Whether exercise dose influences clinical outcomes for people suffering with pain is an open question. In this review, the authors evaluated whether exercise dose makes a difference for outcomes specifically for people suffering with tendinopathy, both in the upper and lower limbs. Being interested in exercise adherence and dose, I found this review fascinating (please read the full text here!).

This was a huge review. They included 110 studies among almost 4000 participants. Most had rotator cuff, Achilles, patellar, or lateral elbow tendinopathy, and just a few had gluteal tendinopathies. It was difficult to determine exercise intensity because it was poorly reported, but authors were able to classify studies as adding external load or not. Studies were also classified based on frequency, sets and repetitions.

The main findings were:

• Interventions that added loaded had better effects than interventions arms that did not. Importantly, they grouped all intervention arms into those with large/small effects to start with to reduce bias from unbalanced factors (eg length of time of intervention, adherence, etc). The greater effect for adding load was only present for studies that had large effects to start with.
• Interventions with lower frequency (<1x/day) had better effects than higher frequency interventions (>1x/day). This effect was present for both large/small effect intervention arms.

Unfortunately, whether exercise dose influences clinical outcomes is still an open question, even after this review. What it adds though, is arguably the best (and definitely the broadest) evidence that it is a question worth pursuing. Clinical take home is to consider adding load and using lower frequency exercise interventions.