It may seem counterintuitive to prescribe exercise for chronic pain—after all, vigorous movement could seemingly irritate physical ailments. But since the 1980s, physicians have been recommending that patients with chronic pain avoid bed rest and remain active instead.
According to some studies, exercise may offer several specific and general health benefits that can improve chronic pain symptoms, such as depression, deconditioning, and weight gain. Furthermore, researchers have shown that after a single session of exercising, endorphin levels go up. (Remember that endorphins naturally relieve pain.) Overall, however, there is a paucity of data on the benefits of exercise for people with chronic pain.
In one systematic review, investigators found small-to-moderate beneficial effects in pain reduction and enhanced physical function for people with chronic pain who exercise. However, they did not find consistent benefit in terms of improved psychological function or quality of life.
According to these researchers: “The available evidence suggests physical activity and exercise is an intervention with few adverse events that may improve pain severity and physical function, and consequent quality of life. However, further research is required and should focus on increasing participant numbers, including participants with a broader spectrum of pain severity, and lengthening both the intervention itself, and the follow-up period.”
In addition to understanding whether exercise can benefit those with chronic pain, it’s important to understand which exercises have been used in patients with chronic pain, as well as any potential benefits. Let’s take a look at some of these exercise types below.
Able to be performed on land or in water, aerobic exercises include walking, cycling, jogging, running, and swimming. Aerobic exercise has been linked to weight loss, which can reduce pressure on the joints, and may improve symptoms of chronic pain.
Strength/resistance training can improve a person’s ability to support bone and cartilage via improved musculature around a joint. This type of exercise can also decrease stiffness and provide a measure of pain relief.
When the lumbar spine is affected by lower back pain, resistance training by means of repetitive full range-of-motion exercise could increase disc metabolism and improve metabolic exchange and the repair of lumbar discs.
This type of exercise can also be performed on land or in water and involves progressive resistance with the goal of improving muscle strength, muscle power, and muscle endurance. Examples include the use of elastic bands, free weights, body-weight resistance vs gravity, and water resistance.
Swimming and any other exercise performed in water is considered aquatic exercise. Typically, water exercises—other than swimming—are performed vertically, with the water supporting the exerciser or providing resistance. Such exercises may proffer short-term benefit to people with hip or knee osteoarthritis, but no long-term benefit has yet been demonstrated.
Exercises that are aimed at boosting range of motion around a joint involve progressive stretching and muscle mobilization. Flexibility exercises may help prevent falls in people with chronic pain.
Motor control exercise
These exercises target the core muscles and activate deep trunk muscles to restore and control central coordination. They can be done on both land and in water. According to limited evidence, this type of exercise may be good for people with lower back pain.
Balance, or proprioceptive, training can be performed on land or in water and focuses on the maintenance of balance in unstable situations. Of note, both motor control exercises and balance training require initial supervision by a therapist for not only instruction on technique, but also an understanding of the body’s feedback, which dictates the progression of these exercises.
This ancient Chinese practice, which is based on martial arts, entails a series of controlled, slow movements meant to ameliorate physical and mental fitness. It is a safe exercise for people with tender and swollen joints due to rheumatoid arthritis.
An ancient Hindu practice, yoga promotes health, relaxation, and control. It combines different types of exercise and involves stretching and flexibility training plus isometric strength training (ie, holding poses).
This system of exercise usually requires special equipment and emphasizes strengthening the core muscles. Pilates incorporates flexibility, strength, and posture, as well as improved mental awareness.
Although there is limited evidence for the benefit of exercise in people with chronic pain, it’s likely a good idea that people with chronic pain do exercise. Adverse effects of exercise are typically limited to transient muscle tenderness. By contrast, prescription medications for pain relief carry the risk of life-altering adverse effects, such as dependence. Moreover, exercise increases self-efficacy and self-management in patients, and could decrease healthcare utilization.
Finally, exercise is key to cardiovascular and bone health in all people. The repercussions of lack of physical exercise and mobility in people with chronic pain could contribute to cardiovascular and all-risk mortality.