Expectations Impact Exercise-Induced Hypoalgesia: A Blinded Randomized Controlled Trial of High and Low Load Resistance Exercise

ABSTRACT: Miyanji, I, Cajina, HJ, Pain, A, Hanney, WJ, and Anderson, AW. Expectations impact exercise-induced hypoalgesia: A blinded randomized controlled trial of high and low load resistance exercise. J Strength Cond Res XX(X): 000-000, 2026-Exercise has physiological and mental health benefits for musculoskeletal pain. However, the direction and magnitude of pain perception changes after exercise may be influenced by exercise characteristics, such as load, and contextual factors, including patient expectations for pain relief. Although both influence exercise-induced hypoalgesia, prior studies have not examined the combined effects of expectations for pain relief and exercise load. The purpose of this study was to examine the effect of positive or negative expectations on exercise-induced hypoalgesia during a high or low load dynamic resistance exercise. A blinded, randomized controlled trial was conducted in which 60 healthy subjects were randomly assigned to either high exertion exercise (push-ups) with a positive expectation instructional set, low exertion with positive expectation, high exertion with negative expectation, or low exertion with negative expectation. Pressure pain threshold (PPT) was measured over the anterior deltoid (local site) and quadriceps (remote site) pre-/post-exercise. Primary outcomes were changes in PPT at each site by intervention assignment, analyzed using a mixed-model analysis of variance with alpha level for significance set at p < 0.05. Positive expectations significantly increased PPT over the deltoid during high load exercise (p = 0.01), whereas negative expectations significantly decreased PPT at the quadriceps during low load exercise (p = 0.01). Expectations for pain relief and exercise interact, emphasizing the need to consider patient expectations when administering exercise for pain. Strength and conditioning providers may want to consider contextual factors, including expectations, presented in the relationship between coach and client.