Comparative effectiveness of various exercise interventions on central sensitisation indices: A systematic review and network meta-analysis

Ibrahim, Aya Abd Elkhabir; McWilliams, Daniel F.; Smith, Stephanie L.; Chaplin, Wendy J.; Salimian, Mitra; Georgopoulos, Vasileios; Kouraki, Afroditi; Walsh, David A.

Abstract

Background: Central sensitisation (CS) increases musculoskeletal pain. Quantitative sensory testing (QST) or self-report questionnaires might indicate CS. Indices of CS might be suppressed by exercise, although the optimal exercise regimen remains unclear. Objectives: We conducted a systematic review and network meta-analysis (NMA) to investigate effectiveness of different exercise regimens on these CS indices in adults. Methods: We searched 6 electronic databases from inception to November 2023. Meta-analysis of randomised controlled trials (RCTs) investigated effects of exercise on all CS indices. Two independent reviewers assessed risk of bias. NMA of RCTs compared CS indices between exercise types. Sensitivity analysis using only high-quality studies was performed to verify the robustness of our results. Certainty was assessed using the GRADE approach. Results: Of the 249 eligible studies identified, 164 were RCTs, of which 89 provided data suitable for NMA. Meta-analysis revealed large improvement of post-intervention CS indices compared to baseline (SMD −0.81, 95 % CI −0.93 to −0.70). All reported categories of exercise, except stretching exercise alone, were more effective than non-exercise controls. Combined exercises that include stretching together with strengthening exercises (SMD −1.67, 95 % Credible Interval (CrI) −2.41 to −0.97), or strengthening, stretching and aerobic components (SMD −1.61, 95 % CrI −2.74 to −0.56) were most effective at reducing CS indices compared to non-exercise controls. Sensitivity analysis confirmed the robustness of our findings, particularly for combined stretching and strengthening exercise. Conclusions: Our meta-analysis suggested that various exercise interventions are effective in improving CS. Multi-component exercise tends to be the most effective, but some exercise combinations might be better than others. Combined exercise featuring strengthening and stretching components, with or without aerobic exercise, shows the greatest likelihood among other combinations of being the optimal exercise type. These findings might have utility informing future trials and personalising treatment strategies for people with CS features.

Citation

Ibrahim, A. A. E., McWilliams, D. F., Smith, S. L., Chaplin, W. J., Salimian, M., Georgopoulos, V., Kouraki, A., & Walsh, D. A. (2025). Comparative effectiveness of various exercise interventions on central sensitisation indices: A systematic review and network meta-analysis. Annals of Physical and Rehabilitation Medicine, 68(4), Article 101894. https://doi.org/10.1016/j.rehab.2024.101894

• Journal Article Type: Review
• Acceptance Date: Aug 15, 2024
• Online Publication Date: Jan 15, 2025
• Publication Date: 2025-05
• Deposit Date: Jan 20, 2025
• Publicly Available Date: Jan 24, 2025
• Journal: Annals of Physical and Rehabilitation Medicine
• Print ISSN: 1877-0657
• Electronic ISSN: 1877-0665
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 68
• Issue: 4
• Article Number: 101894
• DOI: https://doi.org/10.1016/j.rehab.2024.101894
• Keywords: Network meta-analysis, Central sensitisation, Exercise, Pain
• Public URL: https://nottingham-repository.worktribe.com/output/44234152
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S1877065724000770?via%3Dihub