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Exercise

Exercise and Chronic Pain

  • People with chronic pain may have a difficult time approaching physical activity because they may relate it to flare-ups. As a result, they avoid physical activity. Physical inactivity can lead to more health problems (Ambrose et al., 2015).
  • Physical activity is unlikely to cause harm in those with chronic pain (Geneen et al., 2017)
  • Physical activity is defined by the WHO as “any bodily movement produced by skeletal muscles that require energy expenditure, including activities undertaken while working, playing, carrying out household chores, traveling, and engaging in recreational pursuits” (Geneen et al., 2017)
  • Physical activity should be recommended for all individuals with chronic pain (Ambrose et al., 2015)

Benefits of Exercise

  • Exercise leads to the production of endogenous opioids which decrease pain. Consistent exercise can lead to long-lasting pain reduction (Geneen et al., 2017)
  • Aerobic exercise can lead to weight loss which can then lead to a decrease in pain (Geneen et al., 2017)
  • Resistance exercise and strength training can support bone and cartilage health, relieve stiffness, and decrease pain
  • Balance and flexibility training reduces the risk of falls.
  • Physical activity positively influences quality of life, activities of daily living, emotional affect, overall physical function, and independence (Ambrose et al., 2015).
  • It reduces disability and the risk of developing comorbid illnesses such as hypertension, cardiovascular, type 2 diabetes, osteoporosis, and obesity.
  • Regular exercise can improve sleep and fatigue
  • Exercise decreases inflammation
    • Studies show that the frequency of exercise has a greater effect on inflammation than the duration of exercise.

Types of Exercise

  • Aerobic exercise
    • Examples: walking, cycling, swimming
    • Low to moderate intensity can improve chronic pain symptoms
    • High-intensity workouts can be beneficial for those who can tolerate it
  • Strength training
    • This is defined as contracting muscles against resistance.
    • Strength training can be done using free weights, resistance machines, elastic bands, resistance against water, and resistance against one’s own body weight.
    • It is safe and effective for a variety of chronic pain conditions.
    • Aquatic strength training is not as effective as land-based strength training.
  • Flexibility Training
    • This improves joint range of motion and muscle stiffness.
    • It is beneficial for anxiety and depression.
    • It is most beneficial when done with aerobic exercise and/or strength training
  • Movement Therapies
    • Yoga, Tai Chi, Qigong
    • These are low-intensity and tend to be well tolerated among those with chronic pain
    • They improve balance, mobility, joint flexibility, depression, and anxiety.

Exercise without Causing More Pain

  • Acute strenuous bouts of aerobic activity can increase pain.
  • People with chronic pain tend to do better when they choose a low-intensity activity that is within their abilities.
  • Daily activity should be encouraged, even if the intensity is low and the duration is short.
  • It is best to start with low intensity and progress steadily. Small amounts of activity can have large benefits.
  • It’s tempting to avoid physical activity when experiencing a pain flare-up, but a small amount of activity is still recommended.
  • It may be beneficial to work with a physical therapist to help prevent flare-ups.

Types of Pain

  • Low Back Pain
    • One study showed that weekly pilates and strength training sessions can reduce pain (Fernandez-Rodriguez et al., 2022)
    • Core stability exercises can be beneficial for reducing low back pain (Coulombe et al., 2017)
  • Fibromyalgia
    • Low-moderate intensity warm pool exercises done twice a week for 12 weeks had an immediate positive effect on pain (Ambrose et al., 2015)
    • 12 weeks of Tai Chi reduced fibromyalgia pain
    • Twice a week strength training resulted in significant pain reduction
    • 8 weeks of yoga reduced fibromyalgia pain

Ways to Exercise More

  • Pick something you enjoy
    • Going to the gym and taking classes
    • Yoga, hiking, running, soccer, swimming, kayaking, etc.
    • Gardening and household chores are also considered forms of physical activity
  • Make it a social thing
    • Invite your friends to do physical activity with you
    • Join clubs that involve physical activity- hiking, running, dancing, etc.
  • Buy a dog and take it on walks
  • Do it for a cause
    • There are lots of charity organizations that host 5Ks

 

Sources

Ambrose KR, Golightly YM. Physical exercise as non-pharmacological treatment of chronic pain: Why and when. Best Pract Res Clin Rheumatol. 2015 Feb;29(1):120-30. doi: 10.1016/j.berh.2015.04.022. Epub 2015 May 23. PMID: 26267006; PMCID: PMC4534717.

 

Coulombe BJ, Games KE, Neil ER, Eberman LE. Core Stability Exercise Versus General Exercise for Chronic Low Back Pain. J Athl Train. 2017 Jan;52(1):71-72. doi: 10.4085/1062-6050-51.11.16. Epub 2016 Nov 16. PMID: 27849389; PMCID: PMC5293521.

 

Fernández-Rodríguez R, Álvarez-Bueno C, Cavero-Redondo I, Torres-Costoso A, Pozuelo-Carrascosa DP, Reina-Gutiérrez S, Pascual-Morena C, Martínez-Vizcaíno V. Best Exercise Options for Reducing Pain and Disability in Adults With Chronic Low Back Pain: Pilates, Strength, Core-Based, and Mind-Body. A Network Meta-analysis. J Orthop Sports Phys Ther. 2022 Aug;52(8):505-521. doi: 10.2519/jospt.2022.10671. Epub 2022 Jun 19. PMID: 35722759.

Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2017;4(4):CD011279. Published 2017 Apr 24. doi:10.1002/14651858.CD011279.pub3