Exercise is great, we know this, right?
Well sort of.
Many people know exercise is good for us on a general level, but the question is, do they know it’s right for them on an individual level and is it the right fix for their problem?
This is an entirely different proposition, applying that general information to the person. This idea that these things are good for us can be quite vague, one of those things we may have glanced over in a newspaper or half heard on the news whilst eating our cornflakes.
People also build up ideas about what is the correct treatment for them. This can be from their own in depth research on the internet (right!), what they have picked up from friends and family or from previous treatment with a therapist. This can lead to some pretty strong ideas about what should and perhaps should not be done to help them.
These beliefs don’t always align with the best available data we have about interventions. A prime example of this is the belief that exercise risks out weight the benefits with back pain (55% of folk in New Zealand). This stat was taken from this Darlow paper in 2016 HERE.
We know that exercise can be effective with back pain, certainly not a magic bullet, but one of the best things we have at our disposable within a comprehensive treatment plan, especially as it is low cost and low risk too.
Our beliefs drive our expectations and actions. Predicted expectations are gaining weight as a prognostic factor in recovery over the past decade. They may influence my participation and behaviour in a treatment plan that will ultimately affect the outcome. If I don’t believe in something I am much less likely to do it.
How can we combat this? Well in my opinion the best tool we have is good quality information we can use to combat the beliefs that may hold people back. A key to start affecting beliefs, again in my opinion, is not to challenge to firmly but inform people using well-evidenced information.One of my favourite one liners is “ That’s what we used to think but we are learning new things all the time, the latest research suggests….”
Here are some small titbits of information that we can use to start informing our patients and clients about the role of exercise in pain AND health, which of course ultimately affects pain too!
Remember that giving people information is really designed to change behaviour rather than just show how smart you are so monitoring what happens is pretty important.
This paper HERE from 2017 in PLOS one shows moderate to strong effectiveness of exercise as an intervention for many MSK issues. This is in contrast to the belief that things need to be zapped, needled or popped back into place.
My therapist only gave me some exercises. Yep. Because they followed the evidence!
So many people see the body as a bit of machinery. The more it works the more the parts need replacing. Is this true? Absolutely NOT. The body is an organic organism that adapts both positively and negatively to stimulus. The more active we are (within reason) the stronger we become. The less active, well…..
A classic common belief is that our invertible discs wear out the more we use them. This classic study from Battie HERE (2009) looked at twins to determine the major contributors to disc degeneration. They suggest that the “commonly held view that disc degeneration is primarily a result of ageing and "wear and tear" from mechanical insults and injuries was not supported by this series of studies”
This study HERE from 2017 found that if you have a rotator cuff tear, the tear getting worse did not appear to be simply related to activity levels. In fact they suggest pain development is actually associated with LOWER activity levels.
If I had a pound for every time it has been suggested to me that running damages the knees then I would be a rich man. A study of marathon runners HERE showed that they had LESS meniscal abnormalities than non runners.
Two recent studies have shown a POSITIVE effect of activity on intervertebral discs. Firstly this study HEREfrom 2017 showed that MORE vigorous activity was associated with BETTER disc health on MRI.
Secondly, in this paper from 2016 HERE. Runners were shown to have intervertebral discs that had increase hypertrophy compared to the non athletic group. The authors suggest that running actually strengthens the discs, whether we can infer a causal relationship here is unclear but this goes against activity causing wear and tear which is a common belief.
This study HERE showed that older adults who were MORE active also had better endogenous pain inhibitory mechanisms when their conditioned pain modulation (CPM) was tested. Simply put : ) this means the more active the better their natural pain killing mechanisms were. Which of course is super cool.
This study HERE showed that regular physical activity caused an increase in interlukin -10 which is an anti inflammatory cytokine that can reduce nociceptor sensitisation.
Now the caveat here is this study was performed in an animal population but as we know that there are associations between inactivity and both acute and chronic pain in humans it is a linked that potentially needs to be better explored.
This large study HERE looked at the relationship between recreational exercise and chronic pain. Both older and younger folk were studied and the researchers found that for both groups exercise participation was associated with reduced chronic pain. A relationship was also present for the frequency, duration and intensity of that exercise.
This comprehensive paper HERE makes a case for a lack of exercise being a primary prevention against 35 chronic conditions suffered by us poor humans. This goes beyond what most of us involved in the musculoskeletal field would have to deal with but also shows the importance of exercise for systemic health too.
We are understanding more and more that the mind and the body cannot really be separated. Physical health and mental health are interlinked in the human being and guess what…..exercise plays a role in improving mental health too. This paper HERE explores the mechanisms that may relate to mental health and exercise.
This randomised control trial looked at aerobic exercise and a variety of measures of psychological health HERE. The authors found significant group differences that favoured the exercise group.
Strength training in this paper HERE was found to have a significant association with decreased mortality in adults over 65. BUT only a minority of this age group actually meet the current guidelines.
This prospective study of 15 years duration HERE found that physical activity was a predictor of cardiovascular disease.
There are a whole bunch of others studies that relate to these topics but I just picked a few. I think it demonstrates that physical activity and exercise have an effect on us on a number of different levels, from the heart to the head to pain as well.