SynthesisSports medicine (Auckland, N.Z.)2020
Effects of Exercise Training on Fear-Avoidance in Pain and Pain-Free Populations: Systematic Review and Meta-analysis.
Synthesis in Sports medicine (Auckland, N.Z.), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
22 citing papers in PubMed, 3 syntheses or guidelines pooled it, 44 citations in OpenAlex.
- Relationship Between Fear of Movement and Physical Activity in Patients With Cardiac, Rheumatologic, Neurologic, Pulmonary, or Pain Conditions: A Systematic Review and Meta-Analysis.Physical therapy · 2025Pooled it
- Effects of exercise/physical activity on fear of movement in people with spine-related pain: a systematic review.Frontiers in psychology · 2023Pooled it
- Rehabilitation to improve outcomes of lumbar fusion surgery: a systematic review with meta-analysis.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2022Pooled it
- Is therapeutic exercise as a standalone intervention effective in reducing kinesiophobia in adults with nonspecific chronic low back pain? A systematic review and meta-analysis with meta-regression.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Review
- Kinesiophobia and its impact on shoulder function in patients following arthroscopic rotator cuff repair of the supraspinatus tendon: a cross-sectional study.BMC musculoskeletal disorders · 2026Article
- The effect of a multimodal exercise program on paraspinal muscle morphology and clinical outcomes in chronic low back pain.Isokinetics and exercise science · 2026Article
- Impact of Exercise Therapy on Outcomes in Patients with Low Back Pain: An Umbrella Review of Systematic Reviews.Journal of clinical medicine · 2025Review
- Examination of the Relationship Between Pain Intensity, Pain Perceptions, and Kinesiophobia in Patients with Non-Specific Chronic Musculoskeletal Pain.Muscles (Basel, Switzerland) · 2025Article
- Co-development of an evidence-informed, theoretically driven exercise programme for people with chronic non-specific neck pain (the EPIC-Neck programme - "Exercise Prescription Improved through Co-design").BMC musculoskeletal disorders · 2025Article
- Reliability of the Polish Version of the Kinesiophobia Causes Scale (KCS) Questionnaire in Assessing the Level of Fear of Movement Among People Suffering from Chronic Nonspecific Low Back Pain.Diagnostics (Basel, Switzerland) · 2025Article
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- Determinants of outcomes for patients with chronic low back pain and fear-avoidance beliefs following treatment with specific stabilisation exercises.Journal of back and musculoskeletal rehabilitation · 2024Article
- "Restoring That Faith in My Shoulder": A Qualitative Investigation of How and Why Exercise Therapy Influenced the Clinical Outcomes of Individuals With Rotator Cuff-Related Shoulder Pain.Physical therapy · 2023Article
- Patient-reported outcome measures in physical therapy practice for neck pain: an overview of reviews.Journal of patient-reported outcomes · 2023Review
- Fear-Avoidance Beliefs Are Associated with Pain Intensity and Shoulder Disability in Adults with Chronic Shoulder Pain: A Cross-Sectional Study.Journal of clinical medicine · 2023Article
- From hands-on to remote: Moderators of response to a novel self-management telehealth programme during the COVID-19 pandemic.European journal of pain (London, England) · 2022Article
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- Treatments for kinesiophobia in people with chronic pain: A scoping review.Frontiers in behavioral neuroscience · 2022Article
- Similar Pain Intensity Reductions and Trunk Strength Improvements Following Whole-Body Electromyostimulation vs. Whole-Body Vibration vs. Conventional Back-Strengthening Training in Chronic Non-specific Low Back Pain Patients: A Three-Armed Randomized Controlled Trial.Frontiers in physiology · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundFear of pain and movement is an important factor in the development of hypervigilance and avoidance behaviours.
objectiveWe examined the effectiveness of exercise training on improving fear-avoidance beliefs.
methodsA systematic review (data sources: MEDLINE, CINAHL, SPORTDiscus, EMBASE, CENTRAL) and metaanalysis of randomised controlled/clinical trials of exercise training in adults versus relevant nonexercise comparators that quantified fear-avoidance was conducted.
resultsAfter screening 4603 identified records, 17 (2014 participants) and 13 (1152 participants) studies were eligible for qualitative and quantitative synthesis, respectively. Pairwise meta-analysis showed exercise training was more effective than all non-exercise comparators (standardised mean difference (SMD) [95% CI] - 0.378 [- 0.623, - 0.133], P = 0.002, Grading of Recommendations Assessment, Development and Evaluation [GRADE]: very low) for reducing fear-avoidance. Exercise training was more effective than true control for reducing fear avoidance (- 0.407 [- 0.750, - 0.065], P = 0.020, GRADE: very low), however it was not more effective than other interventions (- 0.243 [- 0.614, 0.128], P = 0.199, GRADE: very low). In people with low back pain, exercise training was more effective than non-exercise comparator groups for reducing fear-avoidance (- 0.530 [- 0.755, - 0.304], P < 0.001, GRADE: very low). For individuals with neck pain, exercise training was not more effective than non-exercise comparator groups for reducing fear-avoidance (0.061 [- 0.360, 0.482], P = 0.777, GRADE: very low).
conclusionThere is very low to low-quality evidence that exercise training is effective for reducing fear-avoidance, including in people with low back pain. Exercise training may be more effective than no intervention for reducing fear avoidance, but there is very low-quality evidence that non-exercise interventions are as effective as exercise for fear avoidance. Few studies with low risk of bias is a limitation. TRAIL REGISTRATION: PROSPERO Registration Number: CRD42019139678.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.