Objective To evaluate the exercise‐induced hypoalgesic (EIH) effects of different types of physical exercise in individuals with neck pain. Design Systematic review with meta‐analysis. Literature Search An electronic search of six databases was completed to include studies assessing EIH effects on neck pain. Study Selection Criteria Randomized controlled trials, controlled trials, and observational studies that assessed before and immediate after‐effects of a single session of physical exercise in people with neck pain were included. Two reviewers independently screened records, extracted outcomes, assessed the risk of bias, and rated the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Data synthesis EIH is characterized by increased pain threshold, pain tolerance, and/or decreased sensitivity to painful stimuli or unpleasantness, which may last up to 30 min after a single bout of exercise. EIH is usually measured with quantitative sensory testing (QST) and is mostly taken as the difference between pre‐ and postexercise pressure pain threshold (PPT). Data were pooled and analyzed using a fixed‐effect meta‐analysis. Results Eleven articles were included in this review; nine with low risk of bias and two with some concerns about the risk of bias. Three studies with chronic whiplash‐associated disorders (WAD) were included in the meta‐analysis; isometric exercise had a larger EIH effect at the local testing site compared with submaximal aerobic exercises (MD = −0.21, [95% CI = −0.43, 0.00], p = 0.05, I2 = 92%), submaximal aerobic and isometric exercises had equal EIH effects at the remote testing site (MD = 0.01, [95% CI = −0.33, 0.35], p = 0.95, I2 = 0%), and submaximal aerobic exercises exerted comparably larger EIH effect at the remote testing site than local testing site (MD = −0.01, [95% CI = −0.20, 0.18], p = 0.93, I2 = 56%). The certainty of evidence (GRADE) for these analyses was low to very low. According to the descriptive analysis of the studies of chronic nonspecific neck pain, isometric and range of motion (ROM) exercises have shown EIH effects. Active stretching exercises have illustrated contradictory effects. Conclusion Isometric and ROM exercises exerted hypoalgesia at local and remote sites. A larger EIH effect following submaximal aerobic exercises was exerted at the remote testing site compared with the local site.

Physical inactivity is a leading risk factor for global mortality with flexibility being the key factor for determining an individual's health status. This study explored the impact of physical activity on the flexibility of lumbar spine and lower extremities in undergraduates. It further explored the association between the flexibility of lumbar spine and lower limbs in individuals who shared the same amount of physical activity. The sample of 70 undergraduates was chosen from the University of Peradeniya, Sri Lanka using stratified random sampling method. 35 students from each gender were divided into three categories (low, moderate, and high) based on their physical activity level evaluated using International Physical Activity Questionnaire-short form (IPAQ-SF). Modified Schober test was used to measure the flexibility of lumbar spine while Sit-and-Reach and Groin Flexibility tests were used to measure the flexibility of lower limbs. The results showed a weak significant correlation between physical activity and flexibility of lower limbs (r=0.236, p=0.048), but no significant correlation between physical activity and flexibility of lumbar spine (r=-0.179, p=0.701). It explored a moderate positive significant correlation between the flexibility of lumbar spine and lower limbs (r= 0.536, p=0.008) in subjects who were low in physical activity but not in subjects who were moderately and highly physically active.Furthermore, the study indicated the males to be more flexible in both lumbar spine (22.3) and lower limbs (7.7) compared to the corresponding values of females (21.4 and 6.7) respectively. Therefore, it is important to take measures to alleviate the physical inactivity in young adults with low physical activity to improve the general status of health by preventing the influence of flexibility of one region on another.

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