OBJECTIVE: To assess the extent to which pain sensitivity is altered in obese women with frequent knee symptoms who walk with either a hybrid training system (HTS) that provides antagonist muscle electrical stimulation versus sensory transcutaneous electrical nerve stimulation (TENS). DESIGN: Randomized, double-blinded, controlled trial. SETTING: University-based fitness center. PARTICIPANTS: Twenty-eight obese women 40 to 70 years old with daily knee symptoms. INTERVENTIONS: Participants were randomized to 12 weeks of biweekly 30-minute walking exercise with either HTS (HTSW group) or sensory TENS (control group). MAIN OUTCOME MEASURES: Pressure pain thresholds (PPT) at the more symptomatic knee (local PPT) and PPT at the ipsilateral pain-free wrist (remote PPT). RESULTS: After adjustment for pre-intervention values and BMI, there was a statistically significant improvement in local PPT in the HTSW group in comparison to the control group (p = 0.039). After adjustment for pre-training value, age, and BMI, changes in remote PPT comparing groups did not reach statistical significance, although the HTS group tended to demonstrate increased remote PPT (p = 0.052) in comparison with the control group. Moreover, after adjustment for pre-training value, knee pain and QOL comparing groups did not reach statistical significance, although the HTS group tended to demonstrate decreased knee pain (p = 0.069) in comparison with the control group. CONCLUSIONS: Augmentation of walking exercise with HTS was more effective than application of sensory TENS in improving local pain sensitivity at the knee, but not at the wrist in obese women with frequent knee symptoms.

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