What is the clinical evidence from this study?

Study design: Cohort. Population: Chronic pain (n=18837). Intervention: Estimated cardiorespiratory fitness (eCRF) vs. Lowest quintile of eCRF. Primary outcome: Chronic pain and changes in pain severity (OR 0.56 (women), OR 0.64 (men), 95% CI 0.49-0.64 (women), 0.53-0.78 (men)).

What does this research mean for the field?

Higher estimated cardiorespiratory fitness is associated with lower odds of chronic pain and more favorable longitudinal changes in pain severity in the general population. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

The research aims to explore the relationships between estimated cardiorespiratory fitness and chronic pain, both cross-sectionally and longitudinally.

May 6, 2026Open Access

Cardiorespiratory fitness and pain severity: Longitudinal associations from the general population—The HUNT study

Key Result

Higher estimated cardiorespiratory fitness was associated with lower odds of chronic pain (women: OR 0.56, CI 0.49-0.64; men: OR 0.64, CI 0.53-0.78) and favorable changes in pain severity.

Key Points

The research aims to explore the relationships between estimated cardiorespiratory fitness and chronic pain, both cross-sectionally and longitudinally.
Data from 18,837 adults in the HUNT study were analyzed cross-sectionally and longitudinally over 11 years.
Participants were stratified by baseline pain status: no or mild pain and moderate/severe chronic pain.
Logistic regression was used to calculate odds ratios for chronic pain severity related to levels of cardiorespiratory fitness.
Higher estimated cardiorespiratory fitness was associated with lower odds of chronic pain (women: OR 0.56, 95% CI 0.49-0.64; men: OR 0.64, 95% CI 0.53-0.78).
High baseline and maintained cardiorespiratory fitness showed lower odds of pain worsening in those with no or mild pain.
In participants with chronic pain, maintaining or increasing cardiorespiratory fitness was associated with greater odds of pain reduction.

Study Design

Type

Cohort (n=18,837)

Structured PICO

Does higher estimated cardiorespiratory fitness reduce the odds of chronic pain and prevent pain worsening in the general adult population?

Population

18,837 adults from the general population in Norway (HUNT3 study), including 11,517 with no or mild pain and 5,312 with moderate/severe chronic pain for longitudinal analysis.

Intervention

Higher estimated cardiorespiratory fitness (eCRF) calculated using a validated nonexercise algorithm

Comparator

Lower estimated cardiorespiratory fitness (eCRF)

Outcome

Chronic pain (cross-sectional) and changes in pain severity over 11 years (longitudinal)patient reported

Higher estimated cardiorespiratory fitness is associated with lower prevalence of chronic pain and protects against pain worsening over an 11-year period in the general population.

Main Result

Effect estimate: OR 0.56 (women), OR 0.64 (men) (95% CI 0.49-0.64 (women), 0.53-0.78 (men))

Abstract

Introduction: Reduced cardiorespiratory fitness (CRF) is associated with chronic pain, but longitudinal population-based evidence is limited. Whether CRF can prevent pain worsening or promote improvement is unclear. Objective: This study investigated (1) the cross-sectional association between estimated CRF (eCRF) and chronic pain, (2) the longitudinal association between eCRF and changes in pain severity over 11 years, and (3) whether changes in eCRF are associated with changes in pain severity. Method: Data were collected from the Trøndelag Health Study (HUNT) in Norway. Cross-sectional analyses included 18,837 adults from HUNT3 (2006-08), and longitudinal analyses followed participants to HUNT4 (2017-19), stratified by baseline pain status: no or mild (n = 11,517) or moderate/severe chronic pain (n = 5312). Cardiorespiratory fitness was estimated using a validated nonexercise algorithm and categorized into sex- and age-specific quintiles. Logistic regression estimated odds ratios with 95% confidence intervals. Results: Cross-sectionally, higher eCRF was associated with lower odds of chronic pain, with the largest difference between the highest and the lowest quintiles (women: OR 0.56, 95% CI 0.49-0.64; men: OR 0.64, 95% CI 0.53-0.78). Longitudinally, among participants with no or mild pain, both high baseline eCRF and maintained high eCRF were associated with lower odds of pain worsening. Among those with chronic pain, maintaining or increasing eCRF was associated with greater odds of pain reduction, whereas high baseline eCRF showed a nonsignificant trend in the same direction. Conclusion: Higher eCRF was associated with lower odds of chronic pain and with more favorable changes in pain severity in the general population.