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

Q: 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 (unfit). Primary outcome: Moderate to severe chronic pain (cross-sectional, highest vs lowest eCRF quintile in women) (OR 0.56, 95% CI 0.49-0.64).

Live Førland Havstad; Astrid Woodhouse; Tormod Landmark; Dorthe Stensvold; B M Nes; Martin Skagseth; Mari Glette

doi:10.1097/pr9.0000000000001447

April 28, 2026PAIN ReportsOpen Access

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

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Key result

Higher cardiorespiratory fitness linked to ~44% lower odds of chronic pain.

OR 0.56
95% CI 0.49-0.64
n=18,837

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Why the study?

Longitudinal population-based evidence linking cardiorespiratory fitness to chronic pain is limited, and whether fitness prevents pain worsening or promotes improvement remains unclear.

Does higher estimated cardiorespiratory fitness prevent or improve chronic pain severity in the general population?

Key Points

To examine cross-sectional associations between estimated cardiorespiratory fitness and chronic pain, as well as 11-year longitudinal associations between fitness levels and changes in pain severity.
Analyzed data from the Trøndelag Health Study (HUNT) in Norway, evaluating 18,837 adults cross-sectionally at HUNT3 (2006–08) and prospectively following participants for 11 years to HUNT4 (2017–19).
Stratified longitudinal analyses by baseline pain status into cohorts with no or mild pain (n = 11,517) and moderate to severe chronic pain (n = 5312).
Estimated cardiorespiratory fitness (eCRF) using a validated nonexercise algorithm categorized into sex- and age-specific quintiles, computing odds ratios via multivariable logistic regression.
Cross-sectionally, the highest versus lowest eCRF quintile had significantly lower odds of moderate to severe chronic pain in women (OR 0.56, 95% CI 0.49–0.64) and men (OR 0.64, 95% CI 0.53–0.78).
Among participants with no or mild baseline pain, the highest fitness quintile in women (OR 0.67, 95% CI 0.57–0.79) and fourth in men (OR 0.69, 95% CI 0.57–0.83) had lower odds of pain worsening; maintaining high fitness across 11 years reduced worsening odds by 32% (OR 0.68, 95% CI 0.59–0.80).
Among participants with moderate to severe baseline pain, maintaining high fitness (OR 1.26, 95% CI 1.04–1.51) or improving from unfit to fit (OR 1.39, 95% CI 1.08–1.80) significantly increased the odds of pain reduction over 11 years.

Study Design

Type

Cohort (n=18,837)

Multicenter

No

Structured PICO

Does higher estimated cardiorespiratory fitness prevent or improve chronic pain severity in the general population?

P

Population

18,837 adults aged 20 and older from the Norwegian general population, followed for 11 years to evaluate the association between estimated cardiorespiratory fitness and changes in chronic pain severity.

E

Exposure

Higher estimated cardiorespiratory fitness (eCRF), categorized into sex- and age-specific quintiles, or maintained/improved high eCRF over 11 years.

C

Comparator

Lower estimated cardiorespiratory fitness (lowest quintile, or remaining unfit).

O

Outcome

Odds of moderate to severe chronic pain cross-sectionally, and changes in pain severity (worsening or improvement of ≥1 point on the 6-point Bodily Pain Scale SF-8) over 11 years.patient reported

Main Result

Odds Ratio: 0.56 (95% CI 0.49–0.64)

Higher estimated cardiorespiratory fitness is associated with lower odds of having chronic pain and with a reduced likelihood of pain worsening over 11 years in the general adult population.

Limitations

The SF-8 pain scale may be prone to floor and ceiling effects and less sensitive to change than continuous instruments.
Potential selection bias towards individuals with favorable psychological and behavioral profiles.
The eCRF algorithm relies on self-reported physical activity, which may lead to overestimation of activity levels.
Attrition and missing data may have resulted in a healthier analytical sample, potentially biasing associations.
The relative ethnic and genetic homogeneity of the HUNT population may limit generalizability to diverse populations.
SF-8 Bodily Pain Scale has only 6 response categories and may be prone to floor and ceiling effects.
Potential selection bias of individuals with more favorable psychological and behavioral profiles.
eCRF nonexercise algorithm includes self-reported physical activity which may lead to overestimation and reflect activity behavior rather than pure fitness.
Attrition and exclusion due to missing data may have resulted in a healthier analytical sample.
Relative ethnic and genetic homogeneity of the HUNT population may limit generalizability.

Implication

May support fitness promotion to mitigate chronic pain; extends cross-sectional observations longitudinally but remains hypothesis-generating pending trials.

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.

Discussion

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Cite This Study

Havstad et al. (2026) conducted a cohort in Chronic pain (n=18,837). Estimated cardiorespiratory fitness (eCRF) vs. Lowest quintile of eCRF (unfit) was evaluated on Moderate to severe chronic pain (cross-sectional, highest vs lowest eCRF quintile in women) (OR 0.56, 95% CI 0.49-0.64). Higher estimated cardiorespiratory fitness was associated with lower odds of chronic pain (OR 0.56 for women, 0.64 for men) and more favorable longitudinal changes in pain severity over 11 years.

synapsesocial.com/papers/69fada7f03f892aec9b1e4b3 https://doi.org/10.1097/pr9.0000000000001447

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

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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