Modulation of Exercise-Induced Hypoalgesia Following an Exercise Intervention in Healthy Subjects.

BACKGROUND: Exercise is recommended to promote and maintain health and as treatment for more than 25 diseases and pain conditions. Exercise-induced hypoalgesia (EIH), a measure of descending pain inhibitory control, has been found to be impaired in some chronic pain conditions, but it is currently unclear if EIH is modifiable. This study investigated whether a long-term exercise intervention could modulate EIH in healthy subjects. METHODS: In 38 healthy subjects, EIH was assessed as change in pressure pain threshold (PPT) after a three-minute isometric wall squat within the first week and after approximately seven weeks of military training (MT). Further, temporal summation of pain (TSP) and Knee injury and Osteoarthritis Outcome Score (KOOS) were assessed. Physical performance capacity was assessed using the Endurance 20-m shuttle run fitness test (20MSR). Hypoalgesic (EIH > 0.0 kPa) and hyperalgesic (EIH ≤ 0.0 kPa) subgroups were defined based on baseline EIH. Change in EIH following MT was used as the primary outcome. RESULTS: Increased EIH (P = 0.008), PPT (P < 0.003), and 20MSR (P < 0.001) were found following MT, with no changes in TSP and KOOS (P > 0.05). Subjects with a hyperalgesic EIH response at baseline (26% of the participants) presented significantly improved EIH following MT (P = 0.010). Finally, an association between 20MRS change and EIH change was found (r = 0.369, P = 0.023). CONCLUSIONS: MT increased EIH, especially in subjects who demonstrated a hyperalgesic response at baseline. Improvement in physical performance capacity was associated with an improvement in EIH, indicating that improvement in physical performance capacity may improve central pain mechanisms.

Exercise-Induced Hypoalgesia After Isometric Wall Squat Exercise: A Test-Retest Reliabilty Study.

Background: Isometric exercises decrease pressure pain sensitivity in exercising and nonexercising muscles known as exercise-induced hypoalgesia (EIH). No studies have assessed the test-retest reliability of EIH after isometric exercise. This study investigated the EIH on pressure pain thresholds (PPTs) after an isometric wall squat exercise. The relative and absolute test-retest reliability of the PPT as a test stimulus and the EIH response in exercising and nonexercising muscles were calculated. Methods: In two identical sessions, PPTs of the thigh and shoulder were assessed before and after three minutes of quiet rest and three minutes of wall squat exercise, respectively, in 35 healthy subjects. The relative test-retest reliability of PPT and EIH was determined using analysis of variance models, Person's r, and intraclass correlations (ICCs). The absolute test-retest reliability of EIH was determined based on PPT standard error of measurements and Cohen's kappa for agreement between sessions. Results: Squat increased PPTs of exercising and nonexercising muscles by 16.8% ± 16.9% and 6.7% ± 12.9%, respectively (P < 0.001), with no significant differences between sessions. PPTs within and between sessions showed moderately strong correlations (r ≥ 0.74) and excellent (ICC ≥ 0.84) within-session (rest) and between-session test-retest reliability. EIH responses of exercising and nonexercising muscles showed no systematic errors between sessions; however, the relative test-retest reliability was low (ICCs = 0.03-0.43), and agreement in EIH responders and nonresponders between sessions was not significant (κ < 0.13, P > 0.43). Conclusions: A wall squat exercise increased PPTs compared with quiet rest; however, the relative and absolute reliability of the EIH response was poor. Future research is warranted to investigate the reliability of EIH in clinical pain populations.