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Exercise-induced hypoalgesia in response to different exercise types and intensities: A narrative review
 
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1
5th Military Clinical Hospital with Polyclinic SPZOZ in Krakow, Poland
 
2
Centrum Medyczne w Łańcucie Sp. z o.o. / Medical Center in Łańcut, Poland
 
3
Department of Medical Education, Jagiellonian University Medical College in Krakow, Poland
 
4
Szpital św. Anny w Miechowie / St. Anne’s Hospital in Miechów, Poland
 
5
Samodzielny Publiczny Zakład Opieki Zdrowotnej MSWiA w Krakowie / Independent Public Healthcare Facility of the Ministry of Interior and Administration in Krakow, Poland
 
6
The University Hospital in Krakow, Poland
 
7
Warszawski Szpital Południowy Sp. z o.o. / Warsaw Southern Hospital, Poland
 
 
Corresponding author
Barbara Boba   

5. Wojskowy Szpital Kliniczny z Polikliniką SPZOZ w Krakowie, ul. Wrocławska 1–3, 30-901 Kraków
 
 
Ann. Acad. Med. Siles. 2026;80:261-266
 
KEYWORDS
TOPICS
ABSTRACT
It has been documented in the literature that physical activity can lead to hypoalgesia. The aim of this review is to provide insight into the effects that different exercise programs have on the pain threshold of pain-free individuals. Two databases, PubMed and Google Scholar, were searched. A total of 13 studies were included in this review. The results indicate that, in most cases, exercise leads to an exercise-induced hypoalgesia (EIH) response of various type and intensity. The EIH effect can occur after stationary cycling, treadmill running, dancing, functional training, submaximal isometric exercises, and dynamic exercise programs. However, in some studies, the expected EIH effect was not achieved. This applies to upper limb aerobic exercise, resistance training, and cycling. The literature on the relationship between exercise intensity and the EIH response is ambiguous, with some studies revealing a positive correlation and others showing different results. Various exercise programs can result in EIH in healthy individuals. However, more research is needed to discover what type and intensity of exercise is most effective in inducing hypoalgesia.
FUNDING
The study did not receive any special funding.
CONFLICT OF INTEREST
The authors declare no conflict of interest.
REFERENCES (34)
1.
St Sauver JL, Warner DO, Yawn BP, Jacobson DJ, McGree ME, Pankratz JJ, et al. Why patients visit their doctors: assessing the most prevalent conditions in a defined American population. Mayo Clin Proc. 2013;88(1):56–67. doi: 10.1016/j.mayocp.2012.08.020.
 
2.
González-Iglesias M, Martínez-Benito A, López-Vidal JA, Melis-Romeu A, Gómez-Rabadán DJ, Reina-Varona Á, et al. Understanding exercise-induced hypoalgesia: An umbrella review of scientific evidence and qualitative content analysis. Medicina (Kaunas). 2025;61(3):401. doi: 10.3390/medicina61030401.
 
3.
Naugle KM, Fillingim RB, Riley JL 3rd. A meta-analytic review of the hypoalgesic effects of exercise. J Pain. 2012;13(12):1139–1150. doi: 10.1016/j.jpain.2012.09.006.
 
4.
Mogil JS, Sternberg WF, Balian H, Liebeskind JC, Sadowski B. Opioid and nonopioid swim stress-induced analgesia: a parametric analysis in mice. Physiol Behav. 1996;59(1):123–132. doi: 10.1016/0031-9384(95)02073-x.
 
5.
Hughes L, Grant I, Patterson SD. Aerobic exercise with blood flow restriction causes local and systemic hypoalgesia and increases circulating opioid and endocannabinoid levels. J Appl Physiol (1985). 2021;131(5):1460–1468. doi: 10.1152/japplphysiol.00543.2021.
 
6.
Koltyn KF, Brellenthin AG, Cook DB, Sehgal N, Hillard C. Mechanisms of exercise-induced hypoalgesia. J Pain. 2014;15(12):1294–1304. doi: 10.1016/j.jpain.2014.09.006.
 
