Increasing Physical Activity for Chronic Pain Management

Why is Physical Activity Important for Those with Chronic Pain?

Chronic pain is commonly defined as pain that is present for 3 months or longer and persists beyond the expected length of healing. While individuals with chronic pain may be reluctant to engage in physical activity due to fear of injury, research demonstrates the importance of remaining physically active. Physical activity refers to any activity undertaken during one’s day (e.g., transport, occupational, or recreational activity), while exercise is a specific activity carried out to maintain or improve one’s health or fitness.

Physical activity and exercise may reduce pain severity and improve physical function for individuals with chronic pain. Additionally, physical activity is likely to improve mental and physical health conditions that commonly co-occur with chronic pain, such as depression, anxiety, cardiovascular disease, and diabetes.

Staying Active for Better Chronic Pain Management

There are numerous ways a person with chronic pain can increase their physical activity. Two evidence-based approaches are activity pacing and graded activity, which may be used separately or in combination. If the individual is unsure whether an activity is safe, it is recommended to consult a healthcare provider.

Activity pacing involves increasing activity at a self-guided pace while leaving time for rest to minimize fatigue and other symptoms. A central practice in activity pacing is alternating frequently between activity and rest. Before engaging in an activity, it is essential to identify valued activities and how much of an activity one thinks one can do before experiencing a significant and lasting increase in pain (i.e., a pain flare).

Generally speaking, it is safe to do an activity with a small increase in pain if that increase is acceptable and manageable to you. If you experience an increase that doesn’t feel manageable, you may need to start with a smaller amount of activity or break it down into more doable chunks.

Understanding and honoring your current limits and setting realistic goals are vital to activity pacing. When done correctly, those with chronic pain often find that they can do more activity with fewer negative repercussions over time.

Graded activity takes a different approach to increase activity. Rather than focusing on activity and rest cycles, graded activity focuses on finding a baseline amount of activity that one can do consistently without pain flares and gradually increasing the amount of activity over time. Again, selecting an activity you value and enjoy is one of the keys to maintaining motivation.

Some people may stay at a baseline activity level for a few days or weeks before increasing. How much you increase your activity is up to you, though it's recommended to increase it by small amounts. Like activity pacing, successful graded activity depends on consistency.

How to Maintain Physical Activity for Optimal Chronic Pain Treatment

To maximize the benefits associated with physical activity, practice it regularly. Research has shown that the reasons for initiating physical activity often differ from those for remaining physically active long-term.

Starting a physical activity routine is often motivated by expectations of long-term benefits, such as reduced cancer risk or increased lifespan. But maintaining a physical activity routine is more likely the result of enjoyment of the selected activity, satisfaction with the outcomes resulting from the activity, and congruence of the adopted routine with one’s identity, beliefs, and values. This is why choosing activities you enjoy and value is the best way to stick to a physical activity plan.

Although potentially unconscious, regularly active individuals often develop self-representations of themselves as “an active person” or an “exerciser”. Such changes in identity contribute to automatic tendencies to enact behaviors that are aligned with one’s identity. The automatic tendency to be regularly active that results from identifying as an “active person” also reduces the time and energy burden of conscious exercise planning and self-monitoring.

Similarly, habits, which are behaviors automatically triggered by situational cues (e.g., brushing teeth at the same time every day), also contribute to regular physical activity through unconscious processes. To build a physical activity habit, consider being active in the same context regularly (e.g., time of day, location) or integrating activity into another pre-existing routine.

For More Help with Physical Activity for Chronic Pain

The following resources are available for those interested in these approaches but want more information. Healthcare providers (e.g., physical therapists, occupational therapists, and psychologists) who specialize in managing chronic pain may also be of great help.

• https://painhealth.csse.uwa.edu.au/pain-module/pacing-and-goal-setting/
• https://tapmipain.ca/patient/managing-my-pain/pain-u-online/pacing-module.html
• https://www.southtees.nhs.uk/services/pain-management/physiotherapy-for-pain-management/graded-activity/

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