Exercise Intervention for Chronic Pain Management, Muscle Strengthening, and Functional Score in Obese Patients with Chronic Musculoskeletal Pain: A Systematic Review and Meta-analysis

Tirza Z Tamin, Nyoman Murdana, Yupitri Pitoyo, Eka D Safitri


Background: obesity and osteoarthritis have strong inter-relationship with multi-factorial mechanism that caused pain and leads to decreased quality of life. Exercise has been identified as prevention and management against obesity and joint pain. This systematic review aims to assess the effect between exercises compared to diet group for chronic pain management, physical and mental function in obese patients with chronic musculoskeletal problem. Methods: we performed a systematic search of Randomized Control Trial studies from Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EBSCO; SCIENCEDIRECT (Elsevier); SCOPUS, grey literature, trial registry, ongoing study for published studies, and from the ClinicalTrial.gov, thesis of rehabilitation medicine in RSCM, and proceeding books for unpublished studies that was last updated on November 2016. Risk of bias was assessed using Cochrane risk-of-bias tool and data were analyzed using Review Manager 2014. Results: one study showed no difference in pain reduction (assessed using VAS) between two groups. Two studies showed improvement in physical function measured using 6MWT in exercise group at 6 and 18 months with mean difference 28.12 [11.20, 45.04] and 26.21 [9.01, 43.41]. There was no significant effects observed for Mental and Physical Function based on SF-36 after 6 months (1 study) and 18 months (2 studies) observation, with mean difference 1.10 [-0.79, 2.99] and 0.08 [-1.53, 1.70] respectively for Mental Function score and -0.30 [-2.54, 1.94]  and -0.36 [-2.30, 1.57] respectively for Physical Function score. Conclusion: exercise can improve physical function objectively, but could not reduce pain in obese patients with chronic musculoskeletal problem subjectively.


Exercises intervention; Chronic pain management; Functional score; Quality of life; Systematic review


Anandacoomarasamy A, Leibman S, Smith G, et al. Weight loss in obese people has structure-modifying effects on medial but not on lateral knee articular cartilage. Ann Rheum Dis. 2012;71(1):26–32.

WHO. Obesity and overweight [Internet]. WHO. 2018 [cited 2018 Mar 28]. Available from: http://www.who.int/mediacentre/factsheets/fs311/en/

Kementrian Kesehatan RI. Riset kesehatan dasar [Internet]. 2013 [cited 2018 Feb 20]. Available from: http://www.depkes.go.id/resources/download/general/Hasil%20Riskesdas%202013.pdf.

Zdziarski LA, Wasser JG, Vincent HK. Chronic pain management in the obese patient: a focused review of key challenges and potential exercise solutions. J Pain Res. 2015;8:63–77.

Vincent HK, Adams MCB, Vincent KR, Hurley RW. Musculoskeletal pain, fear avoidance behaviors, and functional decline in obesity: potential interventions to manage pain and maintain function. Reg Anesth Pain Med. 2013;38(6):481–91.

Bjordal JM, Klovning A, Ljunggren AE, Slørdal L. Short-term efficacy of pharmacotherapeutic interventions in osteoarthritic knee pain: A meta-analysis of randomised placebo-controlled trials. Eur J Pain Lond Engl. 2007;11(2):125–38.

Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Ann Intern Med. 2009;151(4):264.

Higgins J, Green S (editors). Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011] [Internet]. The Cochrane Collaboration; 2011. Available from: http://handbook.cochrane.org.

Christensen R, Henriksen M, Leeds AR, et al. Effect of weight maintenance on symptoms of knee osteoarthritis in obese patients: a twelve-month randomized controlled trial. Arthritis Care Res (Hoboken). 2015;67(5):640-50.

Rejeski WJ, Focht BC, Messier SP, et al. Obese, older adults with knee osteoarthritis: weight loss, exercise, and quality of life. Health Psychol. 2002;21(5):419-26.

Messier SP, Loeser RF, Miller GD, et al. Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the arthritis, diet, and activity promotion trial. Am Coll Rheumatol. 2004;50(5):1501-10.

Messier SP, Mihalko SL, Legault C, et al. Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial. JAMA. 2013;310(12):1263-73.

Paddon-Jones D, Rasmussen BB. Dietary protein recommendations and the prevention of sarcopenia. Curr Opin Clin Nutr Metab Care. 2009;12(1):86–90.

Tamin TZ. Model dan efektivitas latihan endurans untuk peningkatan kebugaran penyandang disabilitas intelektual dengan obesitas. Jakarta: Universitas Indonesia; 2009.

Tamin TZ. Prinsip uji latih dan penerapan latihan rekondisi. Pelatihan tim rehabilitasi medik sport. Perjan RS CiptoMangunkusumo; 2004.

Roos EM, Herzog W, Block JA, Bennell KL. Muscle weakness, afferent sensory dysfunction and exercise in knee osteoarthritis. Nat Rev Rheumatol. 2011;7(1):57–63.

Aghakhani N, Sharif Nia H, Samad Zadeh S, et al. Quality of life during hemodialysis and study dialysis treatment in patients referred to teaching hospitals in Urmia-Iran in 2007. Casp J Intern Med. 2011;2(1):183–8.

Rokade PB. Release of endomorphin hormone and its effects on our body and moods: A Review. 2011;436–8.

King LK, March L, Anandacoomarasamy A. Obesity & osteoarthritis. Indian J Med Res. 2013;138(2):185–93.

Roditi D, Robinson ME. The role of psychological interventions in the management of patients with chronic pain. Psychol Res Behav Manag. 2011;11(4):41–9.

Crofford LJ. Psychological aspects of chronic musculoskeletal pain. Best Pract Res Clin Rheumatol. 2015;29(1):147–55.

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