When it comes to pain management, more and more chronic pain patients are starting to see the value of exercise in their long-term pain solution.
Exercise is amazing because it kills so many birds with one stone.
• Improve your sense of well-being therefore decrease your susceptibility to pain
• Increase your confident with movements therefore removing, catastrophising, fear-avoidant behaviour or kinesiophobia (fear of movement)
• Make you stronger therefore increase your capacity for living your daily life – e.g. cup analogy or load management
• Produce an analgesic response (direct effect from exercise, i.e. immediate pain relief)
• Improve bone mineral density and to some extent reverse osteoporosis
• Reverse degeneration findings on MRI (more research needed)
These are just some examples of exercise that I can think of on to of my head but there are more!
Exercise is good for your blood pressure
If you have high blood pressure, you’d probably want to pay attention to this.
Exercise can reduce your blood pressure by up to 15mmHg!
This means if you are borderline stage 1 hypertension, exercise alone could very much bring you within the prehypertension classification.
Again, this is looking at exercise as an intervention alone. Imagine if you were to combine exercise with eating better, managing your stress better, improve your pain experience, practise gratitude, what a difference it would all make?
If you were to participate specifically in aerobic or cardio training such as running, swimming or cycling, the benefit is comparable to commonly prescribed hypertensive drugs.
What if I don’t like cardio?
Strength training and isometric contractions have also be found to be safe for patients with high blood pressure. While it was previously thought that aerobic exercises are more beneficial, recent studies suggest resistance or weight training can just be as effective!
The lesson here is that it’s okay. While it may be true different exercises may have different effects, the most important of all comes down to actually doing it. Preferably for the long-term. So, do what sticks.
Exercise may help with your cholesterol levels
If you love, love, love high-cholesterol foods such as red meat or shellfish, exercise may be able to help.
In individuals with normal-range cholesterol or high cholesterol, exercise can increase the “good cholesterol” i.e. high‐density lipoprotein‐cholesterol (HDL‐C) levels and also decrease the particle size of the “bad cholesterol” i.e. low‐density lipoprotein‐cholesterol (LDL‐C).
However, it’s important to note that the effect size is small and that exercise in combination with dietary interventions gives better outcomes than either of them on its own.
Again, being healthy is not just about fixing problems. It’s about taking a big picture view of all the changes that may help and constructing the best possible solution for yourself.
Fight diabetes with exercise
Regular exercise with different intensities on its can reduce your risk of type 2 diabetes by 25% to 40%. Pretty sweet huh?
Perhaps sometimes we tend to focus too much on what is the best thing to do and forget about the difference the sum of everything else can make.
Being healthy really isn’t about eating super foods, 16/8 intermittent fasting, hot yoga, or any fancy health interventions you can think of alone.
It’s really about making better health choices, one at a time, and embodying these decisions so they become a part of who you are. It’s the sum of all the adjustments you have made that will lead to sustainable, long-term change.
Exercise does come with a dose-response relationship. The more you do, the more results you see.
Similarly, doing something is better than doing nothing. So much so that The American Diabetes Association recommends that sedentary behavior, such as prolonged sitting or standing, should be interrupted with 5‐minute of walking.
It really can come down to just taking more toilet breaks.
If you want to take it further, add some squats into the walking.
Remember, every bit counts!
Can exercise help with weight loss?
This is kind of controversial. My personal opinion is that the core pillar of any weight loss program is dietary modifications or reducing energy intake.
Many gyms, fitness classes, and personal trainers try to sell exercise as an effective strategy for losing weight.
However, research shows that the exercise alone has a limited effect with weight loss. Even when combined with dietary restrictions, the change is modest.
It’s really hard to understand this because we think the more energy you burn will mean the more weight you will lose. In a hypothetical sense, that is true but that is not the complete picture.
Vox published an article a few years ago with some pretty solid infographics to help people understand why exercise is a terrible weight loss strategy.
First, the amount of calories you burn from physical activity – low- and high-intensity exercise inclusive – accounts for only a small part of your energy expenditure. Your basal metabolic rate is the main consumer of energy.
The next time you hear someone trying to upsell a fat-burning workout to you, invite them to share some scientific data on how their exercise is effective at burning fat.
Second, you simply can’t burn enough energy with physical activity to create meaningful weight change.
Vox used an example the example of a 90kg (200-pound) man who runs four days a week, and for 60-minutes in each run. After four weeks, he would have lost a total of 2.3kg (5 pounds).
This is assuming he nothing else in his life changed. When we start to take into account the “compensatory behaviours” that happen with exercising, you start to relax more or rest more so we can recover. We may even consume more food! These changes alone can completely negate the marginal weight loss from exercise.
Furthermore, some studies have found that your metabolic rate may decrease with exercise or weight loss. While the relationships are still unclear, what we know for certain is that weight loss is complex goal that will need a whole-person approach for successful outcomes.
Conclusion? Exercise-alone does help with obesity. However, it is unclear if these effects are meaningful or can be sustained in the long-term.
Exercise to boost work performance
I don’t think we talk about this enough in Singapore: Exercise literally changes your brain.
For a country where people seem to prioritise work over general well-being, using work productivity to sell exercise seem to be the obvious approach to getting people active.
