- Regular exercise is a defined and to measurably lower inflammation, which will decrease your pain.
- It is basic to healing from any chronic disease, including chronic pain. It won’t solve your pain by itself, but other interventions will have limited impact without it.
- There are well-documented weekly recommendations regarding the type and amount of exercise.
- Both aerobic conditioning and resistance training are important.
- If you are not willing to exercise, you have to ask yourself, “why?”
Being inactive is unhealthy.1,2 This is a statement that is reflected in many reviews of the benefits of exercise. So, regular exercise is good for your health. There are multitude of papers documenting the benefits of regular exercise, including decreasing chronic pain. Due to the overwhelming amount of data, some of this blog will be presented in a list format.
According to the CDC, 60% of Americans do not engage in the recommended amount of weekly exercise. About 25% are completely sedentary.3 The consequences are severe.
What are the benefits of exercising?
The list of reasons to exercise is almost endless but it begins with adding about four extra years to your lifespan. More importantly, the quality of life is maintained almost to the end.2 There is less of chance of a slow decline in your health, which is not the way you want to pass on.
We don’t want to think much about death, but there are a few factors to consider from the literature and also from my observations being in medicine for over 45 years.
- People don’t want to be dependent on others. There is a fierce drive to hold onto your driver’s license, live in your own house, take care of your daily hygiene needs, and to be able to partake in enjoyable activities.
- People are less afraid of death than the possibility of prolonged suffering.
- No one wants to die. The only ones who do are miserable to the point that they can no longer endure it anymore or are completely dependent on others.
- Social isolation is intolerable. But what happens when your thinking capacities drop, you don’t hear as well, can’t go out for a cup of coffee with friends, or your life is consumed with medical problems?
Here is a short list of diseases/ conditions that are lowered with regular exercise and increased if living a sedentary life.1,2
- Lower risk of ALL cancers – except prostate and melanoma3
- Heart disease
- Chronic pain
- Adult-onset Diabetes
- Decreased cognitive function/ dementia
- Disability/ less capacity to engage in self-care
- Serious falls
How much exercise?
The research breaks down exercise into light, medium, and intense. The tipping point for significant health benefits is between 150-300 minutes per week of moderate exercise. An example of moderate exercise would be brisk walking and if you decided to jog, you could lower the time to 75-150 minutes per week.1,2
You don’t have to engage in intense exercise to receive significant health benefits. The minute you begin any light exercise, you have positively impacted your health. You may feel that a little exercise is not worth your time. That is simply not true. The relative benefits are actually higher if you have been inactive.
How intense should the exercise be?
It is important to be careful as you engage in a new level of activity. The CDC recommends getting a medical clearance if you have a chronic medical condition. If you are going engage in more vigorous exercise, clearance should be obtained in men over 40 and women over 50.4
Although the benefits far outweigh the risks, in every age group, there is a higher chance of a cardiac event during exercise compared to not exercising. If you have been sedentary, then just begin with light exercise for 5-10 minutes/day.1,2 It is a lifestyle change and you’ll gradually improve in all domains. The key is being persistent – whether you feel like it or not. Consider the reality that for a short period of potential discomfort, you’ll feel better the whole rest of the day.
People often say that they can’t exercise because of their pain. It is a catch-22 in that exercise is anti-inflammatory, calms the nervous system, and decreases pain. However, in the short-term, it may increase your pain. There is no point in taking a “mind over matter” approach and try to keep pushing through the pain. Just exercise to tolerance or find exercise a body part that is not painful. It is important to enjoy your exercise time in order to maintain it. Again, any exercise in any part of your body will start you on the road to better health. Also remember, you aren’t trying to “conquer” chronic pain. As you lower your inflammation in your body, the pain does decrease.
What kind of exercise?
There are two general categories of exercise. Aerobic conditioning and resistance training. They both need to be utilized with doing aerobic activities maybe three or four days/ week and resistance training two to three days/ week. Heavy resistance training does have an aerobic component but walking or jogging does not meet the strengthening needs.
Regarding aerobic conditioning, it doesn’t matter how you increase your heart rate. Any activity works. Again, make sure that you stay in a range that is safe for you. It is common for orthopedic surgeons to see patients with tendonitis (inflammation) of the achilles tendon, tendons around the kneecap, plantar fascia, or even have stress fractures in the bones of their feet. It is always from a person deciding to “get in shape” and start to overexercise – usually walking or jogging. Otherwise, any graduated activity that increases your heart rate is effective. Think in terms of a long-range change and there is no rush.
The rest of this article will discuss resistance training as there are specific benefits and not enough people consider it as part of their routine. The main reason to implement regular strength training to halt or reverse the muscle loss of aging called, “sarcopenia.” It lowers your chances of becoming dependent of others for your self-care. If you think being in pain is bad enough, people really dislike feeling helpless. You might consider visiting a nursing home for a few hours. It will motivate you to do whatever you can to stay out of that situation. Research shows that lack of control causes inflammatory markers to increase, thereby increasing your pain.4
Resistance training is integral to aging
We all lose a certain percentage of muscle mass every year (estimated to be about 3% after age 60). Since lifespans are significantly longer in the last half of the twentieth century, it means each of us will lose over 30 percent of our strength.7 So, resistance training becomes more important as we age.6
You not only prevent muscle loss (sarcopenia), but you can also reverse it. It’s been shown that people over forty-five receive a tremendous benefit from resistance training. There are many ways to accomplish this including the weight room, Pilates, yoga, elastic bands, and isometrics.
