Review Article

https://doi.org/10.12965/jer.1836406.205 Journal of Exercise Rehabilitation 2018;14(6):902-910

Effect of aerobic exercise in the treatment of myofascial

pain: a systematic review
Sara Ahmed1, Shereen Khattab2, Chris Haddad3, Jessica Babineau4, Andrea Furlan1, Dinesh Kumbhare1,*
1
Department of Medicine, University of Toronto, Toronto, ON, Canada
2
Department of Psychology, McMaster University, Hamilton, ON, Canada
3
Department of Physical Education & Kinesiology, University of Toronto, Toronto, ON, Canada
4
Department of Library & Information Services, University Health Network – Toronto Rehabilitation Institute, Toronto, ON, Canada

Myofascial pain is prevalent chronic pain disorder that is comorbid with aerobic exercise program on myofascial pain in breast cancer patients.
many conditions. Strengthening and stretching exercises are capable Visual analogue scale pain intensity ratings and the number of myofas-
of inducing hypoalgesic effects in people with myofascial pain syndrome. cial trigger points present in the neck and shoulder/axillary area of par-
The goal of this systematic review was to summarize the effects of aer- ticipants significantly decreased in the exercise group compared to
obic exercise on the management of myofascial pain. A comprehensive those in the control group. Pain pressure thresholds significantly in-
database search was conducted. A total of 1,331 articles were identified creased in muscle areas of the cervical spine in the water exercise group.
for review. One article was eligible for inclusion after full screening. Risk Aerobic exercise presents a potential treatment modality for managing
of bias was assessed using the Downs and Black quality assessment myofascial pain. Additional research is necessary.
questionnaire (1998). Mean difference scores were calculated for con-
tinuous variables. The identified study had a low risk of bias. It was a Keywords: Myofascial pain, Exercise therapy, Myofascial pain syn-
randomized controlled trial assessing the influence of an 8-week water drome, Physical education and training

INTRODUCTION (Srbely et al., 2010).

Currently, the most effective methods for managing myofascial
Myofascial pain syndrome (MPS) is a prevalent chronic pain pain aim to treat MTrPs, as they are the primary triggers of gen-
disorder affecting approximately 85% of patients in pain clinics eralized and referred pain in myofascial pain disorders. Common
and 9% of the patient population in internal medicine clinics interventions include a combination of stretching and strengthen-
(Gerwin, 2001). At some time in their lives, 85% of the general ing exercises, dry needling, and injections of local anaesthetics
population presents with myofascial pain (Simons, 1996). Myofas- and/or corticosteroids into MTrPs, which work to overcome the
cial pain is characterized by myofascial trigger points (MTrPs), energy crisis within a trigger point (Gerwin, 2014). MTrPs re-
which are localized hyperirritable taut bands of skeletal muscle ceive poor oxygen and energy supplies from the blood due to their
(Lavelle et al., 2007). Hypotheses in the literature suggest that contracted state. Low oxygen and energy availability contributes
trigger points are induced by central and peripheral sensitization further to the maintenance of the contracted state within the
states as well as systemic inflammation (Fernández-de-las-Peñas MTrP, as adenosine triphosphate and oxygen are required to relax
and Dommerholt, 2014). Central sensitization is also thought to a muscle. The goal of myofascial pain interventions is to increase
induce MTrP formation due to neuroplasticity within the dorsal blood flow to the trigger point, which diffuses pro-inflammatory
horn that is associated with chronic peripheral nociceptive input markers and brings metabolic resources to the trigger point. This