So, what exercise can exercise do for your brain?
Second, exercise improves cognitive function. Not just for you but possibly also your offspring and their descendants. For a society that is excessively concerned with providing the best for our children – from financial stability to education excellence, perhaps we could also consider investing time into exercise for their benefit.
Third, exercise can increase children’s academic performance!
Traditionally, we see physical activity as something that comes with only physical benefits and contributes only to physical well-being. Research tells us exercising comes with benefits that far transcends that.
We attribute better work productivity from working out to an increased sense of well-being. Perhaps from the increase in endorphins from being active. However research tells us that exercise is not a feel-good-only activity.
It can literally change your brain in observable, measurable ways.
If we are willing to sleep four hours every night because we prioritise work over health, perhaps we could find our motivation to exercise from work instead of our health.
It doesn’t matter what it takes to get you moving as long as you start moving.
Remember, every bit counts.
Does exercise help with pain?
Yes! We know exercise helps with pain AND injury for decades now.
It’s a bit of a tough sell in Singapore because we tend to perceive pain as damage. We think we are experiencing pain because we are damaged. As such, exercise is going to make us more damaged.
Unfortunately, such narratives are prevalent here and they lead to confusion over what is best evidence treatment.
One of the reasons why education is so important in long-term pain relief is that it changes how you think of your pain. In Pain Neuroscience Education (PNE), we heavily emphasised that damage does not equal damage.
In fact, there are many occasions in our usual lives where we find pain to be desirable. Take for example a massage. You probably would want your massage to have some pain. If it’s totally pain-free, you probably think it doesn’t work.
Some of us will foam roll, trigger point (with a tennis ball) or stretch on a daily basis. Do you do that on tissues that are not sensitive and totally pain-free? No.
You see, pain is not the problem. The narratives that we use to interpret (or pathologise) safe and normal activities is perhaps a greater problem to successful recovery outcomes.
How does exercise help with pain?
We don’t really know exactly but we know there are direct effects (immediate relief that is the direct result from the exercise) or secondary/indirect effects (pain relief that happens due to other changes associated with exercise).
Isometric exercises, that is exercise without movement such as holding a weight, is well established to help with pain relief. The analgesia effect is attributed to the cortical inhibition that happens only with isometric exercises. If you were to perform bicep curls instead of just holding it, the cortical inhibition response actually doesn’t happen.
So I totally hear you that exercises make your pain worse. However, perhaps, there are other exercises that we could explore that may give you immediate pain relief!
Working out can also help with long-term pain relief as it helps you make your physical body more robust and more resilient.
As you progress to move complex movements or lift more weights, you will gain more confidence with what you can do. With that, you may find yourself to be no longer afraid of activities that you used to avoid.
Heavy weights for the injured tendon
A study published in 1998, found heavy weights to be more effective than other traditional treatments for Achilles tendinopathy/tendinosis.
That is crazy right?
When we are in pain or injured, the medical doctor, chiropractor, or physiotherapist will often to ask you to take it easy. Rest, let it heal, etc. Yet in this study published over two decades ago, heavy weights was what led 100% of the patients back to pre-injury running in just twelve weeks!
In the patients with the same diagnosis who received advice to rest, anti-inflammatory drugs, changes of shoes, orthotics prescription, or physiotherapy ALL ended up going for surgery as the ultimate intervention.
If you think about it, standard medical care hasn’t changed that much.
We are still telling people to rest, change your shoes, take some pain-killers even though the efficacy of such interventions are questionable!
Exercise for knee pain
We see comparable results in patients diagnosed with knee osteoarthritis. Doctors, chiropractors, and even physiotherapists may recommend that such patients avoid high-impact or high-intensity activities because their joints are “wearing out“.
Yet studies have repeatedly found that weight training improves BOTH pain levels and physical function in just eight to twelve weeks.
Some of you are probably living with pain for a decade or two because you have been receiving the bad advice from junk science.
What about exercising for back pain?
We have taken it a step further with back pain.
By far the most successful approach to managing back pain takes an education, exercise, and lifestyle change approach.
We have known that exercise works for back pain for a while now that we are no longer interested in if exercise works. We are interested in what else can we do on top of exercise to get even better results.
How does that sound?
With the three-prong Cognitive Functional Therapy approach, patients experience MORE improvements in disability, depression-anxiety, and fear towards movements than exercise even after three years.
This is a true long-term solution.
You are absolutely right in thinking that exercise may not make some of the underlying diagnosis go away. Take for example, rheumatoid arthritis. It is true exercise cannot cure you from the autoimmune disease but yet patients with rheumatoid arthritis who choose to participate in exercise experience less pain and better function.
I am willing to accept that exercise is not a one-size-fit-all solution.
In that sense, exercise may not make your problem go away completely. However, across multiple pain, injuries, and medical conditions, physical activity has been demonstrated to have at least some benefits.
Health is not merely an absence of disease. It’s about achieving peak physical, mental, and social well-being.
Exercise can be your one step that will bring you closer to the life you want to live.
The question is what are you going to do about it today?
If you are looking for an exercise-based approach to finding freedom from pain, book in an appointment with me via the form below to discover the difference the right care can make. I promise it will be nothing like what you have had before.