Pain Perception and Exercise-Induced Hypoalgesia Across Circadian Rhythms

NCT ID: NCT07290465

Last Updated: 2025-12-18

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

56 participants

Study Classification

INTERVENTIONAL

Study Start Date

2026-01-31

Study Completion Date

2026-04-30

Brief Summary

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The goal of this randomized crossover clinical trial is to investigate whether exercise-induced hypoalgesia (EIH) is influenced by circadian rhythm in healthy adults aged 18-40 years.

The main questions it aims to answer are:

* Does the time of day (morning vs. evening) influence changes in pain perception following exercise?
* Do chronotype, sex, or stimulation site (bony vs. muscular) alter the magnitude of this effect?

Participants will:

* Complete questionnaires
* Undergo quantitative sensory testing
* Attend both morning and evening sessions in randomized crossover order

Detailed Description

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Exercise-induced hypoalgesia (EIH) is a temporary reduction in pain sensitivity following physical activity. High-intensity functional training (HIFT) has been shown to produce EIH, yet the influence of circadian rhythms on this response is not well established. Circadian timing regulates physiological processes, including pain modulation, and may contribute to variability in exercise-related analgesia.

This randomized crossover trial will examine whether time of day (morning vs. evening) affects EIH in healthy adults. It will also explore the relationship between an individual's chronotype, the efficacy of EIH and the difference in magnitude between men and women, the difference in effect between bony and muscular landmarks for pressure stimulus application.

Null Hypothesis (H0) : Circadian rhythm has no significant influence on the efficacy of exercise-induced hypoalgesia (EIH), as measured by changes in pain perception before and after high intensity functional training at different times of day (morning vs. evening).

Alternative Hypothesis (H1): Circadian rhythm significantly influences the efficacy of exercise-induced hypoalgesia (EIH), with differences in pain perception before and after high intensity functional training depending on the time of day (morning vs. evening).

Each participant will complete both morning and evening sessions in randomized order, separated by ≥72 hours. Participants who completed the morning sessions will cross over to the evening sessions and vice versa. Within each session, they will perform a 12-minute supervised deep breathing control condition and a 12-minute HIFT intervention, separated by a 30-minute rest.

Conditions

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Exercise Induced Hypoalgesia Circadian Rhythm Pain Perception Healthy Participants Chronotype Physical Therapy

Keywords

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Exercise-Induced Hypoalgesia Pain Perception Circadian Rhythm Chronotype Healthy Participants High-Intensity Functional Training Supervised Deep Breathing Pressure Pain Threshold (PPT) Pain pressure tolerance threshold (PPTol) Quantative Sensory Testing Bony Landmarks Muscular Landmarks Physical Therapy Randomized Control Trial Crossover Pain Management

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Participants who completed the morning sessions will cross over to the evening sessions and vice versa in a randomized order with a washout period.
Primary Study Purpose

BASIC_SCIENCE

Blinding Strategy

DOUBLE

Participants Outcome Assessors
Both the participant and assessor will be masked to the individual's chronotype

Study Groups

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Morning Chronotype

Participants classified as morning chronotype using the Munich Chronotype Questionnaire (MCTQ) will attend both a morning session and an evening session in randomized order with at least 72 hours between visits. Within each session the participant completes both a 12-minute supervised deep-breathing control condition and a 12-minute High-Intensity Functional Training (HIFT) intervention, separated by a 30-minute break to minimize carryover effects. Pain perception is assessed before and after each condition.

Group Type EXPERIMENTAL

High-Intensity Functional Training (HIFT)

Intervention Type BEHAVIORAL

A 12-minute, instructor-led HIFT protocol delivered via the same video to all participants. After a 5-minute warm-up, participants perform six exercises targeting major muscle groups. The exercises are 4 lunges followed by one push-up, 10 high knees followed by 10 shuffles, burpees, squat jumps, skaters, and plank up-downs. Each exercise is done for 40 seconds then 20 seconds rest. The cycle repeats twice for a total of 12 minutes. Rate of Perceived Exertion (Borg scale) is recorded at baseline, post-warmup, during each rest interval, and immediately post-exercise. A physiotherapist supervises performance, ensures correct technique, and enforces safety and target intensity while motivating and encouraging the participant.

Supervised Deep Breathing

Intervention Type BEHAVIORAL

A 12-minute deep breathing session delivered via a prerecorded audio and supervised by a physiotherapist. The breathing rhythm includes inhaling for 4 seconds and exhaling for 6 seconds for a total 1 minute, followed by 1 minute of normal breathing. This cycle is repeated six times for a total duration of 12 minutes. Participants lie supine in a comfortable position and wear headphones. A self-reported Rate of Perceived Relaxation (RPR, 0-10) is recorded before and after. This serves as a non-exercise control to account for relaxation and attention effects.

Evening Chronotype

Participants classified as evening chronotype using the Munich Chronotype Questionnaire (MCTQ) will attend both a morning session and an evening session in randomized order with at least 72 hours between visits. Within each session the participant completes both a 12-minute supervised deep-breathing control condition and a 12-minute High-Intensity Functional Training (HIFT) intervention, separated by a 30-minute break to minimize carryover effects. Pain perception is assessed before and after each condition.

