Hypoalgesia after aerobic exercise in healthy subjects: A systematic review and meta-analysis

Figures & data

Figure 1. Preferred reporting items for systematic reviews and meta-analysis (PRISMA) diagram of the study screening process for examining the effect of acute aerobic exercise on exercise-induced hypoalgesia in healthy participants.

Table 1. Overview included studies including characteristics of participants, exercise and control interventions, and experimental pain measurements. HFmax = maximal heart frequency, HRR = heart rate reserve, MAP = maximum aerobic power, min = minutes, n.A. = not applicable, PPT = pressure pain threshold, RPE = rate of perceived exertion, SD = standard deviation, VO2max = maximum rate of oxygen consumption, W = Watt.

First author (year)	Participants (males) age [years] mean ± SD	Study design	Exercise modality	Exercise intensity/duration #1 [n]	Exercise intensity/duration #2 [n]	Exercise intensity/duration #3 [n]	Control intervention [n]	Measurement instrument for PPT	Measurement sites
Hviid et al. (2019)	35 (17)	Cross-over	Walking	6 Min at mean RPE of 11 (6–20) [n = 35]	same as #1 [n = 35]	n.a.	6 Min quiet rest [n = 35]	Handheld algometer (Somedic)	local: Quadriceps femoris; remote: Trapezius
	26.0 ± 2.9
Jones et al. (2019)	16 (14)	Cross-over	Cycling	5 Min warm-up +15 Min at 60–70% HRR [n = 16]	n.a.	n.a.	20 Min light activity (RPE not above resting) [n = 16]	Handheld algometer (Wagner)	local: Rectus femoris; Remote: n.a.
	23.6 ± 3.9
Naugle et al. (2014)	27 (12)	Cross-over	Cycling	5 Min warm-up +20 Min at 70% HRR [n = 27]	5 Min warm-up +20 Min at 50% HRR [n = 27]	n.a.	25 Min quiet rest [n = 27]	Handheld algometer (Jtech)	local: n.a.; remote: Ventral forearm
	21.8 ± 4.1
Naugle et al. (2016)	^143 (20)	Cross-over	Cycling	5 Min warm-up +20 Min at 70% HRR [n = 43]	5 Min warm-up +20 Min at 50–55% HRR [n = 43]	n.a.	25 Min quiet rest [n = 43]	Handheld algometer (Jtech)	local: n.a.; remote: Ventral forearm
Niwa et al. (2022)	73 (38)	Cross-over	Cycling	30 Min at 70% HRR [n = 73]	30 Min at 50% HRR [n = 73]	30 Min at 30% HRR [n = 73]	30 Min quiet rest [n = 73]	Handheld algometer (Somedic)	local: Quadriceps femoris; remote: Biceps brachii
	20.6 ± 1.1
Pessoa et al. (2021)	^2Group #1 [n = 16 (5)]:	Parallel	Treadmill	2 Min warm-up +5 Min at 75–85% HRmax (220-age)+3 Min cool-down [n = 16]	n.a.	n.a.	Placebo mobilization [n = 16]	Handheld algometer (Wagner)	local: Tibialis anterior; remote: Interosseous dorsal
	24.7 ± 4.8
	Control group [n = 16 (4)]: 21.9 ± 2.9
Tomschi et al. (2023)	36 (18)	Cross-over	Cycling	30 Min at 75% VO2max [n = 36]	45 Min at 75% VO2max [n = 36]	60 Min at 75% VO2max [n = 36]	30 Min quiet rest [n = 36]	Handheld algometer (Wagner)	Local: Knee; remote: Elbow
	26.6 ± 3.2
Tomschi et al. (2024)	50 (50)	Cross-over	Rowing	30 Min at 70% (±5%) HRmax [n = 50]	n.a.	n.a.	30 Min quiet rest [n = 50]	Handheld algometer (Wagner)	Local: Knee; remote: Forehead
Tronarp et al. (2018)	36 (15)	Cross-over	Cycling	30 Min at 50% MAP (maximum aerobic power) [n = 36]	75 Min at 20% MAP [n = 36]	n.a.	30 Min standing [n = 36]	Handheld algometer (Somedic)	local: Quadriceps femoris; remote: Ventral forearm
	26.8 ± 7.6
Vaegter et al. (2014)	56 (28)	Cross-over	Cycling	2 Min warm-up +13 Min at 75% VO2max [n = 56]	n.a.	n.a.	15 Min quiet rest [n = 56]	Handheld algometer (Somedic)	local: Quadriceps femoris; remote: Biceps brachii
	^3median: 22
	range: 20–30
Vaegter et al. (2018)	34 (21)	Cross-over	Cycling	15 Min incremental cycling (start: 20 W, increment 20 W/Min) until RPE of 16 achieved. Thereafter intensity was maintained [n = 34]	same as #1 [n = 34]	n.a.	15 Min quiet rest [n = 34] before #1 and #2	Handheld algometer (Somedic)	local: Quadriceps femoris; remote: Trapezius
	25.8 ± 3.4
Van Weerdenburg (2016)	15 (9)	Cross-over	Cycling	10 Min warm-up +20 Min at 75–88% HRmax (Karvonen formula) [n = 15]	n.a.	n.a.	30 Min deep breathing [n = 15]	Handheld algometer (SBMEDIC)	local: Rectus femoris; Remote: Thenar muscle
	25.0 ± 6.5
Zheng et al. (2021)	Group #1 [n = 15 (8)]	Parallel	Cycling	5 Min warm-up +23 Min at 70% HRR [n = 15]	5 Min warm-up +25 Min at 50% HRR [n = 15]	n.a.	2 Min warm-up +23 Min quiet rest [n = 15]	Handheld algometer (Wagner)	local: Rectus femoris; remote: Thenar muscle
	24.7 ± 3.2
	Group #2 [n = 15 (7)]
	24.4 ± 2.2
	Group #3 [n = 15 (8)]
	24.3 ± 3.0

