Chronic pain: Exercise can bring relief

There was a time when people with chronic pain were told to avoid physical activity for fear it might damage their joints and muscles and worsen their discomfort. Those days are over. Exercise actually can help reduce your pain and improve your health.Chronic pain can be caused by a number of conditions, including:Arthritis Fibromyalgia Endometriosis Back pain Irritable bowel syndrome Many people have continuing pain without a specific diagnosis. These conditions may be managed by a variety of treatment regimens. But one thing these people have in common is that the pain caused by these conditions can be mitigated by regular exercise. Rest is best A common misconception is that exercise increases pain. And for many years, rest was considered the best treatment for the pain due to various chronic conditions. “But the exact opposite is found to be true in our research. When people rest they became deconditioned. That deconditioning can lead to further problems that may perpetuate the pain,” says Edward Laskowski, M.D., a physical medicine and rehabilitation specialist and co-director of the Sports Medicine Center at Mayo Clinic, Rochester, Minn.When you are inactive, you lose muscle tone and strength, and your cardiovascular system works less efficiently. Also, inactivity increases your risk of high blood pressure, high cholesterol and diabetes, putting you at higher risk of heart attack and stroke. It can disrupt your sleep and worsen fatigue, stress and anxiety – as well as your pain. On the move Engaging in a regular exercise program can help keep your body in top shape and provides the following benefits: Increases energy Improves sleep Promotes weight loss (reducing stress on your joints) Increases bone mass (reducing your risk of injury) Relieves stress In addition, regular exercise can have both direct and indirect benefits for those with chronic pain. Direct benefits Exercise can have a positive effect on the structural problem that is causing your pain. For instance, arthritis can produce painful, inflamed knee joints. Regular exercise and strength training can help build up your muscles, which will provide a natural brace for your knee joint. “So the more you can enhance the structural support of the joint with stronger muscles, the more force and load you can take off bones and cartilage. This can contribute to pain reduction,” says Dr. Laskowski. Indirect benefitsExercise can also have an indirect effect on your experience of pain. For example, during physical activity your body releases certain chemicals (endorphins) that block pain signals from reaching your brain. “Endorphins are the body’s natural pain relieving chemicals that in many cases are more powerful than morphine,” says Dr. Laskowski.The more endorphins that you produce on your own, the less you will need to rely on external forms of pain management, such as medications. These chemicals also help alleviate anxiety and depression, conditions that can make your pain more difficult to control.Regular exercise program The key to achieving many of these benefits is to take part in a regular exercise program that includes flexibility, strengthening and aerobic exercises. Flexibility. Flexibility exercises include simple range-of-motion and stretching movements. Such exercises keep your joints moving through their full range of motion, allowing you to move and carry out daily activities more comfortably. They also prevent your muscles from shortening and tightening, which would increase your risk of injury. Strengthening. Strength training helps you develop stronger muscles, which improve your physical fitness and reduce fatigue. Stronger muscles also make it easier to carry out more vigorous types of daily activities, such as carrying laundry up and down the stairs or lifting items at work. Strength exercises also help you preserve and increase lean muscle mass. This helps you burn more calories and aids in weight loss and in reducing stress to your joints.Aerobic. Aerobic exercises challenge your heart, lungs and muscles, increasing your heart rate, blood pressure and need for oxygen. These exercises help your body work more efficiently and reduce your risk of cardiovascular disease, including heart attack, high blood pressure and high cholesterol. Aerobic activity also increases your stamina so that you don’t become as easily fatigued during daily activities. Keep on keeping on Your exercise program should be tailored to your condition – this can increase your health benefits and decrease the chance of injury. Your doctor can recommend specific activities that will be beneficial to you. And if you are just starting an exercise program, these tips can help you stay on track:Set goals. Start with simple goals and progress to longer-range goals. People who can stay physically active for 6 months usually end up making regular activity a habit. Remember to make your goals realistic and achievable. It’s easy to get frustrated and give up on goals that are too ambitious. Pace yourself. Initially, do a little bit at a time and then rest. When you first start you may experience increased discomfort from working muscles that are not used to exercise. But after a few days, as you gain muscle strength and improve joint flexibility, your pain should start to ease. Add variety. Vary what you do to prevent boredom. For example, try alternating walking and bicycling with swimming or a low-impact aerobics dance class. On days when the weather is pleasant, do your flexibility or stretching exercises outside. Consider joining a health club to broaden your access to different forms of physical activity. Exercise with others. Performing activities with partners who have similar fitness levels can make exercise more rewarding and enjoyable. And peer pressure can help keep you going. Be flexible. If you’re traveling or especially busy on a certain day, it’s OK to adapt your exercises to accommodate your schedule. If you develop a cold or the flu, take time off from your exercise program. Fatigue can increase pain. Track your progress. Record what you do each time you exercise, how long you do it and how you feel during and after exercising. Recording your activities helps you work toward your goals as well as remind you that you’re making progress. Reward yourself. Work on developing an internal reward that comes from feelings of accomplishment, self-esteem and control of your own behavior. After each activity session, take 2 to 5 minutes to sit down and relax. Savor the good feelings that exercise gives you, and think about what you’ve just accomplished. This type of internal reward can help you make a long-term commitment to regular exercise. External rewards also can help keep you motivated. Upon reaching one of your longer-range goals, you might treat yourself to a new pair of walking shoes or a new compact disc of your favorite music.Shopping for a fitness program Play it safeYou have your whole life to enjoy the benefits of exercise, so don’t rush into a strenuous workout regimen before your body is ready. “Remember to start low and progress slow. It is not advised that people push through severe pain,” says Dr. Laskowski. “Consistency is more important than intensity.”Exercise isn’t a cure-all, so you will need to continue with your regular treatment regimen. But with proper guidance and dedication, exercise can be an effective part of your pain management program. (Source: Mayo Clinic, 23 June 2003)