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Reduced heart rate variability (HRV) and fatigue are common after COVID-19 infection and both are potentially influenced by physical activity (PA). We compared resting HRV, PA from accelerometers and questionnaires, and self-reported fatigue in 41 COVID-19 survivors (~8 months postinfection, 38 ± 17 years) with 41 matched controls. Differences in HRV were observed on acceleration capacity (p = 0.041), deceleration capacity (p = 0.032), high-frequency peak frequency (p = 0.019), absolute low-frequency power (p = 0.042), relative very low-frequency power (p = 0.012), SD2 (from Poincare plot; p = 0.047), and DFA2 (slope of long-term detrended fluctuation analysis; p = 0.004). Fatigue was greater in COVID-19 survivors (p < 0.001) with no differences in PA. Moderate-vigorous physical activity (MVPA) (Standardized Beta = -0.427, p = 0.003) and steps per day (Standardized Beta = -0.402, p = 0.007) were associated with DFA2 in COVID-19 survivors after controlling for age, sex, and body fat percentage. Fatigue was correlated to less MVPA (Spearman's rho = 0.342, p = 0.031) and fewer steps per day (rho = 0.329, p = 0.038) in COVID-19 survivors, and was indirectly linked to HRV through these PA mediators (Estimate = -0.20; p = 0.040). We present a model showing the complex relations between HRV, PA, and fatigue that provides the foundation for strategies to improve outcomes and rehabilitation after COVID-19 infection., (© 2024 The Authors. Physiological Reports published by Wiley Periodicals LLC on behalf of The Physiological Society and the American Physiological Society.)

Introduction/purpose: The purpose of this study was to determine the following in persons with midportion Achilles tendinopathy (AT): 1) maximal strength and power; 2) neural drive during maximal contractions and contractile function during electrically evoked resting contractions; and 3) whether pain, neural drive, and contractile mechanisms contribute to differences in maximal strength., Methods: Twenty-eight volunteers (14 AT, 14 controls) completed isometric, concentric, and eccentric maximal voluntary contractions (MVCs) of the plantar flexors in a Biodex ™ dynamometer. Supramaximal electrical stimulation of the tibial nerve was performed to quantify neural drive and contractile properties of the plantar flexors. Pain sensitivity was quantified as the pressure-pain thresholds of the Achilles tendon, medial gastrocnemius, and upper trapezius., Results: There were no differences in plantar flexion strength or power between AT and controls (isometric MVC: P = 0.95; dynamic MVC: P = 0.99; power: P = 0.98), nor were there differences in neural drive and contractile function ( P = 0.55 and P = 0.06, respectively). However, the mechanisms predicting maximal strength differed between groups: neural drive predicted maximal strength in controls ( P = 0.02) and contractile function predicted maximal strength in AT ( P = 0.001). Although pain did not mediate these relationships (i.e., between maximal strength and its contributing mechanisms), pressure-pain thresholds at the upper trapezius were higher in AT ( P = 0.02), despite being similar at the calf ( P = 0.24) and Achilles tendon ( P = 0.40)., Conclusions: There were no deficits in plantar flexion strength or power in persons with AT, whether evaluated isometrically, concentrically, or eccentrically. However, the mechanisms predicting maximal plantar flexor strength differed between groups, and systemic pain sensitivity was diminished in AT., Competing Interests: CONFLICT OF INTEREST AND SOURCE OF FUNDING There are no conflicts of interest to report.