*Corresponding author: Dinesh Kumbhare https://orcid.org/0000-0003-3889-7557 This is an Open Access article distributed under the terms of the Creative Commons At-
Department of Medicine, Division of Physical Medicine and Rehabilitation, tribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/)
Toronto Rehabilitation Institute, 550 University Ave, Suite 7-131, Toronto, which permits unrestricted non-commercial use, distribution, and reproduction in any
medium, provided the original work is properly cited.
ON M5G 2A2, Canada
Tel: +1-416-597-3422, Fax: +1-416-597-7074, E-mail: [email protected]
Received: May 9, 2018 / Accepted: June 11, 2018
Copyright © 2018 Korean Society of Exercise Rehabilitation 902 http://www.e-jer.org pISSN 2288-176X
eISSN 2288-1778
Ahmed S, et al. • Aerobic exercise for the treatment of MP

attenuates pain, reduces inflammation, and can reduce or resolve · Meet criteria for MTrP detection as agreed upon in the litera-
the trigger point (Ortega et al., 2009; Shah and Gilliams, 2008). ture (Kumbhare et al., 2017; Rivers et al., 2015).
Aerobic exercise achieves this effect by increasing blood pressure, A tender spot is found within palpation, with or without refer-
flow and blood oxygen saturation allowing for more blood and ral of pain (trigger point); recognition of symptoms by patient
metabolic substrates to enter the MTrP. during palpation of tender spot; at least three of the following:
Aerobic exercise also provides many benefits against central ·M  uscle stiffness of spasm.
sensitization. It is capable of inducing hypoalgesia by increasing · L imited range of motion of an associated joint.
pain pressure thresholds in muscle tissue (Drury et al., 2004; Kol- ·P  ain worsens with stress.
tyn et al., 2014; Ristic and Ellrich, 2015; Vaegter et al., 2014). In · Palpation of taut band and/or nodule associated with a tender
patients with fibromyalgia, aerobic exercise has been shown to re- spot.
duce circulating levels of pro inflammatory markers such as inter-
leukin (IL)-6 and IL-8 to normal levels and can also reduce sub- Exclusion criteria for participants
stance P, which strengthening exercise is not capable of inducing ·P
 atients with inflammatory arthropathies and osteoarthritis.
(Mork et al., 2010; Wang et al., 2008). Aerobic exercise also pro- ·P
 atients chronic widespread pain.
motes the production of anti-inflammatory cytokines such as IL-10 ·P
 atients with radiculopathy or other neurological disorders.
and decreases in insulin like growth factor 1 (Haydar et al., 2000; ·P
 aediatric populations.
Irwin et al., 2009; Ortega et al., 2009). It potentiates the release
of endogenous opioids, catecholamines, endocannabinoids, and Types of interventions
endomorphins, which are all substances capable of inducing hypo- · Aerobic exercise of any intensity (i.e., swimming, walking,
algesia (Dishman and O’Connor, 2009; McMurray et al., 1987). running).
Therefore, aerobic exercise may modulate central sensitization mech- · Minimum duration of 4 weeks for intervention (an exercise
anisms, increase pain thresholds, and reduce the formation of intervention of less than 4 weeks is unlikely to induce thera-
MTrPs. Aerobic exercise provides a potential noninvasive and cost peutic benefits (Stroth et al., 2009).
effective alternative or complementary treatment to current man-
agement strategies. Comparison group
The purpose of this systematic review was to identify evidence ·C
 ontrol group: no exercise.
in the literature on the therapeutic benefit of aerobic exercise on ·A
 lternative intervention group: treatments that do not involve
myofascial pain. This review asks the following: Does aerobic ex- exercise (e.g., dry needling, analgesics, cognitive behavioural
ercise mitigate pain, number of MTrPs, and improve overall func- therapy).
tionality in MPS? Results from this study will provide insight
into the specific benefits of aerobic exercise on myofascial pain Outcome measures
management, informing its prescriptive appropriateness. ·P  ain intensity measures (e.g., visual analogue scale, VAS).
·P  ain pressure thresholds using algometry.
MATERIALS AND METHODS ·U  se of analgesics.
· Number of trigger points determined by palpation: active and
Study types latent trigger points were combined because the pathophysiol-
Randomized controlled trials (RCTs) and quasi-RCTs investi- ogy underlying their formation is not fully understood (Ger-
gating the effects of aerobic exercises on myofascial pain were in- win, 2014).
cluded in this review. Only English studies were included. Sys- · Functionality measures (e.g., Roland Morris Disability Ques-
tematic reviews, case control, case reports, and cohort were ex- tionnaire, Neck Disability Index).
cluded. Studies published only as abstracts were also excluded. ·R  ange of motion.

