For people coping with persistent pain, the general recommendation to "get more exercise" can be frustrating, unrealistic, and sometimes even scary. The movement itself might hurt, previous attempts to exercise may have caused a worsening of symptoms, and standard recommendations to reach 150 minutes of activity a week can seem like an impossible goal.
A large-scale study now offers a more encouraging message: Physical activity can reduce pain in a very wide variety of medical conditions, and it is possible that relatively moderate, short, and accessible programs may be particularly beneficial.
The study, published in the journal PAIN Reports, is described by the researchers as the most comprehensive review conducted to date on the impact of exercise on pain. It combined data from 157 systematic reviews, which together included 2,736 randomized controlled trials and more than 221,000 participants.
The main conclusion is that physical activity should not be considered merely a general recommendation for a healthy lifestyle. When properly adapted to the individual, it can be a significant part of pain management.
Pain relief in a wide range of conditions
The researchers conducted an "umbrella review": A study that summarizes and analyzes the results of many systematic reviews and meta-analyses. They searched for information in 11 research databases and included only reviews of randomized controlled trials, in which structured physical activity was compared to usual care, no intervention, or less intense activity.
The review included many different pain conditions, including lower back and neck pain, osteoarthritis, fibromyalgia, rheumatoid arthritis, migraines and headaches, cancer-related pain, pain during pregnancy, menstrual pain, osteoporosis-related pain, and additional neurological and chronic conditions.
In the overall summary, physical activity significantly reduced pain in a clinically meaningful way. In studies that used a visual pain scale of 0 to 10, an average reduction of about 1.1 points was recorded. The effect remained significant even after the researchers corrected for potential publication bias – a situation in which studies with positive results tend to be published more than studies that found no benefit.
It is important to note that the effect was observed in both chronic pain and acute pain. Although most of the information dealt with chronic pain, no significant difference was found between the degree of effect on the two types of pain.
There is no single type of activity that fits everyone
One of the most practical findings was that many types of physical activity were found to be beneficial. Aerobic activity, resistance training, aquatic exercise, Pilates, yoga, Tai Chi, combined programs, high-intensity interval training, dance, and even activity delivered through digital means were all found to be associated with a reduction in pain.
This does not mean that all types of activity are equally suitable for every person. The implication is that there is great flexibility in tailoring the program. A person suffering from knee cartilage wear may prefer aquatic activity or muscle strengthening, while a person with fibromyalgia or heightened sensitivity to movement may feel safer starting with Tai Chi, yoga, or gentle Pilates.
Dance was found to be associated with the greatest reduction in pain among the types of activity examined, followed by Pilates and Tai Chi. However, the researchers warn that the finding regarding dance was based on only one systematic review, which dealt with fibromyalgia patients. Therefore, it cannot be concluded that dance is the most effective activity for every person and every medical condition.
The broader message is more important: Pain relief does not necessarily depend on one specific type of movement. Choosing an activity that is enjoyable, accessible, and suitable for the person's abilities may be more important than searching for the "perfect" workout.
Why might short, moderate activity help in particular?
One of the surprising findings was that low-intensity activity was associated with a greater reduction in pain compared to moderate to high-intensity activity. Programs lasting less than 12 weeks also showed a greater effect than longer programs, and programs that included less than 120 minutes of activity a week appeared more effective than those requiring more time.
However, it should not be inferred from this that strenuous activity is harmful or that physical activity stops having an effect after 12 weeks. The researchers emphasize that these are average patterns found in comparisons between many different studies, rather than a precise prescription suitable for every patient.
One possible explanation is the level of adherence. For a person coping with pain, it is easier to commit to a short, moderate program, especially if they fear that movement will cause a flare-up. In long-term studies, it is also possible that professional guidance gradually diminishes, and when the structured framework ends, participants actually engage in less activity.
The findings therefore support an approach of a gradual start: Choose a dose of activity that can be maintained, build confidence in movement, and reduce the fear of worsening pain. Later on, progress can be made according to symptoms, functioning, medical condition, and personal goals.
The review also found no clear advantage for workouts lasting more than an hour, or a significant difference between exercising once or twice a week compared to three times or more. This flexibility is particularly important for people limited by pain, fatigue, workload, or additional medical issues.
How might physical activity reduce pain?
Physical activity can affect pain through several biological and psychological mechanisms operating simultaneously. It encourages the secretion of endorphins, natural substances that help reduce pain, and affects neurotransmitters such as serotonin and norepinephrine, which are involved in mood regulation and pain signal processing.
Regular movement may also reduce systemic inflammation and regulate immune system activity. In addition, it activates the endocannabinoid system, an internal system involved in regulating pain, mood, stress response, and inflammation.
In the long run, improvements in muscle strength, flexibility, balance, fitness, and confidence to move may reduce physical strain and improve a person's ability to function despite the pain. Mind-body activities, such as yoga and Tai Chi, may also add breathing, relaxation, mindfulness, and body awareness.
It is important to emphasize that the review examined the change in pain, but did not directly examine which of these mechanisms was responsible for the improvement.
What are the study's limitations?
Despite the huge number of participants, the researchers rated the certainty of the evidence as moderate rather than high. Many of the included reviews were found to be of low or very low methodological quality, and possible signs of publication bias were found.
The studies were also very different from one another in terms of participant populations, training programs, and the tools used to measure pain. Few studies conducted long-term follow-up, so it remains unclear to what extent relief is maintained after completing the structured program. The particularly large effects found in menstrual pain, migraines, and post-menopausal pain were each based on only one systematic review, and therefore require confirmation in further studies.
Physical activity is also not a cure for all types of pain and does not replace appropriate medical evaluation or treatment. New, severe, unexplained pain, or pain that worsens rapidly requires medical evaluation. People with heart disease, significant neurological or orthopedic issues, and other underlying conditions may need a personalized program guided by a physician or physical therapist.
Nevertheless, the main message is encouraging: To relieve pain, physical activity does not have to be difficult, exhausting, or prolonged. For many people, the right path is to start with moderate, accessible movement tailored to personal ability and symptoms, and gradually increase it later. In this way, activity becomes a possible and achievable part of treatment, rather than a daunting task that is hard to maintain.