Walking for Chronic Pain: Why It Matters, What We Know and How to Get Started: A Position Paper From the European...

Physical activity is a cornerstone of chronic pain management. However, translating general recommendations into practical, clinically meaningful guidance for people living with chronic pain and their healthcare providers remains challenging. Walking represents a promising modality because it is accessible, adaptable, low-cost and easily integrated into daily life.

This position paper synthesises evidence on walking as a therapeutic modality for people living with chronic pain, identifies key knowledge gaps and provides a guiding message for healthcare professionals to support clinical communication and patient self-management.

Narrative synthesis of scientific literature examining walking interventions in chronic musculoskeletal pain conditions. Evidence regarding step counts, progression strategies and behavioural factors influencing engagement in walking was integrated to inform clinically applicable recommendations.

Walking interventions demonstrate small-to-moderate improvements in pain, physical function and health-related quality of life. Benefits of walking occur at activity levels below traditional public-health targets, with the largest gains observed when individuals transition from very low to moderate activity levels. Current research does not support universal step-count targets for pain reduction, emphasising instead individualised progression and consistency. Available evidence shows no association between walking participation and worsening pain severity at the population level. Gradual engagement in walking may also provide opportunities to build confidence in one's ability to be physically active. However, walking interventions are frequently delivered alongside education, goal setting, activity monitoring or healthcare professional support, making it difficult to determine the independent contribution of walking to changes in beliefs about movement and activity.

Walking is a generally safe, scalable, evidence-supported strategy for chronic pain management. Rather than fixed targets, gradual progression tailored to individual capacity represents the most evidence-aligned strategy. This paper provides a guiding message to facilitate implementation of walking and physical activity recommendations in routine care.

This paper translates current evidence on walking and chronic pain into clinically applicable guidance for healthcare professionals and people living with chronic pain. Building on previous EFIC recommendations regarding physical activity, it synthesises evidence across chronic musculoskeletal pain conditions, addresses common barriers such as fear of movement and symptom flare-ups, and provides evidence-informed practical recommendations to support safe, gradual and sustainable walking participation in routine care and self-management.