difference between groups. There were no negative effects. Adherence to the prescribed intervention: could not be assessed in any review. However, risk of withdrawal/dropout was slightly higher in the exercising group (82.8/1000 participants versus 81/1000 participants), though the group difference was non-significant. Healthcare use/attendance: was not reported in any review. Adverse events, potential harm, and death: only 25% of included studies (across 18 reviews

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Cited by

Sorted by citations

Authors
Geneen, L. J., Moore, R. A., Clarke, C., Martin, D., Colvin, L. A., & Smith, B. H.
Affiliations
  • University of Dundee (GB)
  • Plymouth UK
  • Teesside University (GB)
  • Western General Hospital (GB)
Corresponding author
Geneen, Louise J
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2017-04-24
Volume
2020
Issue
2
Pages
CD011279-CD011279
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd011279.pub3
PMC
PMC5461882
OpenAlex
W1581470304
Cited by
1,222
References
39
Citations by year
2026: 46 · 2025: 108 · 2024: 146 · 2023: 171 · 2022: 151 · 2021: 179 · 2020: 171 · 2019: 122 · 2018: 85 · 2017: 28 · 2016: 3 · 2015: 5 · 2014: 2 · 2013: 1 · 2012: 1
FWCI
14.10
Type
journal article
Language
en
Open access
Licence
other-oa
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion, other-oa)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • TeesRep (Teesside University) (publishedVersion, other-oa)
  • Discovery Research Portal (University of Dundee) (submittedVersion, cc-by)
Funders
Ministry of Education, India
Topics
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
Keywords
physical activity, exercise intervention, pain intensity, physical function, quality of life, health care utilization, adverse effects, rheumatoid arthritis, osteoarthritis, fibromyalgia, low back pain, neck pain, whiplash injury, sciatica, post-stroke pain, cancer pain, spinal cord injury, stroke rehabilitation, exercise adherence, exercise safety
MeSH terms
Adult, Exercise Therapy, Health Services Needs and Demand, Humans, Pain Measurement, Patient Compliance, Quality of Life, Review Literature as Topic, Randomized Controlled Trials as Topic, Chronic Pain, Myalgia

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