{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T16:56:41Z","timestamp":1782406601537,"version":"3.54.5"},"reference-count":70,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2021,6,8]],"date-time":"2021-06-08T00:00:00Z","timestamp":1623110400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European Journal of Pain"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>There is a lack of evidence of the relative effects of different exercise modes on pain sensitization and pain intensity in individuals with knee osteoarthritis (KOA).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Ninety individuals with radiographic and symptomatic KOA, ineligible for knee replacement surgery, were randomized to 12\u00a0weeks of twice\u2010weekly strength training in addition to neuromuscular exercise and education (ST+NEMEX\u2010EDU) or neuromuscular exercise and education alone (NEMEX\u2010EDU). Outcomes were bilateral, lower\u2010leg, cuff pressure pain\u2010 and tolerance thresholds (PPT, PTT), temporal summation (TS), conditioned pain modulation (CPM), self\u2010reported knee pain intensity and number of painful body sites.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After 12\u00a0weeks of exercise, we found significant differences in increases in PPT (\u22125.01\u00a0kPa (\u22128.29 to \u22121.73, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.0028)) and PTT (\u22128.02\u00a0kPa (\u221212.22 to \u22123.82, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.0002)) in the KOA leg in favour of ST+NEMEX\u2010EDU. We found no difference in effects between groups on TS, CPM or number of painful body sites. In contrast, there were significantly greater pain\u2010relieving effects on VAS mean knee pain during the last week (\u22128.4\u00a0mm (\u221216.2 to \u22120.5, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.0364) and during function (\u221216.0\u00a0mm (\u221224.8 to \u22127.3, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.0004)) in favour of NEMEX\u2010EDU after 12\u00a0weeks of exercise.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Additional strength training reduced pain sensitization compared to neuromuscular exercise and education alone, but also attenuated the reduction in pain intensity compared to neuromuscular exercise and education alone. The study provides the first dose\u2010 and type\u2010specific insight into the effects of a sustained exercise period on pain sensitization in KOA. Future studies are needed to elucidate the role of different exercise modes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>This study is an important step towards better understanding the effects of exercise in pain management of chronic musculoskeletal conditions. We found that strength training in addition to neuromuscular exercise and education compared with neuromuscular exercise and education only had a differential impact on pain sensitization and pain intensity, but also that regardless of the exercise mode, the positive effects on pain sensitization and pain intensity were comparable to the effects of other therapeutic interventions for individuals with knee osteoarthritis.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ejp.1796","type":"journal-article","created":{"date-parts":[[2021,5,15]],"date-time":"2021-05-15T15:29:22Z","timestamp":1621092562000},"page":"1898-1911","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Strength training in addition to neuromuscular exercise and education in individuals with knee osteoarthritis\u2014the effects on pain and sensitization"],"prefix":"10.1002","volume":"25","author":[{"given":"P\u00e6tur M.","family":"Holm","sequence":"first","affiliation":[{"name":"The Research Unit PROgrez Department of Physiotherapy and Occupational Therapy N\u00e6stved\u2010Slagelse\u2010Ringsted Hospitals Slagelse Denmark"},{"name":"Department of Sports Science and Clinical Biomechanics University of Southern Denmark Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristian K.","family":"Petersen","sequence":"additional","affiliation":[{"name":"Center for Neuroplasty and Pain SMI School of Medicine Aalborg University Aalborg Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathias","family":"Wernbom","sequence":"additional","affiliation":[{"name":"Center for Health and Performance Department of Food and Nutrition and Sport Science University of Gothenburg Gothenburg Sweden"},{"name":"Department of Health and Rehabilitation Institute of Neuroscience and Physiology Sahlgrenska Academy University of Gothenburg Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrik M.","family":"Schr\u00f8der","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery N\u00e6stved\u2010Slagelse\u2010Ringsted Hospitals N\u00e6stved Denmark"},{"name":"Department of Regional Health Research University of Southern Denmark Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Arendt\u2010Nielsen","sequence":"additional","affiliation":[{"name":"Center for Neuroplasty and Pain SMI School of Medicine Aalborg University Aalborg Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00f8ren T.","family":"Skou","sequence":"additional","affiliation":[{"name":"The Research Unit PROgrez Department of Physiotherapy and Occupational Therapy N\u00e6stved\u2010Slagelse\u2010Ringsted Hospitals Slagelse Denmark"},{"name":"Department of Sports Science and Clinical Biomechanics University of Southern Denmark Odense Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,6,8]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2474-11-126"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00421-015-3150-8"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000000562"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejp.651"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.berh.2010.01.013"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejp.1140"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2010.04.003"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejp.1193"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11914-015-0276-x"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2015.09.002"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2019.06.011"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2013.12.023"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroscience.2010.03.035"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2013.05.039"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.23005"},{"key":"e_1_2_10_17_1","first-page":"3","article-title":"Endogenous