Objective: Exercise is recommended as a main treatment in fibromyalgia. However, many people have limited exercise tolerance and report exacerbated pain and fatigue during and following a bout of exercise. This study examined the local and systemic changes in perceived pain and fatigue during exercise and through the 3-day recovery following isometric and concentric exercises in people with and without fibromyalgia., Methods: Forty-seven participants with a physician diagnosis of fibromyalgia (44 women; mean age [SD] = 51.3 [12.3] years; mean body mass index [SD] = 30.2 [6.9]) and 47 controls (44 women; mean age [SD] = 52.5 [14.7] years; mean body mass index [SD] = 27.7 [5.6]) completed this prospective, observational cohort study. A bout of submaximal resistance exercise (isometric and concentric) was performed localized to the right elbow flexors on 2 separate days. Baseline attributes (pain, fatigue, physical function, physical activity, and body composition) were assessed prior to exercise. Primary outcomes were: change in perceived pain and fatigue (0 to 10 on the visual analog scale) in the exercising limb and whole body during recovery with movement (immediately, 1 day following exercise, and 3 days following exercise). Secondary outcomes were perceived pain and exertion during exercise performance and pain and fatigue at rest during recovery., Results: Following a single bout of isometric or concentric exercise, there was increased perceived pain (ηp2 = 0.315) and fatigue (ηp2 = 0.426) in the exercising limb, which was greater in people with fibromyalgia (pain: ηp2 = 0.198; fatigue: ηp2 = 0.211). Clinically, relevant increases in pain and fatigue during exercise and through the 3-day recovery occurred in individuals with fibromyalgia only. Concentric contractions led to greater perceived pain, exertion, and fatigue during exercise compared with isometric exercise for both groups., Conclusions: People with fibromyalgia experienced significant pain and fatigue in the exercising muscle during recovery from low-intensity and short-duration resistance exercise, with greater pain during concentric contractions., Impact: These findings highlight a critical need to assess and manage pain and fatigue in the exercising muscles of people with fibromyalgia up to 3 days following a single bout of submaximal resistance exercise., Lay Summary: If you have fibromyalgia, you might have significant pain and fatigue up to 3 days following an exercise bout, with the pain and fatigue localized to the exercising muscles and no changes in whole-body pain., (© The Author(s) 2023. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: National strategies from North America call for substantive improvements in entry-level pain management education to help reduce the burden of chronic pain. Past work has generated a valuable set of interprofessional pain management competencies to guide the education of future health professionals. However, there has been very limited work that has explored the development of such competencies for individual professions in different regions. Developing profession-specific competencies tailored to the local context is a necessary first step to integrate them within local regulatory systems. Our group is working toward this goal within the context of entry-level physiotherapy (PT) programs across Canada., Aims: This study aimed to create a consensus-based competency profile for pain management, specific to the Canadian PT context., Methods: A modified Delphi design was used to achieve consensus across Canadian university-based and clinical pain educators., Results: Representatives from 14 entry-level PT programs (93% of Canadian programs) and six clinical educators were recruited. After two rounds, a total of 15 competencies reached the predetermined endorsement threshold (75%). Most participants (85%) reported being "very satisfied" with the process., Conclusions: This process achieved consensus on a novel pain management competency profile specific to the Canadian PT context. The resulting profile delineates the necessary abilities required by physiotherapists to manage pain upon entry to practice. Participants were very satisfied with the process. This study also contributes to the emerging literature on integrated research in pain management by profiling research methodology that can be used to inform related work in other health professions and regions., Competing Interests: The nature of participatory research is that stakeholders are participants and are expected to have investments in the area researched; this investment is part of the research process. Consistent with this approach to research, the majority of the authors are university lecturers or professors focusing on pain education and receive a salary for this work. In addition, the following authors report financial compensation and/or royalties related to their work in pain education outside of their academic positions: DW, YTL, LS, MHB, RF, NP, and TW., (© 2022 The Author(s). Published with license by Taylor & Francis Group, LLC.)