Inclusion criteria for participants Search Methods for the identification of studies
· Patients that present MTrPs. A comprehensive database search was conducted by an Infor-
· Presence of MTrPs confirmed by expert diagnosis. mation Specialist (JB) in MEDLINE (including MEDLINE ePub

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Ahmed S, et al. • Aerobic exercise for the treatment of MP

Ahead of Print, In-Process, and Other Non-Indexed Citations), pha of 0.05. The I2 test for heterogeneity was used when applica-
Embase, the Cochrane CENTRAL Register of Controlled Trials, ble; with <25% representing low heterogeneity, 25% to 50%
and Web of Science. Searches in each database were conducted representing moderate heterogeneity, and over 50% representing
from inception of the database to November 2016. The search high heterogeneity. Clinical and methodological variability were
strategy included a variety of subject headings (e.g., MeSH) and assessed to determine sources of heterogeneity. Clinical variables
text words to describe “myofascial pain syndrome” and “exercise.” may include age, duration of pain, and sex of patients. Method-
Searches were limited to English language papers, and to a human ological variables could include duration of exercise intervention,
population when possible. The full MEDLINE search can be re- type of aerobic exercise, randomization, and blinding of assessors.
viewed in Appendix. Duplicates were removed using the citation
software Endnote. RESULTS
Data collection There were 1,331 articles detected by our systematic search af-
Two reviewers independently assessed the resultant articles ter the removal of duplicates. Twenty-three articles were eligible
from the systematic search. The strategy used during the initial for a full screen after the assessment of titles and abstracts using
screening was to obtain titles and abstracts relevant to the review. the inclusion and exclusion criteria. Only one study was eligible
Studies that did not pass the inclusion criteria were discarded and for inclusion from these articles, the remaining 22 articles did not
those that fulfilled the criteria remained for a full text screening. utilize an aerobic exercise intervention but rather strengthening
A third reviewer CH resolved conflicts. Once conflicts were re- and stretching exercises, or a combination of both. Fig. 1 outlines
solved, reviewers SA and SK screened the full text articles and de- the Preferred Reporting Items for Systematic Reviews and Me-
termined those to be included in the review. The same reviewers ta-Analyses flow diagram of the search.
extracted data independently using standard data extraction The study done by Cantarero-Villanueva et al. (2012) was the
forms. Where more than one publication of one trial existed, only only study that met our inclusion/exclusion criteria. This RCT as-
the publication with the most complete data was included. sessed the impact of aerobic swimming exercise supplemented
with strengthening and stretching exercises in breast cancer pa-
Risk of bias tients with MTrPs and cervical and shoulder-axillary pain. Pa-
Reviewers assessed the risk of bias within studies independent- tients who have undergone a mastectomy, were not on any treat-
ly, without blinding to authorship or journal. The Downs and ment except hormone therapy, and had myofascial pain were in-
Black (1998) checklist for methodological quality in randomized cluded. Seventy patients were enrolled in the study after a 90%
and non-randomized studies of healthcare interventions was used powered analysis. Four subjects were excluded prior to the inter-
to assess the following measures: selection, performance, measure- vention and the reason was not provided. Sixty-six patients were
ment, validity, attrition, reporting of data, and statistical power. equally randomized using computer-generated numbers into two
groups, a water exercise intervention or a control group. One par-
Statistical analysis ticipant did not complete the intervention and the reason was not
The effect measures chosen were risk ratios for dichotomous provided. The intervention group engaged in a water exercise
outcomes and mean differences (MD) or standardized mean differ- program three times a week for eight consecutive weeks. Each ses-
ences (SMD) for continuous data. Uncertainty was expressed using sion was held in a warm pool for one hour. The first 10 min was
95% confidence intervals. Cohen criteria was used to determine warm up which consisted of slow aerobic movements and stretch-
the effect size of SMDs, where a SMD between 0.2 to 0.5 is small, ing. The next 35 min consisted of low intensity endurance and
and a SMD between 0.5 to 0.8 is moderate, and a SMD above 0.8 core stability training. The final 15 min were a cool down period
is large. SMDs below 0.2 were considered unsubstantial. Pooled along with neck and shoulder stretching and relaxation exercises.
data would be synthesized using a fixed-effects model for certain Patient outcomes were assessed at baseline and after the 8-week
dichotomous data and a random-effects model for all continuous intervention. The study outcomes were (a) VAS scores for neck
data. Whenever possible, we would compare fixed-effects and ran- and shoulder-axillary pain, (b) pressure pain threshold in the af-
dom-effects if there was data. fected and unaffected sides of the zygapophyseal joints, deltoid,
The chi-square test was used to assess heterogeneity with an al- second metacarpal, and tibialis anterior muscles, (c) number and

