A sweeping analysis of 157 systematic reviews involving more than 221,000 participants found exercise consistently reduced acute and chronic pain, with researchers reporting average relief greater than that seen across separate trials of common pain medications while cautioning that the treatments were not directly compared.
By yourNEWS Media Newsroom
Exercise may offer pain relief comparable to — and in some analyses greater than — commonly used medications, according to a major new review that examined thousands of randomized clinical trials across conditions ranging from arthritis and low back pain to migraines, fibromyalgia and cancer-related pain.
Researchers at Adelaide University analyzed 157 systematic reviews encompassing 2,736 randomized controlled trials and 221,279 participants, making the study one of the broadest examinations yet of exercise as a treatment for clinical pain.
Published in PAIN Reports in 2026, volume 11, article e1455, the umbrella review found that exercise significantly reduced both acute and chronic pain across a wide variety of patient groups and exercise styles.
When pain was converted to a standard 0-to-10 scale, exercise was associated with an average reduction of approximately 1.1 points.
The researchers said that reduction was about 60% larger than the average pain relief reported in separate chronic-pain trials involving commonly used medications.
That comparison requires an important qualification: The study did not randomly assign patients to exercise versus pain medication, did not compare exercise directly with individual drugs and did not identify a particular medication that exercise consistently outperformed. Instead, the researchers compared the magnitude of the exercise findings with average effects previously reported in separate pharmaceutical trials.
Lead researcher Dr. Ben Singh said several physiological processes may help explain why physical activity can reduce pain.
“When we exercise, our body releases chemicals including endorphins and serotonin that can help reduce how strongly we feel pain and increase our pain tolerance,” Singh said.
Exercise can also affect inflammation, mood and the way the nervous system processes pain, giving researchers several possible explanations for the effects observed across different conditions.
The findings are potentially significant because chronic pain is among the most common and disabling health problems worldwide. An older U.S. estimate cited in coverage by Mercola.com put the number of Americans affected by chronic pain at 76.5 million, with a substantial portion reporting severe or disabling symptoms.
Review Combined 2,736 Trials Across Numerous Pain Conditions
Rather than conducting a single new clinical trial, Singh and his colleagues performed an umbrella review — a study that pools and analyzes evidence from existing systematic reviews and meta-analyses.
The researchers searched 11 major scientific databases from their inception through August 2024.
Nearly 5,700 records were initially identified before the researchers narrowed the evidence to 157 eligible systematic reviews. To qualify, reviews had to include randomized controlled trials comparing exercise with a control condition and report pain as an outcome.
Participants included adults with average ages ranging from about 20 to 79.
The underlying studies covered a wide range of conditions, including knee osteoarthritis, low back pain, other forms of arthritis, fibromyalgia, cancer, chronic musculoskeletal pain, osteoporosis and osteopenia, rheumatoid arthritis, migraines and headaches, neck pain, neurological pain, pregnancy-related pain and type 2 diabetes.
The researchers combined standardized pain measurements across the reviews and found an overall statistically significant reduction in pain among people assigned to exercise.
The effect was observed for both chronic and acute pain.
Fibromyalgia was among the heavily represented conditions. The disorder is characterized by widespread pain and tenderness and can also involve fatigue, sleep difficulties and stiffness. Although more commonly associated with adults, it can also be diagnosed in children and adolescents.
The new analysis adds to decades of research examining non-pharmaceutical approaches to pain.
Earlier Cochrane research on herbal treatments for low back pain, for example, found evidence that preparations containing devil’s claw, white willow bark and topical cayenne could reduce short-term pain compared with placebo, though the quality of evidence varied and researchers called for larger, better trials.
Other research into medications for back pain has similarly found that some commonly used pain medicines produce only modest improvements, reinforcing interest in approaches that can be combined with or, in appropriate cases, reduce reliance on medication.
Benefits Appeared Across Aerobic Exercise, Resistance Training, Yoga and Tai Chi
The Adelaide researchers found pain reductions across nearly every major category of exercise they examined rather than identifying a single form of movement as universally superior.
“Our study found that exercise was associated with substantial reductions in acute and chronic pain across all forms of exercise – whether that be via aerobic or resistance exercise, or through gentler movement such as yoga, Pilates or tai chi,” Singh said.
Aerobic exercise, resistance training, yoga, Pilates and tai chi all produced significant reductions in pain.
Pilates and tai chi were among the exercise forms showing particularly favorable results.
Dance produced the largest reduction among individual exercise categories, although that finding came from only one systematic review involving patients with fibromyalgia. Researchers therefore cautioned against interpreting it as proof that dance is generally the most effective exercise for pain.
Similar limitations applied to some of the strongest findings for individual conditions.
The largest reductions appeared among patients with primary menstrual pain, migraines or headaches and pain associated with postmenopausal conditions.
However, each of those estimates was drawn from a single systematic review rather than being replicated across several independent reviews.
The researchers said the results were encouraging but require additional investigation.
The analysis also produced a finding that runs counter to the assumption that greater amounts of exercise necessarily provide greater pain relief.
Programs lasting less than 12 weeks were associated with larger reductions in pain than longer programs.
Lower-intensity exercise also produced larger estimated effects than higher-intensity programs.
And exercise programs totaling less than 120 minutes each week were associated with greater pain reduction than those requiring more time.
That does not prove that short or easy exercise programs are inherently better than longer or more strenuous ones. People able to tolerate demanding exercise may differ from those placed in lower-intensity programs, and the underlying trials were not specifically designed to determine an ideal exercise dose across every condition.
