While exercise is standard care for people with persistent pain, those in pain often experience increased pain sensitivity after exercise. This case-control study utilized a randomized crossover design to compare 15-minute sessions of moderate-intensity aerobic cycling and resistance training. By measuring changes in pressure sensitivity after exercise, the project investigated whether exercise-induced hypoalgesia responses differ between these modalities in individuals with persistent low back pain compared to pain-free controls.
The EXHALE ART study aimed to compare the effects of a single session of aerobic versus resistance exercise on pressure pain sensitivity in people with persistent low back pain and pain-free controls.
In a randomized case-control design, 50 participants with persistent low back pain and 49 pain-free controls performed 15 minutes of moderate-intensity cycling and lower-body resistance exercise. We measured pressure pain thresholds (PPT) at local (back) and remote (arm, leg) sites to evaluate the systemic nature of the hypoalgesic response.
Our findings demonstrate a clear impairment of endogenous pain modulation in the low back pain group. While pain-free controls showed hypoalgesic responses, particularly following resistance exercise at the local site (+74 kPa), individuals with persistent low back pain showed no significant increase in pain thresholds after either modality. Interestingly, despite the lack of change in pressure sensitivity, the persistent low back pain group reported a small but statistically significant decrease in subjective pain intensity after aerobic exercise, but not after resistance training.
A single session of exercise did not elicit a potent change in pain sensitivity in individuals with persistent low back pain, regardless of modality. The high variability in responses in both groups suggests that future research and clinical practice should focus on identifying subgroups of patients who may benefit from tailored exercise intensities or targeted protocols to better engage the body's natural pain-relieving mechanisms.