Purpose: Pain relief after exercise, exercise-induced hypoalgesia (EIH), is established across the lifespan. Conditioned pain modulation (CPM: pain inhibits pain) may be a mechanism for EIH., Methods: In 55 adolescents, pressure pain thresholds were measured before and after exercise (deltoid, quadriceps, and nail bed) and during CPM at the nail bed and deltoid test stimulus sites. The relationship between EIH and CPM was explored., Results: EIH occurred at deltoid and quadriceps; CPM occurred at nail bed and deltoid. CPM and EIH correlated at deltoid; adolescents with greater CPM experienced greater pain relief after exercise. At this site, CPM predicted 5.4% of EIH. Arm lean mass did not add a significant effect. Peak exercise pain did not influence EIH. Adolescents with none, minimal, moderate, or severe peak exercise pain experienced similar EIH., Conclusions: A potential relationship exists between CPM and EIH in adolescents. Pediatric physical therapists should consider the CPM response when prescribing exercise as a pain management tool., Competing Interests: Statement: The authors declare no conflict of interest.

Introduction: Pain reports are greater with increasing weight status, and exercise can reduce pain perception. It is unknown, however, whether exercise can relieve pain in adolescents of varying weight status. The purpose of this study was to determine whether adolescents across weight status report pain relief after high-intensity aerobic exercise (exercise-induced hypoalgesia (EIH))., Methods: Sixty-two adolescents (15.1 ± 1.8 yr, 29 males) participated in the following three sessions: 1) pressure pain thresholds (PPT) before and after quiet rest, clinical pain (McGill Pain Questionnaire), and physical activity levels (self-report and ActiSleep Plus Monitors) were measured, 2) PPT were measured with a computerized algometer at the fourth finger's nailbed, middle deltoid muscle, and quadriceps muscle before and after maximal oxygen uptake test (V˙O2max Bruce Treadmill Protocol), and 3) body composition was measured with dual-energy x-ray absorptiometry., Results: All adolescents met criteria for V˙O2max. On the basis of body mass index z-score, adolescents were categorized as having normal weight (n = 33) or being overweight/obese (n = 29). PPT increased after exercise (EIH) and were unchanged with quiet rest (trial × session, P = 0.02). EIH was similar across the three sites and between normal-weight and overweight/obese adolescents. Physical activity and clinical pain were not correlated with EIH. Overweight/obese adolescents had similar absolute V˙O2max (L·min(-1)) but lower relative V˙O2max (mL·kg(-1)·min(-1)) compared with normal-weight adolescents. When adolescents were categorized using FitnessGram standards as unfit (n = 15) and fit (n = 46), the EIH response was similar between fitness levels., Conclusions: This study is the first to establish that both overweight and normal-weight adolescents experience EIH. EIH after high-intensity aerobic exercise was robust in adolescents regardless of weight status and not influenced by physical fitness.

The authors compared men and women with similar experimental pain at rest to determine if sex differences in pain relief occurred following fatiguing isometric contractions. Men (n=13) and women (n=13) were matched retrospectively in pairs from a large database based on baseline pain perception. Pain (threshold and ratings) was measured with a noxious stimulus before and after quiet rest or a submaximal isometric contraction. Following quiet rest, there was no change in pain ratings or pain threshold for either men or women. Following the isometric contraction, pain thresholds increased for both men and women, whereas pain ratings decreased for men only. Pain reports prior to exercise may contribute to sex differences in pain relief following exercise.

Introduction: Whether there is a gender difference in fatigue and recovery from maximal velocity fatiguing contractions and across muscles is not understood., Methods: Sixteen men and 19 women performed 90 isotonic contractions at maximal voluntary shortening velocity (maximal velocity concentric contractions, MVCC) with the elbow flexor and knee extensor muscles (separate days) at a load equivalent to 20% maximal voluntary isometric contraction (MVIC)., Results: Power (from MVCCs) decreased similarly for men and women for both muscles (P > 0.05). Men and women had similar declines in MVIC of elbow flexors, but men had greater reductions in knee extensor MVIC force and MVIC electromyogram activity than women (P < 0.05). The decline in MVIC and power was greater, and force recovery was slower for the elbow flexors compared with knee extensors., Conclusions: The gender difference in muscle fatigue often observed during isometric tasks was diminished during fast dynamic contractions for upper and lower limb muscles., (Copyright © Published 2013 by Wiley Periodicals, Inc. This article is a US Government wmusork and, as such, is in the public domain in the United States of America.)