Exercise-Induced Hypoalgesia, Load Adaptation and Measuring Dose

Exercise therapy improves pain, function and quality of life across several pain sites, but no single type of exercise stands out. Kelly Naugle's work shows that some people with chronic pain, often those high in catastrophizing, lack the usual exercise-induced hypoalgesia effect. A study by Ben Smith and colleagues suggests that exercising into pain can give a small short-term benefit, so pain need not be a barrier. Paul links Meeusen's work on overtraining syndrome to chronic pain: psychological and emotional load affect recovery as well as physical load. A bucket metaphor frames resilience, with distress, fear of movement, low return to work expectancy and poor self-perceived function as holes to repair. Load is a whole-person experience, and dose may need to follow how the person feels on the day. Paul combines RPE, the subjective units of distress scale and repetitions in reserve into one chart, refers to Foster's session RPE method, and shows a spreadsheet for recording frequency, intensity, time and total volume.