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

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.