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Should exercise therapy for chronic musculoskeletal conditions focus on the anti-inflammatory effects of exercise?
  1. J Runhaar1,
  2. S M A Bierma-Zeinstra1,2
  1. 1Department of General Practice, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
  2. 2Department of Orthopaedics, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
  1. Correspondence to Dr J Runhaar, Department of General Practice, Erasmus University Medical Center Rotterdam, Room NA 1906, PO Box 2040, 3000 CA Rotterdam, The Netherlands; j.runhaar{at}erasmusmc.nl

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Over the past decades, the role of low-grade systemic inflammation has been acknowledged in several chronic musculoskeletal conditions.1 For many of these musculoskeletal conditions, exercise therapy is one of the most effective non-surgical and non-pharmacological treatments and the recommended treatment of first choice.1 ,2 Most guidelines do not provide specific guidance on the content of the exercise therapy, since different modalities of exercise therapy show comparable effectiveness. This highlights the lack of knowledge on the possible mechanisms of action of exercise therapy for musculoskeletal conditions and this black box phenomenon makes optimising the positive effects of physical exercise interventions difficult. We therefore possibly do not provide these patients an optimal treatment for their symptoms when prescribing a physical exercise intervention.

The mechanisms of action of exercise therapy

The comparable effectiveness for different modalities of exercise therapy also suggests that systemic effects might be more important than local effects. One such systemic effect might be systemic inflammation. Individuals who are more physically active show lower …

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