Exercising with chronic pain — advice from an expert

November 17, 2021

*It's vital to check with your doctor before starting any exercise regimen, especially if you live with chronic pain.*

One in four Canadians over the age of 15 have some sort of chronic pain. Chronic pain is defined as pain that lasts beyond the body's typical healing time- often more than three months. Conditions like fibromyalgia, rheumatoid arthritis and osteoarthritis are common types of chronic pain that can make daily life more challenging, even though the conditions themselves do not directly cause injury.

Whereas old medical advice usually involved rest, today's medical professionals are often recommending exercise to help treat symptoms and prevent complications.

Chronic pain and exercise safety

The question for many people with chronic pain is whether it's safe to exercise. For most people, it's more dangerous to not exercise, says Alex Edye-Mazowita, disability case manager at Manitoba Blue Cross. A clinical exercise physiologist certified with the Canadian Society for Exercise Physiology, Edye-Mazowita helps people recover from disabilities and get back to healthy work.

"A lot of these chronic pain conditions are going to indirectly causes secondary complications because a person isn't active due to the pain," he says.

For example, people with fibromyalgia and osteoarthritis are at an increased risk of cardiovascular issues due to being sedentary, says Edye-Mazowita, who has a Master of Science degree.

People with chronic pain who are sedentary are also going to have more joint inflammation, fatigue and higher risk of muscle loss. For older sedentary people, falls can be catastrophic due to weaker bones.

"Research has shown conclusively that the majority are able to exercise and there's no risk of harm from doing so, which is a key thing," he says. "There may be some discomfort, it might be tough to get started because you're fatigued- so while there are barriers to overcome, you are able to do it safely."

Exercise and fibromyalgia

Fibromyalgia's symptoms include widespread pain throughout the body, fatigue and mental health problems, which can make exercise seem daunting to someone with the condition.

Lighter movement, such as stretching, can be tempting because it's not as taxing. Unfortunately, these gentler forms of exercise aren't as helpful at reducing pain for people with fibromyalgia.

"According to research, both aerobic exercise and resistance training appear to decrease pain, with combined exercise being the most effective," says Edye-Mazowita.

Exercise with osteoarthritis

Osteoarthritis involves the deterioration of the joints' cartilage. Since this often involves knee and hip pain, high-impact exercise like running and step aerobics is not recommended, Edye-Mazowita says.

"For people with osteoarthritis, low-impact exercise, like aquatic exercise, will help prevent further injury while improving pain," he says.

The biggest risk factor for negative outcomes with osteoarthritis is body weight, so the more weight put on the cartilage, the more it will deteriorate, Edye-Mazowita says.

Walking and cycling can also offer benefits while having a lower risk of injury, since they don't put as much stress on your cartilage, he adds.

It's important to keep in mind that for people with osteoarthritis, doing low-impact exercise is much more beneficial than staying off the joints completely- not using your joints will actually make your cartilage worse, Edye-Mazowita says. So, it's important to get up and move, as tempting as it is to remain at rest.

Exercise and rheumatoid arthritis

Rheumatoid arthritis is an autoimmune disease that causes inflammation throughout the body, including the joints. Rheumatoid arthritis is different than other chronic pain conditions because the disease itself causes secondary complications, like bone density loss — not just because patients are more likely to be sedentary due to pain.

"With rheumatoid arthritis, what we want is activity that is weightbearing," Edye-Mazowita says. Weight-bearing activity, like weightlifting and resistance training, will help maintain bone density and muscle mass.

Even higher-intensity exercise can be beneficial for rheumatoid arthritis, he says. Although multi-year studies have shown that individuals who lift weights sustain damage to the small joints in the hands and feet, this damage is less progressed than non-exercising patients- while providing secondary benefits such as improved fitness and balance.

Once again, the risk of not exercising tends to outweigh the risk of exercising, Edye-Mazowita says.

Temper expectations

"Exercise has been shown to decrease subjective pain — but not to nothing. And that is the key here," Edye-Mazowita says. "People shouldn't be expecting that they will be completely cured, that the chronic pain will go away. It's not a magic bullet. What it does is bring pain levels down to a mild or moderate level, which is the goal of most therapeutic medicines."

The more pain a person is in, the more they'll benefit from exercise, but even someone with mild pain may see benefits, Edye-Mazowita says.

It's vital to check with your doctor before starting any exercise regimen, especially if you live with chronic pain.

While starting will be difficult, the benefits of exercise in reducing pain- as well as dozens of other health benefits- will be worth it.

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