Exploring the Relationship Between Physical Activity and Pressure Pain Tolerance in the General Population. The Tromsø Study 2015-2016

Abstract

Background: Physical activity (PA) is commonly recommended for the treatment and prevention of pain. Several small-sample studies have indicated a relationship between PA and pressure pain sensitivity.

Methods: This study used data from the seventh Tromsø Study (2015-2016) cohort to assess how questionnaire-based leisure time PA (LTPA), occupational PA (OPA), and exercise-expended metabolic equivalent of task (MET) hours per week (n = 21,083), as well as accelerometer-measured total counts and moderate-to-vigorous PA (MVPA; n = 6778) relate to pressure pain tolerance (PTol). Flexible parametric survival analysis was used to estimate hazard ratios (HR) with 95% confidence intervals (CI).

Results: Higher LTPA and MET-hours per week were associated with higher levels of PTol (p < 0.001). With sedentary LTPA as a reference group, results indicated a HR of 0.87 (95% CI: 0.83, 0.92) for light, 0.75 (0.71, 0.80) for moderate, and 0.63 (0.53, 0.73) for vigorous PA. Compared to < 7.5 MET-hours per week, HRs were 0.92 (0.88, 0.96) for 7.5-14.9 MET-hours per week, 0.84 (0.78, 0.89) for 15-22.5 MET-hours per week, and 0.86 (0.82, 0.91) for > 22.5 MET-hours per week. A similar pattern was observed for accelerometer-measured PA, with a HR of 0.91 (0.88, 0.95) for MVPA and 0.93 (0.90, 0.96) for total activity counts. No clear pattern was observed for OPA. Interaction analysis indicated generally stronger effects for men, but no differences across age groups.

Conclusion: The findings suggest that higher PA in leisure-time contexts is associated with higher pain tolerance levels in the general population.

Significance statement: Higher physical activity levels are linked to increased pressure pain tolerance, highlighting its role in modulating pain. Notably, only leisure-time activity shows a beneficial effect, while occupational activity does not. These findings suggest that the type and combination of activity may uniquely influence pain perception, challenging the idea that all physical activity benefits pain equally. Since physical activity is widely used in clinical pain management, this distinction has key implications for tailoring exercise-based interventions to optimize outcomes.