Aligning prescribed and received exercise dose in chronic musculoskeletal pain

Abstract

Chronic musculoskeletal pain is commonly managed with exercise training, yet real-world outcomes remain inconsistent. We contend that this variability reflects a misalignment between the exercise dose prescribed in clinical trials and dose accumulated during rehabilitation. Here, we propose that dose alignment is essential for interpreting treatment effects and understanding the gap between efficacy and real-world effectiveness, and outline a framework clarifying how prescribed exercise guides therapeutic exposure in routine rehabilitation.