Group Type EXPERIMENTAL

High-Intensity Functional Training (HIFT)

Intervention Type BEHAVIORAL

A 12-minute, instructor-led HIFT protocol delivered via the same video to all participants. After a 5-minute warm-up, participants perform six exercises targeting major muscle groups. The exercises are 4 lunges followed by one push-up, 10 high knees followed by 10 shuffles, burpees, squat jumps, skaters, and plank up-downs. Each exercise is done for 40 seconds then 20 seconds rest. The cycle repeats twice for a total of 12 minutes. Rate of Perceived Exertion (Borg scale) is recorded at baseline, post-warmup, during each rest interval, and immediately post-exercise. A physiotherapist supervises performance, ensures correct technique, and enforces safety and target intensity while motivating and encouraging the participant.

Supervised Deep Breathing

Intervention Type BEHAVIORAL

A 12-minute deep breathing session delivered via a prerecorded audio and supervised by a physiotherapist. The breathing rhythm includes inhaling for 4 seconds and exhaling for 6 seconds for a total 1 minute, followed by 1 minute of normal breathing. This cycle is repeated six times for a total duration of 12 minutes. Participants lie supine in a comfortable position and wear headphones. A self-reported Rate of Perceived Relaxation (RPR, 0-10) is recorded before and after. This serves as a non-exercise control to account for relaxation and attention effects.

Interventions

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High-Intensity Functional Training (HIFT)

A 12-minute, instructor-led HIFT protocol delivered via the same video to all participants. After a 5-minute warm-up, participants perform six exercises targeting major muscle groups. The exercises are 4 lunges followed by one push-up, 10 high knees followed by 10 shuffles, burpees, squat jumps, skaters, and plank up-downs. Each exercise is done for 40 seconds then 20 seconds rest. The cycle repeats twice for a total of 12 minutes. Rate of Perceived Exertion (Borg scale) is recorded at baseline, post-warmup, during each rest interval, and immediately post-exercise. A physiotherapist supervises performance, ensures correct technique, and enforces safety and target intensity while motivating and encouraging the participant.

Intervention Type BEHAVIORAL

Supervised Deep Breathing

A 12-minute deep breathing session delivered via a prerecorded audio and supervised by a physiotherapist. The breathing rhythm includes inhaling for 4 seconds and exhaling for 6 seconds for a total 1 minute, followed by 1 minute of normal breathing. This cycle is repeated six times for a total duration of 12 minutes. Participants lie supine in a comfortable position and wear headphones. A self-reported Rate of Perceived Relaxation (RPR, 0-10) is recorded before and after. This serves as a non-exercise control to account for relaxation and attention effects.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Healthy participants
* age 18 to 40 years
* good level of English that allow the enrolled participant to provide informed consent and complete the questionnaires provided
* being categorized as "moderate" in the International Physical Activity Questionnaire (IPAQ)

Exclusion Criteria

* inability to report pain intensity reliably
* consumption of narcotics or tobacco products
* regularly taking pain medications and analgesics
* pregnant or planning to get pregnant
* surgery within the last 12 months
* acute or chronic pain conditions
* uncontrolled hypertension
* cardiovascular diseases, pulmonary diseases, neurological diseases with significant changes in somatosensory and pain perception, metabolic diseases, serious systemic diseases or conditions that restrict normal daily activities, inflammatory conditions (e.g. rheumatoid arthritis), or orthopedic injuries
* intolerable pain during the pain perception test
* serious psychiatric conditions (e.g., schizophrenia and bipolar disorder) or psychological disorders (e.g., depression) that may affect pain thresholds (16).
* Severe sleep disorders and circadian rhythm disturbances
* BMI \> 30
* serious fatigue or delayed-onset muscle soreness (9) at least 24 h after exercise sessions or a sudden change in activity for more than one week
Minimum Eligible Age

18 Years

Maximum Eligible Age

40 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Medipol University

OTHER

Sponsor Role lead

Responsible Party

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Fatema Mohamed Daoud Soliman

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Gizem Ergezen Şahin, Dr. Assistant Professor

Role: STUDY_DIRECTOR

Department of Physiotherapy and Rehabilitation/Istanbul Medipol University

Locations

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Istanbul Medipol University

Istanbul, Beykoz, Turkey (Türkiye)

Site Status

Countries

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Turkey (Türkiye)

Central Contacts

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Fatema Mohamed Soliman, PT, MSc (Cand.)

Role: CONTACT

Phone: +90 537 736 20 79

Email: [email protected]

Aliaa Salem Menshawi, PT, MSc (Cand.)

Role: CONTACT

Phone: +905527304660

Email: [email protected]

Facility Contacts

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Fatema Mohamed Soliman, PT, MSc (Cand.)

Role: primary

Related Links

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https://doi.org/10.1097/j.pain.0000000000001939

The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises.

https://doi.org/10.1016/j.jpain.2012.09.006

A meta-analytic review of the hypoalgesic effects of exercise

https://doi.org/10.1186/s13102-024-00969-4

Exercise induced hypoalgesia after a high intensity functional training: a randomized controlled crossover study

https://doi.org/10.1016/j.bjae.2024.05.004

Quantitative sensory testing: a practical guide and clinical applications

https://doi.org/10.1097/MRR.0000000000000111

Day-to-day reliability of pressure pain threshold and pain ratings in college-aged men. International journal of rehabilitation research.

https://doi.org/10.3389/fphys.2019.00682

New Insights Into the Circadian Rhythm and Its Related Diseases.

Other Identifiers

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E-10840098-202.3.02-1597

Identifier Type: -

Identifier Source: org_study_id