PHYSICAL EXERCISE

Richard W. Hanson, Ph.D.

One of the important goals of pain self-management is to develop and maintain a healthy physical activity level. Many persons with chronic pain become overly inactive and sedentary. Some doctors contribute to the problem by recommending bed rest and inactivity as a response to chronic pain. Unfortunately, this often makes the chronic pain syndrome worse by promoting physical deconditioning, excessive disability, and increased depression.

Physical Deconditioning and Disuse Syndrome

Following are some potential adverse medical consequences of prolonged physical inactivity and immobilization:

1. Muscle deterioration (atrophy)
2. Stiffening of joints
3. Loss of calcium from the bone making them more brittle.
4. Impairments in the functioning of the heart and blood pressure system.
5. Loss of red blood cells.
6. Decrease in sex hormones and the impaired development of sperm.
7. Decreased resistance to infection.
8. Increased proportion of body fat in relation to muscle tissue and development of obesity.
9. Decreased catecholamine secretion leading to chemical changes in the brain which result in increased depression.

Physical Reconditioning

The obvious solution to the deconditioning and disuse syndrome is developing a physical reconditioning exercise program. The basic goals of physical exercise include:

1. Increase joint flexibility.
2. Improve muscle tone and strengthen weak muscles.
3. Increase aerobic and cardiovascular fitness.
4. Decrease excessive body fat.

Developing a Personalized Exercise Program

A very important self-management goal for most chronic pain sufferers is the development of a regular physical exercise program. Although it is beyond the scope of this Handbook to specify what that exercise program should consist of, it may be noted that several of the chronic pain self-management books listed in the recommended readings chapter toward the end include descriptions of some basic physical exercises which you may find useful. Ideally, your personal exercise program should be developed under the initial guidance of a properly trained professional such as a physical therapist.  In particular, it is important that the professional be familiar with the special requirements of those with chronic pain conditions.

Following are some basic principles and guidelines which apply to physical exercise programs.

• Prior to undertaking a physical exercise program, it is always wise to first obtain clearance from your physician. Some chronic pain sufferers have other medical conditions (e.g., heart disease, elevated blood pressure, respiratory conditions) which must be considered in developing a physical exercise program.
• Physical exercise programs are more likely to be successful if you start slowly and make gradual increments in whatever it is you are trying to do. We recommend use of the quota system which is described in the next chapter.
• The experience of some pain and discomfort when doing physical exercise is not necessarily a bad thing. The key issue here is to distinguish hurt from harm. Just because you experience some hurt while exercising does not automatically mean that the activity is dangerous or that you are harming yourself. The old cliché, "No pain, no gain" applies to many chronic pain conditions.  I
• Increased joint flexibility can be developed through appropriate range of motion (stretching) exercises. Important target areas include the legs, trunk, neck, shoulders and arms. It is much easier to stretch muscles and joints, when the muscles are relaxed. Many chronic pain sufferers also find it easier to do these exercises when submerged in warm water.
• Increased muscle tone can be developed through muscle resistance including static isometric and moving isotonic exercises (e.g., use of weights and stretch bands).
• Increased aerobic fitness can be developed through exercises which elevate your heart rate for extended periods of time (usually a minimum of 20 minutes). These exercises may include walking, use of treadmills, bicycling, use of stationary bicycles, swimming, etc. It is typically recommended that aerobic exercises be carried out a minimum of three times per week in order to be beneficial.
• Decreased body fat can be developed through a combination of aerobic exercise, muscle toning exercise, and decreased dietary consumption of high caloric foods.
• No physical exercise program or weight loss program will be effective unless it is carried out and maintained consistently. Exercise and proper nutrition have to become life-long habits in order for you to keep realizing the benefits.

Benefits of Physical Exercise

Regular physical exercise is beneficial to many chronic pain sufferers for the following reasons:

• Properly paced exercise can promote healing in injured body tissue.
• Exercise can prevent or slow down further deterioration in many degenerative arthritic conditions.
• Exercise can prevent the occurrence of many painful physical injuries.
• Exercise promotes the development of endorphins, your body's natural pain killers (see chapter 3).
• Exercise can increase your tolerance for physical activity. 
• Exercise promotes not only improved physical functioning, but increased psychological well-being as well. That is, regular physical exercise can enhance self-esteem, counteract depression, and serve as a healthy outlet for frustration and anger.

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