You will also be exerting stress on your bones, which simulates them to from new bone. It is a way to prevent your skeleton from becoming brittle (osteoporosis).
I prefer resistance training to be done outside of a person’s residence, as few people will consistently work out at home. It’s helpful to be in an environment where others are exercising; also, the equipment is better. Pilates is also excellent in that it emphasizes core strength, and yoga is helpful if the extreme postures are avoided.
The weight room
Regarding the resistance workout program, essentially all of the machines are safe. Avoid the free weights, as there is more the risk of straining your core muscles. Begin with very light weights and do sets of high repetitions – ten to fifteen per muscle group. Work on opposing sets of muscles. Avoid unsupported bending at your waist no matter what the situation. Supported bending is fine and so is twisting.
Most health clubs offer at least one free personal training session to set you up and ensure your safety. Many physical therapists will help transition their patients from the specific/functional exercise phase into a long-term conditioning program.
Benefits of resistance training
Strength training is a significant factor in reducing pain and improving your sense of well-being from lowering your inflammatory markers. Here are some benefits of resistance training.
First, there is the obvious benefit of having more strength, so a smaller percentage of your energy is spent on daily activities. You are able to stay well away from the pain threshold.
Second, you have more capacity to engage in vigorous physical activities that are enjoyable and relaxing. Actively placing your attention on these neurological circuits stimulates neuroplasticity in a desirable direction. Many of these activities can shared with other people. Social isolation is over 50% in the US 8 and spending quality time with others is part staying healthy.
Third, although it’s not going to be at the level of the long-distance runner, there is some degree of the release of pleasant hormones such as serotonin, dopamine, and endorphins with strength and aerobic training. (Endorphins and enkephalins are the body’s natural pain killers).
Finally, I feel the most important contribution that strength training adds is a reprogramming function. You are now sending a different set of signals to the body regions that have been firing pain impulses to the brain. As you are voluntarily stressing a given muscle group, you have control as to the intensity of the signals. Somehow the combination of control and different inputs has a significant impact on pain.
Regular exercise improves almost every aspect of life, including sleep. Activities should involve both aerobics and resistance training. If it fits in with a hobby you love, that is an additional benefit. Invite a friend to join you, take a neighbor’s dog for a walk, accompany a grandchild to the park, join a local team—all of these activities allow you to connect not only with your body, but also with your community. Experience of connection in itself promotes a feeling of safety and lowers inflammatory markers.
However, per the sleep hygiene principles, intense exercise should not be performed in the evening. If you must exercise late in the day, keep it light and relaxing; otherwise, the neurochemical stimulation will disturb your sleep. Remember that adequate sleep is one of the cornerstones of alleviating chronic pain.
The key to incorporating exercise into your care is to select an activity you enjoy from the start. Exercise is a long-term commitment, and it is important to have fun while you do it. It’s easy to look at your exercise equipment and feel badly that you aren’t using it more than you should; but those thoughts are counter-productive to your healing. If you reframe exercise as a reward comprised of leaving the house, being with people, and moving your body, you’re more apt to keep it up.
Questions and considerations
- If you are serious about breaking free from chronic pain, you must exercise. It is a concrete and defined way of affecting your body’s physiology. Are you exercising at all? Are you exercising the recommended amount of time per week? If you are not, you have to ask yourself, “why?”
- Any exercise helps and the proportional benefits are actually greater at the beginning of your program. Benefits increase with more exercise, but you have to begin somewhere.
- If you are not in good physical shape, it is hard to have good mental health and enjoy many other activities. What do you want your overall life to look like?
- Consider the time you may be spending with medical visits, looking for solutions on the Internet, reading self-help books, considering surgery, and discussing your pain and medical care. What if you took 30 min a day from these activities and exercised?
- These comments sound like I am lecturing and I am. I continually challenge myself and my patients with the question, “What do you want?” The answer is usually, “I want to be free from my pain.” Then do it. There are many basic ways to break free from chronic pain without aggressive medical treatments. Sleep and exercise are foundational steps. If these two are not in place, you will not be able to move forward easily regardless of other interventions.
- “Just do it.”
- Paterson DH and Darren ER Warburton. Physical activity and functional limitations in adults: a systematic review related to Canada’s physical activity guidelines. International Jrn of Behavioral Nutrition and Physical Activity (2010); 7:38-50.
- Powell KE, et al. Physical activity for health: What kind? How much? On top of what? Annual Review Public Health (2011); 32:349-65. doi: 10.1146/annurev-publhealth-031210-101151.
- Moore SC, et al. Association of leisure-time physical activity with the risk of 26 types of cancer in 1.44 million adults. JAMA (2016); 176:816-825. doi: 10.1001/jamainternmed.2016.1548
- Surgeon General Report. Physical activity and health. CDC (1999). https://www.cdc.gov/nccdphp/sgr/adults.htm
- Dantzer R, et al. Resilience and immunity. Brain, Behavior, and Immunity (2018); 74:28-42.
- Volpi E, et al. Muscle tissue changes with aging. Current Opin Clin Nutr Metab Care (2004); 7:405-410.
- Crimmins EM. Lifespan and healthspan: Past, present, and promise. The Gerontologist (2015); 6:901-911. doi: 10.1093/geront/gnv130
- Cigna US Loneliness Index. Cigna, 2018.