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Ahmed S, et al. • Aerobic exercise for the treatment of MP

PRISMA 2009 Flow Diagram

Records identified through

database searching (n = 1,747)

Identification
·M EDLINE, MEDLINE in process and
other nonindexed citations (n = 792)
· Embase (n = 299) Additional records identified
· Cochrane CENTRAL (n = 151) through other sources
· Web of Science (n = 505) (n = 0)
Screening

Records after duplicates removed

(n = 1,331)

Records met exclusion

Records screened
criteria
(n = 171)
(n = 1,160)
Eligibility

Full-text articles excluded,

Full-text articles assessed with reasons
for eligibility (n = 22)
(n = 23)
22 Articles did not
Included

administer the target

Studies included in intervention
qualitative synthesis
(n = 1)

Fig. 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. Adapted from Moher et al. (2009).

location of active and latent trigger points in the affected and un- ticipants were asked about their physical activity during the study
affected sides of the upper trapezius, levator scapulae, scalene, pec- period to ensure their physical activity did not equal or exceed
toralis major, and infraspinatus muscles. that of the intervention group. The sample size was adequate since
a minimum of fifteen participants were required in each group to
Risk of bias assessment achieve a power of 90%, however 32 and 33 individuals were in
According to Downs and Black’s (1998) checklist for method- the intervention and control group, respectively. Thus the study
ological quality in randomized and non-randomized studies of was sufficiently powered.
healthcare interventions the study of Cantarero-Villanueva et al.
(2012) study was determined to have low risk of bias, except for Effects of interventions
some risk of performance bias. This was due to the lack of clarity This RCT compared pain (by VAS), pain pressure thresholds,
to whether investigators where blinded from the intervention as- and number of MTrPs in the cervical and shoulder area of breast
signment. The authors clearly reported their aim, outcome mea- cancer survivors with neck and shoulder-axillary pain before and
sures and methods, patient characteristics, intervention, con- after a water exercise intervention. The authors reported signifi-
founders, results, and attrition. Accordingly, the external validity cant changes in all three outcomes after the exercise intervention.
of the study was adequate. The study contained consecutive pa- Tables 1 and 2 summarize the results of the study.
tients attending the Breast Oncology Unit of the Hospital Virgen There were significant differences in pain intensity scores after
de las Nieves and Hospital Clínico San Cecilio, Granada (Spain) the water exercise intervention in the neck and shoulder/axillary
from June 2010 to September 2011. Randomization procedures area between participants in the water exercise group and the con-
were computer generated. Only assessors were blinded to the in- trol group. There was variability in the observed pain pressure
tervention since patients were receiving an overt treatment. Pa- thresholds between participants in the water exercise group and
tient compliance was adequately measured. Patients in the treat- the control group. The authors reported significant pain pressure
ment group completed 85% of the exercise sessions. Control par- threshold differences between the water exercise group and the