The findings do suggest, however, that meaningful pain relief does not necessarily require high-intensity workouts or lengthy weekly commitments.
Researchers also found little meaningful difference between exercising once or twice per week and exercising three or more times, or between shorter and longer individual exercise sessions.
That could make exercise more practical for people whose pain itself creates a barrier to physical activity.
The results align with other recent research into movement-based treatments.
A large review of traditional Chinese exercise practices drew on 92 pooled analyses representing 1,744 randomized controlled trials and examined tai chi, qigong, baduanjin, wuqinxi and yijinjing. That research reported benefits for several musculoskeletal outcomes, including pain and physical function.
Migraine specialists have also long incorporated lifestyle measures into treatment plans. Guidance by Stephen Silberstein, Peter Goadsby and Richard Lipton emphasized active patient participation and a wellness approach that can include regular exercise and rest, sound nutrition and avoiding known headache triggers.
Evidence Rated Moderate Despite Large Number of Studies
The enormous number of participants does not eliminate limitations in the evidence, the Adelaide researchers cautioned.
The systematic reviews did not all measure pain in the same way.
Some used visual analog scales, while others relied on condition-specific questionnaires or broader measures containing pain components. Combining those tools requires statistical standardization and makes straightforward comparisons more difficult.
The study also could not divide pain into highly specific biological subtypes beyond broad groupings such as acute and chronic pain.
Many of the original clinical trials lacked extensive follow-up, leaving uncertainty about whether reductions in pain continue after structured exercise programs end.
Adherence was another issue.
The individual trials differed in how closely they monitored whether participants actually completed their prescribed exercises, making it difficult to determine how much exercise subjects ultimately performed.
Some of the most striking results also depended on relatively narrow evidence.
The large reductions reported for menstrual pain, migraines and postmenopausal pain each rested on a single systematic review. Although those reviews contained multiple clinical trials, Singh and his colleagues said additional independent research is needed before drawing firm conclusions about the size of those effects.
Variation in the methodological quality of the underlying systematic reviews was substantial.
Even after the researchers accounted for study quality, sensitivity analyses and potential publication bias, however, the overall certainty of evidence supporting exercise for pain reduction was rated moderate.
The authors reported no conflicts of interest and no dedicated funding for the review, although some researchers involved receive support through Australian research grants.
Findings Add to Interest in Reducing Reliance on Medication Alone
The study does not argue that people experiencing pain should abandon medication or replace physician-directed treatment with exercise.
Instead, the researchers said the evidence supports making properly prescribed exercise a routine part of multimodal pain care.
“Health care providers need definitive guidance, not just whether exercise helps, but which exercises work for which patients, and how to prescribe them effectively,” Singh said.
That distinction is important because telling a patient simply to “stay active” does not specify the type, frequency, intensity or duration of activity most appropriate for a particular condition.
The review suggests clinicians may have considerable flexibility.
Patients who cannot tolerate intensive workouts may still obtain benefits from gentler movement such as yoga, Pilates or tai chi. People unable to meet conventional exercise targets may also benefit from programs requiring fewer than two hours per week.
The findings arrive against a broader history of concern about medication-centered pain treatment, particularly opioid prescribing.
U.S. opioid prescribing rose sharply beginning in the late 1990s, accompanied by increases in addiction and overdose deaths. Prescription volume eventually declined from its peak, but the consequences of long-term opioid exposure remain an important part of pain-management policy.
Back pain has been a particular focus because of its prevalence and its historic contribution to painkiller prescribing.
Research over the past two decades has increasingly supported multimodal treatment combining physical activity, rehabilitation, behavioral strategies and medication when appropriate rather than relying exclusively on pharmaceuticals.
Exercise also differs from many pain treatments in that it can produce health effects beyond pain reduction, including improvements in strength, mobility, cardiovascular fitness and mood.
“At a time when we’re looking for safe and effective ways to manage pain beyond medication, these findings provide strong evidence for making exercise a more routine part of pain care,” Singh said.
Researchers Call for More Precise Exercise Prescriptions
The authors said the next challenge is moving from the broad conclusion that exercise works toward determining which programs are most appropriate for individual patients and conditions.
The study does not prove that a short, low-intensity program will outperform a longer or harder program for every patient.
Nor does it establish that exercise can replace medication for severe acute injuries, cancer pain, neurological disorders or other conditions requiring medical treatment.
Instead, the review indicates that people may not need to undertake demanding exercise programs to experience measurable pain relief.
Programs lasting less than 12 weeks, lower-intensity exercise and routines totaling less than 120 minutes per week were all associated with relatively strong results.
That could be especially relevant for people living with chronic pain who fear that physical activity will worsen their symptoms or who cannot initially tolerate standard fitness recommendations.
Researchers said treatment can begin conservatively and be adapted according to a patient’s condition, capabilities and response.
The overall findings support exercise as a scalable component of pain management rather than a one-size-fits-all prescription.
Across 157 systematic reviews, 2,736 randomized trials and more than 221,000 participants, the central finding remained consistent: exercise was associated with meaningful reductions in pain across numerous conditions and across widely different forms of physical activity.
The comparison with medication trials is indirect and should not be interpreted as proof that exercise is superior to a particular drug.
But the scale of the evidence, the moderate overall certainty and the benefits observed even with relatively modest exercise programs led the researchers to conclude that physical activity deserves a more defined role in routine pain treatment rather than being offered only as general advice.
Comments