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Review
. 2025 May 29;13(6):168.
doi: 10.3390/sports13060168.

Evaluating the Effects of Exercise on Inflammation Markers in Musculoskeletal Pain: A Systematic Review and Meta-Analysis

Chi Ngai Lo  1 , Nicole Elizabeth Jing Wen Wong  2 , Shina Ho  2 , Elicia Jia Hui Ang  2 , Bernard Pui Lam Leung  2
Affiliations
Review

Evaluating the Effects of Exercise on Inflammation Markers in Musculoskeletal Pain: A Systematic Review and Meta-Analysis

Chi Ngai Lo et al. Sports (Basel). .

Abstract

This systematic review and meta-analysis aimed to investigate the effectiveness of exercise interventions in regulating inflammatory biomarkers among individuals with musculoskeletal pain. A comprehensive search of MEDLINE, CINAHL, Web of Science, Cochrane Library, and Google Scholar was conducted from inception to November 2024. Only randomized controlled trials (RCTs) published in English that examined the effects of exercise on inflammatory markers-such as C-reactive protein (CRP), interleukins (ILs), and tumor necrosis factor-alpha (TNF-α)-were included. Twenty-three RCTs involving 1128 participants met the inclusion criteria. Meta-analysis of four studies indicated that isokinetic exercise significantly reduced CRP (MD = -0.40, 95% CI: -0.44 to -0.36, p < 0.01, I2 = 0%), IL-6 (MD = -1.59, 95% CI: -2.61 to -0.56, p < 0.01, I2 = 97%), and TNF-α (MD = -4.24, 95% CI: -5.13 to -3.36, p < 0.01, I2 = 90%) levels compared to general exercise. These findings suggest that exercise, particularly isokinetic exercise, may reduce systemic inflammation in patients with musculoskeletal pain and provide therapeutic effects beyond mechanical improvement. The review followed PRISMA guidelines and was registered on PROSPERO (CRD42024500081).

Keywords: cytokines; exercise; inflammation; musculoskeletal pain.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA flowchart.
Figure 2
Figure 2
Risk of bias assessment.
Figure 3
Figure 3
Risk of bias summary.
Figure 4
Figure 4
(a) A forest plot of the effect of isokinetic exercise and general exercise on CRP levels. (b) A forest plot of the effect of isokinetic exercise and general exercise on IL 6 levels. (c) A forest plot of the effect of isokinetic exercise and general exercise on TNF alpha levels.
Figure 5
Figure 5
Forest plot of effect of exercise on TNF levels.
See this image and copyright information in PMC

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