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MSK Pain – CP – Improves physical function

Evidence Summary (Updated 2022)
There is good evidence that physical activity interventions improve physical function in those with chronic pain. Aerobic exercise, such as walking interventions, have been shown to significantly improve physical function to a moderate degree in the short, medium and long-term (8). A moderate effect in favour of improvement has also been demonstrated with resistance exercises (4). Interventions that include group-based activities with a psychological component have been shown to be most beneficial (7).

Quality of Evidence
Grade A – high quality

Strength of recommendation
Grade 1 – strong recommendation

Regular physical activity, including aerobic and resistance exercises, can significantly improve physical function in those with chronic musculoskeletal pain and should be advised. Consider referring those with a significant psychosocial contribution to their presentation to group-based exercise intervention programmes with a psychological component.


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  3. Andrade A, de Azevedo Klumb Steffens R, Sieczkowska SM, Peyré Tartaruga LA, Torres Vilarino G. A systematic review of the effects of strength training in patients with fibromyalgia: clinical outcomes and design considerations. Adv Rheumatol (London, England) [Internet]. 2018 Oct 22 [cited 2022 Jul 11];58(1):36. Available from:
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  6. Belavy DL, Van Oosterwijck J, Clarkson M, Dhondt E, Mundell NL, Miller CT, et al. Pain sensitivity is reduced by exercise training: Evidence from a systematic review and meta-analysis. Neurosci Biobehav Rev [Internet]. 2021 Jan 1 [cited 2022 Jul 8];120:100–8. Available from:
  7. Carnes D, Homer KE, Miles CL, Pincus T, Underwood M, Rahman A, et al. Effective delivery styles and content for self-management interventions for chronic musculoskeletal pain: a systematic literature review. Clin J Pain [Internet]. 2012 May [cited 2022 Aug 24];28(4):344–54. Available from:
  8. O’Connor SR, Tully MA, Ryan B, Bleakley CM, Baxter GD, Bradley JM, et al. Walking exercise for chronic musculoskeletal pain: systematic review and meta-analysis. Arch Phys Med Rehabil [Internet]. 2015 Apr 1 [cited 2022 Aug 24];96(4):724-734.E3. Available from:
  9. Ferro Moura Franco K, Lenoir D, dos Santos Franco YR, Jandre Reis FJ, Nunes Cabral CM, Meeus M. Prescription of exercises for the treatment of chronic pain along the continuum of nociplastic pain: A systematic review with meta-analysis. Eur J Pain [Internet]. 2021 Jan 1 [cited 2022 Jul 8];25(1):51–70. Available from:
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