Tips for Exercising with Chronic Pain

Why Exercise?

Several studies have shown that exercising when you have chronic pain is beneficial.  It can increase function, improve quality of life, reduce disability, improve mood and decrease pain.  However, most patients I see have had a negative experience with exercise and they are (understandably) reluctant to try and increase their activity levels.

The optimal type, duration, intensity or frequency of exercise is not clear for people living with chronic pain.  This makes it both simple and difficult when advising patients as there is a variety of different options.

There are some studies that suggest cardiovascular exercise and strength exercise yield better results, than stretching and at times, a specific tailored program from a professional may be more beneficial. However, this is still not clear as research studies use different chronic pain populations and are often not specific about the exercise protocols studied.  

In this blog, I will try and share a few ‘clinic’ tips that I have found beneficial.

How to Exercise:

When starting to exercise, it will likely be challenging and may cause some temporary increase in pain - this is ok and does not necessarily mean that you are causing more damage.  Although this is ok, the amount you do should not have a devastating impact on the rest of your day.  If your pain levels increase significantly for more than 4 hours after the exercise and you are unable to complete your normal daily tasks, then you may need to reduce the exercise (either time or intensity) to begin with.

It’s hard to find the starting amount of exercise. It should be challenging yet not have large negative consequences.  It’s important to start your journey of increasing activity with positive and enjoyable experiences.  One of my favorite sayings to patients is “it’s better to walk away feeling you could have done more” that way, you can assess the impact of the exercise later on and make a plan to gradually increase it next time.

So, on to the tips...

1)   Pick an exercise that is meaningful or enjoyable for you.  Type of exercise may be the least important thing to worry about.  If you hate the thought of yoga or pool exercise, then don’t pick this as your method of exercise.  If these appeal to you, then great!  Remember too that exercises does not have to be lifting weights and could be activities around the house or fun things like dancing.

2)   Start easy.  Find a way of making the intensity of the exercise easy to start.  For example walking on a flat smooth surface is less intense than hills or rough terrain.  Low intensity options in classes or ‘At Home’ videos would be better choices than high intensity options.

3)   Start small.  Think minutes to start.  No amount of time is too small when you’re starting out, nor is it a waste of time.  I normally ask a patient what duration they think will be suitable and then half it again to begin with!

4)   Do it often.  Daily or even 2-3 x a day may be better when you are starting small and easy.  As your efforts increase then you may be able to reduce the exercise to a few times a week.

5)   Increase slowly.  Only increase the exercise after you have completed it successfully at least 3 times.  When you do increase it, only do it a little; 10-40% of time or effort is a good change. 

Examples:

1) When starting out, walking for 3 x 5 mins a day may be better than walking for 15 mins at once, or 40 minutes 1-2 x week.  This way you are doing a small amount of activity regularly and less likely to flare up your symptoms.  If this gets easy, you could slowly transition to increased time and reduced frequency of walking sessions.

2) If you wanted to do something like dancing, try going to a slow/gentle type of dance and only dance for 2-3 songs over the session with an understanding partner.  Have regular rest breaks and soak up the atmosphere.  As you tolerate this better, slowly spend more and more time dancing and less time sitting.

3) If you want to try a group class, have a chat with the instructor so they know you will be taking some regular breaks.  They may also be able to advise you when to sit out, and modify the exercises for you.  Being present for a 40 minute class but only participating for 10-15 minutes is a great start.  You can work on relaxation and meditation etc during the off periods.

4) Don't be hard on yourself if you miss a session here and there, but remember that consistency is important.  If you are struggling keeping up, re-evaluate your exercise plans and set a goal that is more achievable and realistic.

Written by

Roland Fletcher, Registered Physiotherapist

References

Tse et al. (2013). Journal of Clinical Nursing, 22

McBeth et al. (2012). Arch Intern Med, 172 (1)

Hennings et al. (2012). Clinical Journal of Pain, 28 (9).

van Middelkoop et al. (2011). European Spine Journal, 20:19-39

Sullivan et al (2012) Curr Pain Headache Rep, 16