Exercise-induced quadriceps pain during cycling in healthy individuals: A systematic review and meta-analysis of experimental trials

Objectives. - This meta-analysis summarizes experiments that have assessed quadriceps pain intensity (PI) during cycling in healthy individuals. Secondly, it tested the impact of eleven plausible moderators of that pain: data source, pain measure, participant sex and fitness, study purpose and comparison condition, analgesic intervention, and exercise task, duration, number of bouts, and intensity. Equipment and methods. - Articles published before September 15, 2022 were found by search-ing PubMed, Web of Science, PsychInfo, SportDiscus, Science Direct, and Google Scholar. Inclusion criteria were (i) a randomized between-subjects design or a within-subjects crossover design, (ii) healthy participants without preexisting pain conditions, (iii) leg cycling on a stationary ergometer, and (iv) quadriceps PI measured during cycling. Study quality was assessed, Hedge's d effect sizes were computed, and a mixed effects model was used to generate a mean effect size (A). Moderators were chosen a priori to account for heterogeneity. Results. - A total of 95 effects were derived from 35 studies. A mixed effects model indicated the mean effect size (A) was 0.671 (95% CI = 0.442 to 0.899, z = 5.754, P < 0.001). Total heterogeneity was high in this model (tau(2) = 0.942, I-2 = 80.90%, H-2 = 5.24). (c) 2023 Elsevier Masson SAS. All rights reserved.