7.
Kami K, Tajima F, Senba E. Brain mechanisms of exercise-induced hypoalgesia: To find a way out from “fear-avoidance belief”. Int J Mol Sci. 2022;23(5):2886. doi: 10.3390/ijms23052886.
 
8.
Ramaswamy S, Wodehouse T. Conditioned pain modulation–A comprehensive review. Neurophysiol Clin. 2021;51(3):197–208. doi: 10.1016/j.neucli.2020.11.002.
 
9.
Nir RR, Yarnitsky D. Conditioned pain modulation. Curr Opin Support Palliat Care. 2015;9(2):131–137. doi: 10.1097/SPC.0000000000000126.
 
10.
Lemley KJ, Hunter SK, Bement MK. Conditioned pain modulation predicts exercise-induced hypoalgesia in healthy adults. Med Sci Sports Exerc. 2015;47(1):176–184. doi: 10.1249/MSS.0000000000000381.
 
11.
Wewege MA, Jones MD. Exercise-induced hypoalgesia in healthy individuals and people with chronic musculoskeletal pain: A systematic review and meta-analysis. J Pain. 2021;22(1):21–31. doi: 10.1016/j.jpain.2020.04.003.
 
12.
Löfgren M, Opava CH, Demmelmaier I, Fridén C, Lundberg IE, Nordgren B, et al. Long-term, health-enhancing physical activity is associated with reduction of pain but not pain sensitivity or improved exercise-induced hypoalgesia in persons with rheumatoid arthritis. Arthritis Res Ther. 2018;20(1):262. doi: 10.1186/s13075-018-1758-x.
 
13.
Tomschi F, Zschunke A, Hilberg T. Ten minutes of core stabilisation exercise result in local exercise-induced hypoalgesia in patients with chronic unspecific low back pain. Eur J Pain. 2025;29(3):e4794. doi: 10.1002/ejp.4794.
 
14.
Kuithan P, Heneghan NR, Rushton A, Sanderson A, Falla D. Lack of exercise-induced hypoalgesia to repetitive back movement in people with chronic low back pain. Pain Pract. 2019;19(7):740–750. doi: 10.1111/papr.12804.
 
15.
Hansen S, Vaegter HB, Petersen KK. Pretreatment exercise-induced hypoalgesia is associated with change in pain and function after standardized exercise therapy in painful knee osteoarthritis. Clin J Pain. 2020;36(1):16–24. doi: 10.1097/AJP.0000000000000771.
 
16.
Holden S, Lyng K, Graven-Nielsen T, Riel H, Olesen JL, Larsen LH, et al. Isometric exercise and pain in patellar tendinopathy: A randomized crossover trial. J Sci Med Sport. 2020;23(3):208–214. doi: 10.1016/j.jsams.2019.09.015.
 
17.
Smith A, Ritchie C, Warren J, Sterling M. Exercise-induced hypoalgesia is impaired in chronic whiplash-associated disorders (WAD) with both aerobic and isometric exercise. Clin J Pain. 2020;36(8):601–611. doi: 10.1097/AJP.0000000000000845.
 
18.
Smith A, Ritchie C, Pedler A, McCamley K, Roberts K, Sterling M. Exercise-induced hypoalgesia is elicited by isometric, but not aerobic exercise in individuals with chronic whiplash-associated disorders. Scand J Pain. 2017;15:14–21. doi: 10.1016/j.sjpain.2016.11.007.
 
19.
Hansen S, Petersen KK, Sloth E, Manum LA, McDonald AK, Andersen PG, et al. Hypoalgesia after exercises with painful vs. non-painful muscles in healthy subjects – a randomized cross-over study. Scand J Pain. 2021;22(3):614–621. doi: 10.1515/sjpain-2021-0161.
 