¹Of these: n = 25 (11) 21.7 ± 4.1 younger and n = 18 (9) 63.7 ± 6.6 older participants. ²Only the aerobic training group and the control group are presented. ³Indication of age provided only as median and range.

Figure 2. Forest plot of exercise-induced hypoalgesia for local and remote effects, respectively, and the risk of bias evaluation. HFmax = maximal heart frequency, HRR = heart rate reserve, MAP = maximum aerobic power, RPE = rate of perceived exertion, VO2max = maximum rate of oxygen consumption.

Figure 3. Forest plot of exercise-induced hypoalgesia of different exercise intensities for local effects. HFmax = maximal heart frequency, HRR = heart rate reserve, MAP = maximum aerobic power, RPE = rate of perceived exertion, VO2max = maximum rate of oxygen consumption.

Figure 4. Forest plot of exercise-induced hypoalgesia of different exercise intensities for remote effects. HFmax = maximal heart frequency, HRR = heart rate reserve, MAP = maximum aerobic power, RPE = rate of perceived exertion, VO2max = maximum rate of oxygen consumption.

Figure 5. Forest plot of exercise-induced hypoalgesia of different exercise durations for local effects. HFmax = maximal heart frequency, HRR = heart rate reserve, MAP = maximum aerobic power, RPE = rate of perceived exertion, VO2max = maximum rate of oxygen consumption.

Figure 6. Forest plot of exercise-induced hypoalgesia of different exercise durations for remote effects. HFmax = maximal heart frequency, HRR = heart rate reserve, MAP = maximum aerobic power, RPE = rate of perceived exertion, VO2max = maximum rate of oxygen consumption..

Figure 7. Forest plot of exercise-induced hypoalgesia of different exercise modalities for local effects. HFmax = maximal heart frequency, HRR = heart rate reserve, MAP = maximum aerobic power, RPE = rate of perceived exertion, VO2max = maximum rate of oxygen consumption.

Figure 8. Forest plot of exercise-induced hypoalgesia of different exercise modalities for remote effects. HFmax = maximal heart frequency, HRR = heart rate reserve, MAP = maximum aerobic power, RPE = rate of perceived exertion, VO2max = maximum rate of oxygen consumption..

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