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Ahmed S, et al. • Aerobic exercise for the treatment of MP

Table 1. Mean difference scores for visual analogue scale (VAS) scores and Table 2. Number of myofascial trigger points in the water exercise and control
pain pressure thresholds in the water exercise and control groups before and groups before and after the exercise treatment
after treatment
Variable Preintervention Postintervention
Mean difference Affected upper trapezius muscle
Variable Preintervention Postintervention
(95% CI)
Water exercise group 18 5
Change in VAS scores Control group 18 19
Neck pain Unaffected upper trapezius muscle
Water exercise group 40± 31 12± 15 -30 (-25 to -35) Water exercise group 19 5
Control group 39± 21 42± 23 Control group 14 14
Shoulder/axillary pain Affected sternocleidomastoid muscle
Water exercise group 27± 33 12± 13 - 31 (-25 to -37) Water exercise group 9 1
Control group 38± 35 43± 33 Control group 10 16
Change in pain pressure thresholds Unaffected sternocleidomastoid muscle
C5–6 zygapophyseal joint Water exercise group 9 3
Water exercise group 156.0± 65.8 174.0± 63.5 20.3 (34.1 to 6.5) Control group 6 11
affected
Affected infraspinatus muscle
Control group affected 163.4± 62.7 153.7± 49.7
Water exercise group 10 3
C5–6 zygapophyseal joint
Control group 16 16
Water exercise group 167.4± 66.3 167.3± 62.4 3.6 (17.8 to -10.6)
unaffected Unaffected infraspinatus muscle
Control group 181.9± 61.8 163.7± 54.1 Water exercise group 10 2
unaffected Control group 12 13
Affected deltoid muscle Affected scalene muscle
Water exercise group 181.4± 76.8 206.9± 66.8 -6.7 (9.9 to -23.3) Water exercise group 24 6
Control group 194.6± 111.4 213.6± 69.3 Control group 18 17
Unaffected deltoid muscle Unaffected scalene muscle
Water exercise group 191.6± 83.3 212.6± 61.1 -10.5 (4.3 to -25.3) Water exercise group 14 4
Control group 223.4± 77.7 223.1± 60.4 Control group 6 2
Affected second metacarpal Affected pectoralis major muscle
Water exercise group 210.4± 65.9 243.8± 83.8 22.1 (40.5 to 3.7) Water exercise group 25 10
Control group 234.4± 81.1 221.7± 66.9 Control group 21 27
Unaffected second metacarpal Unaffected pectoralis major muscle
Water exercise group 242.3± 66.3 255.2± 72.6 6.4 (22.3 to -9.5) Water exercise group 4 1
Control group 233.1± 80.9 248.8± 57.7 Control group 6 2
Affected tibialis anterior muscle Affected infraspinatus muscle
Water exercise group 261.2± 108.6 259.4± 82.1 -52.8 (-32.0 to -73.6) Water exercise group 12 2
Control group 293.3± 83.8 312.2± 88.5 Control group 12 18
Unaffected tibialis anterior muscle Unaffected infraspinatus muscle
Water exercise group 275.4± 112.5 268.5± 101.7 -48.6 (-26.9 to -70.3) Water exercise group 8 0
Control group 302.9± 92.1 317.1± 75.4 Control group 5 11

Values are presented as mean± standard deviation unless otherwise indicated.