20.
Tomschi F, Lieverkus D, Hilberg T. Exercise-induced hypoalgesia (EIH) in response to different exercise intensities. Eur J Appl Physiol. 2022;122(10):2213–2222. doi: 10.1007/s00421-022-04997-1.
 
21.
Tomschi F, Schulz J, Stephan H, Hilberg T. Short all-out isokinetic cycling exercises of 90 and 15 s unlock exercise-induced hypoalgesia. Eur J Pain. 2024;28(9):1536–1546. doi: 10.1002/ejp.2276.
 
22.
Tomschi F, Kieckbusch L, Zachow J, Hilberg T. Does exercise-induced hypoalgesia depend on exercise duration? Biology (Basel). 2023;12(2):222. doi: 10.3390/biology12020222.
 
23.
Niwa Y, Shimo K, Ohga S, Tokiwa Y, Hattori T, Matsubara T. Effects of exercise-induced hypoalgesia at different aerobic exercise intensities in healthy young adults. J Pain Res. 2022;15:3615–3624. doi: 10.2147/JPR.S384306.
 
24.
Zi-Han X, Nan A, Rui CJ, Yong-Long Y. Modulation of pain perceptions following treadmill running with different intensities in females. Physiol Rep. 2023;11(18):e15831. doi: 10.14814/phy2.15831.
 
25.
Xu ZH, An N, Xu S, Wang RY, Li Y. The magnitude of exercise-induced hypoalgesia can be improved and correlated with endogenous pain modulation following 4 weeks of treadmill running. [Preprint]. medRxiv. 2024. doi: 10.1101/2024.03.27.24304823.
 
26.
Katz-Betzalel N, Weissman-Fogel I, Kodesh E. Aerobic upper-limb exercise-induced hypoalgesia: Does it work? Appl Sci. 2022;12(22):11391. doi: 10.3390/app122211391.
 
27.
Wu CC, Yang J, Wang XQ. Analgesic effect of dance movement therapy: An fNIRS study. Neuroimage. 2024;301:120880. doi: 10.1016/j.neuroimage.2024.120880.
 
28.
Wilson AT, Pinette J, Lyons K, Hanney WJ. Exercise-induced hypoalgesia during different intensities of a dynamic resistance exercise: A randomized controlled trial. PLoS One. 2024;19(4):e0299481. doi: 10.1371/journal.pone.0299481.
 
29.
Vaegter HB, Hoeger Bement M, Madsen AB, Fridriksson J, Dasa M, Graven-Nielsen T. Exercise increases pressure pain tolerance but not pressure and heat pain thresholds in healthy young men. Eur J Pain. 2017;21(1):73–81. doi: 10.1002/ejp.901.
 
30.
Wu B, Zhou L, Chen C, Wang J, Hu LI, Wang X. Effects of exercise-induced hypoalgesia and its neural mechanisms. Med Sci Sports Exerc. 2022;54(2):220–231. doi: 10.1249/MSS.0000000000002781.
 
31.
Ahmed GM, Mahfouz MM, Elzanaty MY, Abd-Elrahman NAF, Ameen FH. Effect of different exercise intensities on induced hypoalgesia and pressure pain threshold in non-athletic normal young adults. J Cardiovasc Dis Res. 2021;12(05):1043–1048.
 
32.
Tomschi F, Ransmann P, Schmidt A, Hilberg T. Exercise-induced hypoalgesia after a high intensity functional training: a randomized controlled crossover study. BMC Sports Sci Med Rehabil. 2024;16(1):182. doi: 10.1186/s13102-024-00969-4.
 
33.
Koltyn KF. Exercise-induced hypoalgesia and intensity of exercise. Sports Med. 2002;32(8):477–487. doi: 10.2165/00007256-200232080-00001.
 
34.
Aron V, Strul D, Vaegter HB, Pitance L, Armijo-Olivo S. Reliability and measurement error of exercise-induced hypoalgesia in pain-free adults and adults with musculoskeletal pain: A systematic review. Scand J Pain. 2024;24(1). doi: 10.1515/sjpain-2023-0104.
 
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