A review of 157 systematic reviews, covering 2,736 randomized controlled trials and more than 221,000 participants, found that appropriately tailored physical activity can reduce pain across a wide range of conditions.

The average reduction was about 1.1 points on a 0-to-10 pain scale, with benefits seen in both acute and chronic pain, though most of the evidence focused on chronic pain.

The activities linked with benefits included aerobic and resistance exercise, aquatic exercise, Pilates, yoga, Tai Chi, dance, combined programs, interval training and digitally delivered activity; no single approach suited everyone.

Dance was associated with the largest pain reduction, followed by Pilates and Tai Chi, but the dance finding came from one review of people with fibromyalgia and does not show it is best for other conditions.

Across study comparisons, low-intensity activity and programs lasting under 12 weeks or involving under 120 minutes of weekly activity were associated with greater pain reductions; these broad patterns are not prescriptions and do not mean harder or longer activity is harmful.

The findings support starting with manageable movement suited to a person’s abilities and symptoms, then building gradually; the review found no clear added benefit from workouts longer than an hour or exercising three or more times a week rather than once or twice.

Activity may affect pain through endorphins, neurotransmitters, inflammation, immune activity and the endocannabinoid system, as well as by improving strength, fitness, confidence in movement and functioning; the review did not establish which mechanisms caused the benefits.

The evidence was rated moderate in certainty because many included reviews were low or very low quality, findings varied considerably, possible publication bias was identified and long-term follow-up was limited.

Physical activity is not a cure or a substitute for medical care; new, severe, unexplained or rapidly worsening pain warrants medical evaluation, and people with significant underlying conditions may need guidance from a physician or physical therapist.