systems involved in exercise\u2010induced analgesia","volume":"69","author":"Da Silva Santos R.","year":"2018","journal-title":"Journal of Physiology and Pharmacology: an Official Journal of the Polish Physiological Society"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-016-1124-6"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.2165\/00007256-200737020-00004"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30925-9"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000000294"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/AJP.0000000000000771"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.20543"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1186\/ar3064"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.22375"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2020.02.839"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)30417-9"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1080\/08990220.2016.1229178"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000000764"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.38290"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0b013e3181f1bf0d"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.16.4.494"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2013.05.015"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.2165\/00007256-200535040-00004"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.3109\/17453674.2014.973343"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2018.05.011"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1097\/PR9.0000000000000850"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000000312"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1002\/j.1532-2149.2014.499.x"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms16012130"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c869"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0147526"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm8091343"},{"key":"e_1_2_10_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2013.11.012"},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2013.03.018"},{"key":"e_1_2_10_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2014.10.008"},{"key":"e_1_2_10_47_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000001288"},{"key":"e_1_2_10_48_1","doi-asserted-by":"publisher","DOI":"10.1097\/AJP.0000000000000495"},{"key":"e_1_2_10_49_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000000531"},{"key":"e_1_2_10_50_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000001427"},{"key":"e_1_2_10_51_1","doi-asserted-by":"publisher","DOI":"10.1002\/ejp.1465"},{"key":"e_1_2_10_52_1","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0b013e3181915670"},{"key":"e_1_2_10_53_1","first-page":"CD010203","article-title":"High\u2010intensity versus low\u2010intensity physical activity or exercise in people with hip or knee osteoarthritis","volume":"2015","author":"Regnaux J.\u2010P.","year":"2015","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"e_1_2_10_54_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2019.03.005"},{"key":"e_1_2_10_55_1","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2017-098904"},{"key":"e_1_2_10_56_1","doi-asserted-by":"publisher","DOI":"10.1186\/1477-7525-1-64"},{"key":"e_1_2_10_57_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.22317"},{"key":"e_1_2_10_58_1","doi-asserted-by":"publisher","DOI":"10.2340\/16501977-1973"},{"key":"e_1_2_10_59_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13075-014-0470-8"},{"key":"e_1_2_10_60_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-017-1439-y"},{"key":"e_1_2_10_61_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2015.07.013"},{"key":"e_1_2_10_62_1","doi-asserted-by":"publisher","DOI":"10.2522\/ptj.20150668"},{"key":"e_1_2_10_63_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2019.02.097"},{"key":"e_1_2_10_64_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2012.06.009"},{"key":"e_1_2_10_65_1","doi-asserted-by":"publisher","DOI":"10.1007\/s004210000269"},{"key":"e_1_2_10_66_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00421-006-0238-1"},{"key":"e_1_2_10_67_1","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2004.022905"},{"key":"e_1_2_10_68_1","doi-asserted-by":"publisher","DOI":"10.1097\/PR9.0000000000000823"},{"key":"e_1_2_10_69_1","doi-asserted-by":"publisher","DOI":"10.1016\/0304-3959(96)03121-1"},{"key":"e_1_2_10_70_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2796.2004.01443.x"},{"key":"e_1_2_10_71_1","doi-asserted-by":"publisher","DOI":"10.1111\/apha.13302"}],"container-title":["European Journal of Pain"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ejp.1796","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ejp.1796","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ejp.1796","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,29]],"date-time":"2023-08-29T08:21:34Z","timestamp":1693297294000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ejp.1796"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,8]]},"references-count":70,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2021,10]]}},"alternative-id":["10.1002\/ejp.1796"],"URL":"https:\/\/doi.org\/10.1002\/ejp.1796","archive":["Portico"],"relation":{},"ISSN":["1090-3801","1532-2149"],"issn-type":[{"value":"1090-3801","type":"print"},{"value":"1532-2149","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,8]]},"assertion":[{"value":"2021-02-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-05-09","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-06-08","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}