Cardiovascular Exercise for Chronic Pain

I am sure most of us send home patients with exercises to do. Potential aims being:

• Improved muscle strength/endurance
• Improve flexibility of muscles/joints
• Rehabilitating tendinopathies
• Improved motor control
• Pain relief
• Neural tissue “mobilisation”
• Etc, etc, etc.

But what about cardiovascular exercise?

Are there benefits of cardiovascular exercise for chronic pain?

Why should we be encouraging it? What are the benefits of it?

• It has anti-depressive and anxiolytic (anti-anxiety) effects.
• It reduces sensitivity to stress (i.e. it increases resistance to physiological and emotional stressors.
  • Salmon (2001)
• These effects are most likely due to the increased levels of endorphins, noradrenaline, serotonin, and dopamine as  a consequence of the cardiovascular exercise (Ruby et al, 2011).

What parameters should we be advising?

• The American College of Sports Medicine (ACSM) recommends that most adults engage in moderate-intensity cardiorespiratory exercise training for 30 mins daily, 5 days per week, for a total of 150 mins per week (Garber et al, 2011).

So I think it important that our patients, particularly our chronic pain patients, are encouraged to  undertake regular cardiovascular exercise. Unfortunately for these patients this can be difficult given a variety of issues such as pain levels, psychosocial issues, or that they may be significantly de-conditioned.

Ideally we need to find a form of exercise that it not going to exacerbate their pain levels significantly, and this may be difficult. Exacerbation of their pain levels, in my opinion, is going to have very little positive effects.

So although it may be a difficult proposition to find them some way to undertake cardiovascular exercise,  the benefits outlined above would suggest that it is a highly worthwhile cause.

We also might not want to start them immediately on 30 minutes exercise to begin with. Some of our patients may be doing no cardiovascular exercise, so even a few minutes daily can be an important start point, and may be all they can tolerate to begin with. The aim being to gradually build up levels, within a tolerable level.

References:

Salmon P. Effects of physical exercise on anxiety, depression, and sensitivity to stress: a unifying theory. Clinical Psychology Review (2001); 21(1):35-61.