Effects of Aerobic Exercise and Strength Training on Nociplastic Pain and Clinical Features in Temporomandibular Disorders With Myalgia: A Randomized‐Controlled Trial

ABSTRACT Background Patients with temporomandibular disorders (TMD) often exhibit widespread hypersensitivity and comorbidities, suggesting nociplastic pain (NP) involvement. Aerobic exercise (AE) and strength training (ST) enhance tissue oxygenation, pain inhibition, and quality of life. This study compares AE and ST, combined with physical therapy (PT), on NP and TMD clinical features. Methods This randomized‐controlled trial with blinded assessors assigned 43 TMD and NP patients to PT ( n = 15), PT + AE ( n = 15), or PT + ST ( n = 13). A 6‐week intervention included 12 PT sessions (education, manual therapy, jaw/neck exercises), with PT + AE performing high‐intensity intervallic AE (stationary bike) and PT + ST upper/lower extremities exercises. Primary outcome: pressure pain thresholds (PPT) with algometer. Secondary outcomes: central sensitization (CS)‐related symptoms, muscle strength, pain intensity, anxiety, sleep quality, kinesiophobia. Outcomes were assessed post‐intervention (T1) and at 12‐week follow‐up (T2). Results At T1, PT + AE demonstrated significant reductions than PT in CS (−9.5; p = 0.04), pain (−23.2; p = 0.04), kinesiophobia (−4.1; p = 0.04), sleep impairment (−3.8; p = 0.01). Pain reductions persisted at T2 (VAS −26.2; p = 0.04). PT + ST reduced kinesiophobia only at T2 (−3.8; p = 0.01). At T1, PT + AE improved proximal‐PPT against PT + ST (−0.52 kg/cm 2 ; p = 0.03), while PT + ST enhanced trapezius strength (10.9 kg; p < 0.01). Conclusions Adding AE or ST to PT improves outcomes in TMD patients and NP, with PT + AE reducing pain and CS‐related symptoms more effectively.