Effects of Aerobic and Combined Exercise on Pain and Fatigue in Workers With Chronic Neck Pain

NCT07546838 | Completed

• 1 other identifier: EA-CNNP-RCT-2025
• Study Type: interventional
• Target: 78
• Locations: 1 country
• Sites: 1

Brief Summary

This randomized controlled trial investigated the acute effects of aerobic exercise (AE) and combined aerobic and cervical-upper extremity resistance exercise (CE) on the pressure pain threshold (PPT), pain perception, and fatigue in workers with high ergonomic risk and chronic non-specific neck pain (CNNP). A total of 78 workers were randomly assigned to AE, CE, or control groups. The AE and CE groups completed single 40-minute sessions, while the control group received a 30-minute educational session with additional seated rest periods before and after the session. PPT was assessed bilaterally at multiple anatomical sites using a digital pressure algometer. Neck pain, overall pain perception, and fatigue were evaluated using a numerical rating scale (NRS) before, immediately after, and 20 minutes after exercise. The study focused on exercise-induced hypoalgesia (EIH) and was intended to inform brief, workplace-compatible exercise strategies to reduce pain, fatigue, and work-related musculoskeletal risks in this population.

Conditions

Neck Pain Musculoskeletal; Work Related Musculoskeletal Disorders

Keywords

Exercise-induced hypoalgesia; Acute effect of exercise; Chronic Neck Pain; Pressure Pain Threshold; Aerobic Exercise; Resistance Exercise; Ergonomic Risk

Outcome Measures

Primary Outcomes (1)

• Pressure Pain Threshold

  Pressure pain threshold is assessed using a digital algometer to evaluate pain sensitivity. The value at which the sensation of pressure first becomes painful is recorded in lbf/cm². Three consecutive measurements are obtained at each site, and the mean value is used for analysis. Measurements are obtained bilaterally at the C2 region, C5 region, and upper trapezius muscle.

  Three time points: before the intervention (T0), immediately after the intervention (T1), and 20 minutes after the intervention (T2).

Secondary Outcomes (3)

• Acute Neck Pain Perception

  Assessments are performed at three time points: before the intervention (T0), immediately after the intervention (T1), and 20 minutes after the intervention (T2).

• Acute Overall Body Pain Perception

  Assessments are performed at three time points: before the intervention (T0), immediately after the intervention (T1), and 20 minutes after the intervention (T2).

• Acute Fatigue

  Assessments are performed at three time points: before the intervention (T0), immediately after the intervention (T1), and 20 minutes after the intervention (T2).

Other Outcomes (3)

• Ergonomic Risk Level - Rapid Upper Limb Assessment (RULA)

  Baseline

• Functional Aerobic Capacity 6-Minute Walk Test (6MWT)

  Baseline

• Physical Activity Level (IPAQ-SF)

  Baseline

Study Arms (3)

Aerobic Exercise

EXPERIMENTAL

Participants performed moderate-intensity cycling using a recumbent ergometer in a single 40-minute session, including a 5-minute warm-up, 30 minutes of aerobic exercise, and a 5-minute cool-down.

Behavioral: Aerobic Exercise

Combined Exercise

EXPERIMENTAL

Participants performed a combination of aerobic and resistance exercises in a single 40-minute session, including a 5-minute warm-up, 15 minutes of aerobic exercise, 15 minutes of resistance training targeting cervical and upper-extremity muscles, and a 5-minute cool-down.

Behavioral: Combined Exercise

Informed Control

ACTIVE COMPARATOR

A 30-minute educational session on exercise benefits, workplace ergonomics, and postural recommendations. Participants remained seated for 5 minutes before and after the session.

Behavioral: Informed Control

Interventions

Aerobic Exercise BEHAVIORAL

Moderate-intensity aerobic exercise performed using a recumbent cycle ergometer in a single 40-minute session. The protocol included a 5-minute warm-up, 30 minutes of continuous cycling, and a 5-minute cool-down. Exercise intensity was maintained at 64-76% of maximum heart rate and adjusted individually throughout the session. No resistance or strength training exercises were included.