CI, confidence interval. nificant decrease in trigger points after the intervention. Cantare-
ro-Villanueva et al. (2012) reported only mean number of MTrPs
control group after the intervention zygapophyseal joint and no and no variability measures, thus MD scores could not be calcu-
other areas. lated.
The authors reported significantly less active MTrPs in the wa-
ter exercise group after the intervention in all affected muscle ar- DISCUSSION
eas but the sternocleidomastoid muscle. The experimental group
also had a greater reduction in the number of MTrPs relative to One RCT met the inclusion criteria for this study. The study
the control group. In all unaffected muscles areas, there was sig- by Cantarero-Villanueva et al. (2012) was adequately powered,

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Ahmed S, et al. • Aerobic exercise for the treatment of MP

well controlled, accounted for potential confounders, and had low people with myofascial pain.
attrition providing reliable results. The results suggest that water This systematic review provides the first review assessing the
based aerobic exercise is an effective treatment for myofascial pain. benefits of aerobic exercise on MPS. The systematic search for this
Patients had significantly lower neck and shoulder-axillary pain review was extensive, encompassing a wide range of exercise terms
after the intervention as well as higher pain pressure thresholds and four scientific and medical databases were used to locate arti-
over the cervical spine. The number of MTrPs was significantly cles studying the effect of this intervention. Only one study (Can-
reduced among participants in the aerobic exercise treatment tarero-Villanueva et al., 2012) met our inclusion and exclusion
group after the intervention relative to the control group. Results criteria. It had a low risk of bias, presenting strong evidence for
from this study indicate that aerobic exercise may be modulating the potential utility of aerobic exercise as a non-pharmacological
central sensitization mechanisms thereby reducing or preventing intervention for MPS. Several outcome measures were assessed in
the formation of MTrPs. this study, which provided insight into the specific effects aerobic
These findings present effects similar to those found in the lit- exercise may have on myofascial pain, namely the pain intensity
erature on strengthening exercise and myofascial pain. Isometric (VAS), pain pressure thresholds, and the number of MTrPs. There
strengthening exercises have been shown to reduce VAS pain is a need to identify feasible and economical treatments that im-
scores and disability indices in MPS (Acar and Yilmaz, 2012; prove the well-being and quality of life in people living with
Buttagat et al., 2016; Cho et al., 2012; Trampas et al., 2010). The MPS. Cantarero-Villanueva et al. (2012) findings provide evidence
benefits received from these interventions suggest that exercise that aerobic exercise is an effective and practical intervention.
may be increasing blood supply and metabolic resources to MTrPs Several limitations are present when conducting this review.
possibly through the mechanical displacement of muscle fibres. Utilizing palpation to detect MTrPs has poor inter-rater reliabili-
Strengthening and aerobic exercises probably results in local in- ty, and thus may have influenced the MTrP count reported by
creases in blood pressure with improvement in blood flow to re- Cantarero-Villanueva et al. (2012). Their study used one unblend-
sistant areas. This may improve the increased resistance of the vas- ed assessor to perform the MTrP count. There is the risk of expec-
cular bed that characterizes the MTrP (Ballyns et al., 2011; Sikdar tation bias with this approach. However, this could have mitigat-
et al., 2009; Turo et al., 2013). ed the poor interrater reliability associated with palpation if the
In this study, pain pressure thresholds increased only in the cer- assessor was accurate at detecting MTrPs. However, if the accuracy
vical spine muscles of the water exercise group. This muscle group was low or variable the reported outcomes may have been biased.
is utilized extensively during water-based activities and therefore Another limitation was that the studies included in this review
may have been strengthened to a greater extent than other muscle were English language publications only, which may have pro-
groups. This is potentially the explanation for the increased pain duced further bias. A final limitation was that only one article was
threshold observed in the cervical area. Several studies investigat- identified limiting the conclusions on the effects of aerobic exer-
ing the effects of strengthening exercises on muscle groups associ- cise on myofascial pain.
ated with MPS have also reported similar results (Buttagat et al., Despite these limitations, the risk of bias in this study was low,
2016; Trampas et al., 2010). Buttagat et al. (2016) found signifi- which lends to the strength of its conclusions. No intervention re-
cant improvements in pain intensity and pain pressure thresholds lated adverse effects were reported in this study. Therefore, clini-
after patients with myofascial pain in the scapular area were ad- cians may consider recommending aerobic exercise to help man-
ministered scapular stabilizing exercises. Trampas et al. (2010) age patients’ myofascial pain symptoms. Based on the available
also found increases in pain pressure thresholds after strengthen- evidence, aerobic exercise in combination with strengthening and
ing exercise but no reduction in the number of trigger points stretching exercises would be effective at managing myofascial
present. These studies suggest that aerobic exercise and strength- pain due to their complementary effects on pain mitigation, re-
ening exercise influence different but complementary mechanisms duction of trigger point formation, and increasing pain tolerance.
to alleviate myofascial pain. Aerobic exercise may reduce the pres- The appropriate exercise prescription should be personalized and
ence of generalized pain and number of MTrPs, whereas strength- observe any specific patient related contraindications. Further re-
ening exercises may provide additional support to affected muscle search is necessary to elucidate the effects of aerobic exercise alone
groups and increase pain tolerance. More studies are needed to as- or in combination with other types of exercise or treatment meth-
sess outcomes and mechanisms influenced by aerobic exercise in ods such as dry needling on MPS. Furthermore, future research

