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Arthritis Res Ther. 2018 Nov 26;20(1):262. doi: 10.1186/s13075-018-1758-x.

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.

Author information

Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, SE-182 88, Stockholm, Sweden.
Department of Rehabilitation Medicine, Danderyd Hospital, Building 60, SE-182 88, Stockholm, Sweden.
Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, SE-141 83, Huddinge, Sweden.
Rheumatology Clinic, Karolinska University Hospital, SE-171 76, Stockholm, Sweden.
Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, D2:01, SE-171 76, Stockholm, Sweden.
Functional Area Occupational Therapy and Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, D4:51, SE-171 76, Stockholm, Sweden.
Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, SE-171 77, Stockholm, Sweden.
Department of Neuroradiology, Karolinska University Hospital, SE-171 76, Stockholm, Sweden.
Stockholm Spine Center, Löwenströms väg 1, SE-194 89, Upplands Väsby, Sweden.



We aimed to evaluate the 1-year and 2-year outcome of a health-enhancing physical activity (HEPA) support program on global pain, pressure pain sensitivity, and exercise-induced segmental and plurisegmental hypoalgesia (EIH) in persons with rheumatoid arthritis (RA).


Thirty participants (27 women and 3 men) were recruited from a larger intervention cohort that engaged in strength training and moderate-intensity aerobic activity. Assessments were performed before the HEPA intervention and at 1-year and 2-year follow-ups. Global pain was assessed on a visual analogue scale (0-100). Pressure pain thresholds (PPTs) and suprathreshold pressure pain at rest corresponding to 4/10 (medium pain) (SP4) and 7/10 (strong pain) (SP7) on Borg CR 10 scale were assessed by algometry. In a subsample (n = 21), segmental and plurisegmental EIH were assessed during standardized submaximal static contraction (30% of the individual maximum), by algometry, alternately at the contracting right M. quadriceps and the resting left M. deltoideus.


Global pain decreased from before the intervention to 2-year follow-up (median 11 to median 6, P = 0.040). PPTs and SP4 pressure pain at rest did not change from before the intervention to 2-year follow-up, while SP7 decreased from mean 647 kPa to mean 560 kPa (P = 0.006). Segmental EIH during static muscle contraction increased from the assessment before the intervention (from mean 1.02 to mean 1.42, P = 0.001), as did plurisegmental EIH (from mean 0.87 to mean 1.41, P <0.001). There were no statistically significant changes in segmental or plurisegmental EIH from before the intervention to 2-year follow-up.


Participation in a long-term HEPA support program was associated with reduced global pain, whereas pressure pain sensitivity at rest was not reduced and EIH did not change. Thus, our results do not favor the hypothesis that long-term HEPA reduces pain by improving descending pain inhibition in persons with RA.


ISRCTN25539102 , ISRCTN registry, date assigned March 4, 2011. The trial was retrospectively registered.


Arthritis; Exercise-induced hypoalgesia; Long-term follow-up; Pain measurement; Pain threshold

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