Aerobic Exercise

Combined Exercise BEHAVIORAL

Participants performed a combination of aerobic and resistance exercises in a single 40-minute session. The protocol included a 5-minute warm-up, 15 minutes of moderate-intensity aerobic exercise (64-76% HRmax, Borg RPE 11-14), 15 minutes of resistance exercises targeting cervical and upper-extremity muscles, and a 5-minute cool-down. The resistance program focused on cervical motor control and scapular stabilization, including chin tuck, cervical retraction with extension, scapular retraction, vertical pulling, horizontal shoulder abduction, scapular plane abduction, and shoulder elevation. Each exercise was performed for 8-10 repetitions in two sets with 30-second rest intervals. All exercises were supervised and performed with proper postural alignment.

Combined Exercise

Informed Control BEHAVIORAL

Participants attended a 30-minute educational session on exercise benefits, workplace ergonomics, and postural recommendations. Participants remained seated for 5 minutes before and after the session.

Informed Control

Eligibility Criteria

• Age: 20 Years - 65 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Aged 20-65 years
• Diagnosed with chronic non-specific neck pain within the past year
• Neck pain intensity ≥4 on a numerical rating scale for at least 3 months
• Actively employed for at least 1 year in similar occupational conditions
• High ergonomic risk (Rapid Upper Limb Assessment - RULA score ≥3)

You may not qualify if:

• Neurological, cardiopulmonary, or rheumatological disorders
• History of cervical surgery or traumatic injury
• Specific cervical or lumbar pathology
• Whiplash injury, or any traumatic musculoskeletal injury
• Recent physical therapy or regular exercise in the past six months
• Neck pain unresponsive to conservative treatment
• Diagnosed thoracic outlet syndrome, rotator cuff pathology, vertebrobasilar insufficiency, or frozen shoulder
• Pregnancy
• Use of antidepressant medication
• Positive clinical tests (Spurling, cervical distraction, Valsalva, radial, ulnar, and median nerve tension tests)

Sponsors & Collaborators

• Hacettepe University: lead
• The Scientific and Technological Research Council of Turkey: collaborator

Study Sites (1)

Faculty of Physical Therapy adn Rehabilitation, Hacettepe University

Ankara, Çankaya, 06100, Turkey (Türkiye)

Location

Related Publications (3)

• Rice D, Nijs J, Kosek E, Wideman T, Hasenbring MI, Koltyn K, Graven-Nielsen T, Polli A. Exercise-Induced Hypoalgesia in Pain-Free and Chronic Pain Populations: State of the Art and Future Directions. J Pain. 2019 Nov;20(11):1249-1266. doi: 10.1016/j.jpain.2019.03.005. Epub 2019 Mar 21.

  PMID: 30904519 BACKGROUND

• Senarath ID, Chen KK, Weerasekara I, de Zoete RMJ. Exercise-induced hypoalgesic effects of different types of physical exercise in individuals with neck pain: A systematic review and meta-analysis. Pain Pract. 2023 Jan;23(1):110-122. doi: 10.1111/papr.13150. Epub 2022 Aug 2.

  PMID: 35869789 BACKGROUND

• Anarte-Lazo E, Bernal-Utrera C, Lopez-Amor M, Porras-Valencia E, Ruy-Diaz-Rojas FJ, Falla D, Rodriguez-Blanco C. Exercise-induced hypoalgesia after aerobic versus neck-specific exercise in people with acute/subacute whiplash-associated disorders: protocol for a randomised controlled trial. BMJ Open. 2022 Sep 22;12(9):e061679. doi: 10.1136/bmjopen-2022-061679.

  PMID: 36137629 BACKGROUND

MeSH Terms

Interventions

Exercise

Intervention Hierarchy (Ancestors)

Motor Activity; Movement; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Masking Details: Randomized
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Physiotherapist, PhD Candidate

Study Record Dates

• First Submitted: April 17, 2026
• First Posted: April 23, 2026
• Study Start: May 22, 2025
• Primary Completion: October 1, 2025
• Study Completion: October 30, 2025
• Last Updated: April 23, 2026

Record last verified: 2026-04

Locations

TU (1)