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Ahmed S, et al. • Aerobic exercise for the treatment of MP

should investigate the benefits of aerobic exercise on the patho- cise-induced hypoalgesia after isometric and cardiovascular exercise. J
physiological mechanisms of myofascial pain, such as assessing in- Exerc Physiol 2004;7:1-5.
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CONFLICT OF INTEREST Irwin ML, Varma K, Alvarez-Reeves M, Cadmus L, Wiley A, Chung GG,
Dipietro L, Mayne ST, Yu H. Randomized controlled trial of aerobic
No potential conflict of interest relevant to this article was re- exercise on insulin and insulin-like growth factors in breast cancer
ported. survivors: the Yale Exercise and Survivorship study. Cancer Epidemi-
  ol Biomarkers Prev 2009;18:306-313.
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Ahmed S, et al. • Aerobic exercise for the treatment of MP

Appendix 1. MEDLINE search strategy

Database: Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R)
<1946 to Present>
Search strategy:
1 exp Myofascial Pain Syndromes/
2 exp Temporomandibular Joint Disorders/
3 ‘myofascial pain syndrome*’.tw,kw.
4 synalg*.tw,kw.
5 (myofascia* adj6 pain* adj6 syndrome*).tw,kw.
6 (myofascia* and [‘trigger point*’ or trigger-point*]).tw,kw.
7 (pain* adj6 myofascia*).tw,kw.
8 or/1-7
9 exp Exercise/
10 exp Exercise Therapy/
11 exp Exercise Movement Techniques/
12 Physical Fitness/
13 exp “Physical Education and Training”/
14 (exercise* or exercising).tw,kw.
15 (gi gong or gigong).tw,kw
16 ([tai adj ji] or [(tai or thai) adj chi] or taiji or taijiquan or taichi).tw,kw.
17 walking.tw,kw.
18 yoga.tw,kw.
19 (physical adj [fitness or condition* or education or training or mobility or activit* or exertion or effort]).tw,kw.
20 gymnastic*1.tw,kw.
21 calisthenics.tw,kw.
22 aerobic*1.tw,kw.
23 danc*.tw,kw.
24 (jumping or hopping).tw,kw.
25 (running or jogging).tw,kw.
26 ambulat*.tw,kw.
27 muscle strengthening.tw,kw.
28 ((strength or resistance) adj training).tw,kw.
29 ((weight*1 adj2 lifting) or weightlifting or power lifting or weight training).tw,kw.
30 pilates.tw,kw.
31 stretching.tw,kw.
32 plyometric*.tw,kw.
33 (cardio* adj conditioning).tw,kw.
34 ((physical or motion or movement or recreation or activity) adj therap*).tw,kw.
35 isometric training.tw,kw.
36 climbing.tw,kw.
37 cycling.tw,kw.
38 (swim or swimming).tw,kw.
39 (training adj (course* or program*)).tw,kw.
40 kinesi?therap*.tw,kw.
41 exp Sports/

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