Edzard Ernst
MD, PhD, MAE, FMedSci, FRCP, FRCPEd.

The role of exercise in the management of pain

Published Sunday 19 July 2026
Exercise is recommended for managing pain, yet the consistency, magnitude, and certainty of effects across different pain conditions and exercises remain unclear. This umbrella review aimed to synthesize the best available evidence on the analgesic effects of exercise by examining systematic reviews and meta-analyses of randomized controlled trials (RCTs).
Eleven databases were systematically searched from inception to August 2024. Eligible studies included systematic reviews with meta-analyses of RCTs comparing exercise to control conditions, with pain as a primary or secondary outcome. Reviews without meta-analyses, those not involving RCTs, or those primarily focused on experimentally induced or laboratory pain were excluded. Two reviewers independently extracted data and assessed methodological quality using AMSTAR-2. Standardized mean differences in pain were synthesized using random-effects meta-meta-analysis. Certainty of evidence was evaluated using GRADE, with subgroup and sensitivity analyses.
A total of 157 systematic reviews comprising 2,736 RCTs and 221,279 participants were included. Exercise significantly reduced pain compared with controls (pooled standardized mean differences = −0.59; 95% CI, −0.65 to −0.53; P < 0.001). Effects were observed across both chronic and acute pain conditions, encompassing musculoskeletal, neurological, inflammatory, and cancer populations. Aerobic, resistance, yoga, Pilates, and tai chi were effective. Greater effects were observed in lower-intensity, shorter-duration (<12 weeks) programs. Sensitivity analyses supported the robustness of findings, and the overall GRADE certainty was moderate.
The authors concluded that this umbrella review provides robust evidence supporting the effectiveness of exercise for managing a wide range of pain conditions. Our findings suggest that relatively brief, low-intensity programs, often perceived as more achievable by people living with chronic pain, are associated with greater pain reductions on average. However, these patterns reflect trends across diverse studies and should not be interpreted as prescriptive. Rather, they underscore the importance of starting with accessible, lower-dose programs that can be adjusted based on individual needs, preferences, and progression. Given the consistent benefits observed across exercise types and populations, clinicians are encouraged to integrate exercise as a core component of multimodal pain care. These findings reinforce the role of exercise as a safe, adaptable, and patient-centred option, particularly valuable in addressing the limitations of pharmacological pain management. Future research should focus on how to best individualise, deliver, and sustain effective exercise interventions in real-world clinical settings..
This is an excellent paper that provides a wealth of data relevant to both clinicials and patients. The authors report that significant, large reductions in pain were observed for various modes of exercise, including aerobic, aquatic, dance, HIIT, mind body (various), mixed-mode, Pilates, resistance, tai chi, telehealth, exergames and VR, and yoga. The largest reduction in pain was observed for dance, Pilates, and tai chi. It occurs to me that these three forms of exercise are normally all performed in groups and thus have a strong sociaal element to them. Could it be that this is an additional factor in their analgesic benefit?
While these exercises seem particularly effective, the most remarkable finding is, in my view, that practically ALL types of excercise work for practically ALL types of pain. This means, I think, that it might be best to let the patient decide which type of excercise he or she prefers; this might be one way to increase compliance. Because compliance might in many cases a significant problem. If you have severe pain, you are not usually motivated to do excercise!
Posted in alternative medicine, alternative therapist, causation, critical thinking, doctors, EBM, education, evidence, experience, meta-analysis, methodology, mind-body, naturopathy, pain, palliative care, panacea, patient choice, physiotherapists, research, symptom-relief, tai chi, yoga

One Response to The role of exercise in the management of pain

  • Øistein Jansen on Sunday 19 July 2026 at 12:10

    If you don’t understand the pain, the exercise can cause even more pain. Treatment without knowledge is a favorite alternative argument because it happened to work for someone. Treatment of pain is no different.

    Reply

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