How Aerobic Exercise Reduces Pain Sensitization (What Pilates Instructors Should Know)

Chronic musculoskeletal pain is extremely common—about one in three people deal with it. For those with conditions like osteoarthritis, low back pain, or neck pain, pain sensitization can make things even worse. This happens when the nervous system goes into overdrive, making even small aches feel way more intense than they should.

Traditional treatments like pain meds and antidepressants can come with side effects and don’t always offer lasting relief. But here’s some good news: aerobic exercise might be one of the best tools we have for managing pain naturally.

For Pilates instructors working with clients in pain, understanding pain sensitization is essential for applying evidence-informed, clinical Pilates approaches.

What the Research Says About Aerobic Exercise and Pain Sensitization

A 2022 systematic review looked at whether aerobic exercise can reduce pain sensitization in people with musculoskeletal pain. It included 11 studies that tested different types of aerobic activity—like walking and cycling—to see if they made a difference in pain perception. Pain sensitization was measured with validated tools (not just “I feel better” reports), so the findings were pretty solid.

And the results? Every single study found that aerobic exercise reduced pain sensitivity. On average, people experienced about a 10.6% drop in pain sensitivity right after exercise. That’s a pretty strong case for movement as a way to help “turn down” pain signals in the nervous system.

This is particularly relevant for clinical Pilates and strength-based Pilates, where movement can be used as a tool to improve pain tolerance and function.

Why Aerobic Exercise Helps Reduce Pain

So, why does exercise help? Aerobic activity stimulates the body's natural pain-relief system, activating mechanisms that actually quiet pain signals. It’s like flipping a switch in the nervous system that says, “Hey, let’s chill out on the pain.”

That said, not everyone responds the same way. Some subgroups didn’t find any relief after aerobic exercise. For example those whose back or leg pain worsens with walking, or those with a condition called abnormal conditioned pain modulation - which is a dysfunction in the body’s natural ability to reduce pain perception. 

How Much & What Type of Exercise Works?

Here’s the great part: you don’t have to go all out to see benefits. The systematic review found that both single workouts and ongoing exercise programs worked, with durations ranging from as little as four minutes to an hour. The key takeaway? Aerobic exercise doesn’t have to be high-intensity or exhausting. Low-to-moderate intensity movement (think brisk walking, cycling, or swimming) can be just as effective.

And for our Pilates clients? We can apply these findings in really practical ways. For Pilates instructors, this is a simple way to integrate evidence-based practice into sessions without overcomplicating programming—something I go deeper into inside my Pilates instructor mentorship.

Encouraging clients to integrate some aerobic movement—whether it’s a short walk before or after class, a bit of steady-state work in their sessions, or just getting their heart rate up with flowing sequences—could make a big difference in how they experience pain. Even gentle movement could help regulate their pain response over time.

How to Apply This in Pilates Sessions

For our clients who are dealing with chronic pain, gradually building aerobic capacity—without overwhelming them—can be a game changer. Simple strategies like:

• Encouraging steady, rhythmic movement in sessions

• Adding a short aerobic warm-up (marching, easy jumping, flowing sequences)

• Recommending light walking or cycling on rest days

  
  

These are things that can all help reinforce the benefits of aerobic exercise without making it feel like a chore. This approach supports clients with chronic pain, injuries, and other special populations by gradually improving their tolerance to movement and load.

Final Thoughts

Pain sensitization can significantly impact daily life, but aerobic exercise is a simple, science-backed way to help. As Pilates instructors, we have an opportunity to integrate this knowledge into our sessions and encourage clients to embrace movement as part of their pain management toolkit. When we shift the focus from fear to capability, we empower our clients to move with confidence and, ultimately, feel better in their bodies.

Research taken from: “Does aerobic exercise effect pain sensitisation in individuals with musculoskeletal pain? A systematic review PMID: 35114987”

Want to watch a full research review that dives deep into the paper and explains all it's findings?

Join the Pilates Teachers Community for a free 2-week trial! Inside, you’ll find:

• Evidence-based workshops on clinical Pilates, pain, and injuries

• Teachers Workouts to enhance your personal practice + downloadable class program PDF

• In-depth reviews of the latest research in clinical Pilates, pain science, and strength-based training

• A library full of studio Pilates and Strength classes

• Coaching Calls

• A supportive community of like-minded instructors.

  
  

Let’s become better teachers together.

Sign Up 2 Week Free Trial 👉