Exercise Accountability and Pain

September 2, 2015 / Thomas Cohn, MD

A recent study in Medicine and Science in Sports and Exercise points out whether we are reliable in reporting our exercise. The answer is that most of us tend to over report our activity level. When using an objective measure of activity, such as a monitoring device of steps and pulse, the record is much more accurate. The best way to keep healthy and reduce pain is to stick to a regular exercise routine. If you are not being accountable, the activity is usually not being done. Very few people have the self-discipline to be consistent with exercise on their own.

Up until recently, the best way to be accountable is to have an exercise partner. Whether it be a yoga classmate or a running partner, if you had to meet someone else, it was much harder to skip the exercise.

Currently, the electronic age can become out partner, as most people now own a smartphone. Both the Android and the Apple phones have fitness apps built into the phone and have electronics that can monitor motion. As long as one has the phone in hand (or pocket), the phone will record your steps. Most people should be aiming at obtaining at least 10,000 steps a day to maintain general cardiac aerobic fitness.

Fitness Trackers and Exercise

A fitness tracker, such as a Fitbit, Vivofit (by Garmin) or Jawbone can be of great benefit. There are now multiple brands of trackers, those at about $100 dollars tend to monitor:

Steps

Distance

Calories burned

Steps climbed

Sleep patterns

The more expensive ones will add in heart rate monitoring, sometimes blood oxygen levels, and may connect to smartphone notifications. All the fitness trackers have apps that chart your daily, weekly and monthly statistics. Keeping a record of your activity tends to make one more responsible toward meeting fitness goals.

The importance of maintaining physical activity is very evident in the pain patient. My patients who are the most active have the best control of their symptoms and tend to use the least amount of drugs and other interventions. For myself, the fitness tracker keeps me more active, maintaining my aerobic conditioning goals. The more intense aerobic exercise, even for just 15 minutes every day, definitely increases my endorphins (the body’s own pain killers) and decreases my back and leg pain. Without the tracker, I know I would be lazy, and definitely would think I am doing more activity than I actually perform.

Aerobic activity does need to be combined with strengthening and stretching for most pain patients. The areas that are causing pain often need more physical muscle support to prevent symptoms, and strengthening and keeping these muscles healthy is another priority.

Regular Exercise Isn’t Easy, But It’s Worth It

June 3, 2015June 3, 2015 / Thomas Cohn, MD

There is always a reason not to exercise. Being dedicated to exercise and staying healthy is extremely hard. For starters, it takes time to exercise, and the payoff of exercise is not immediate. Often, doing the necessary workouts seems to hurt. However, after getting into the routine, suddenly one realizes they hurt less. Everyone does need to exercise just to maintain a healthy body. When one has a chronic condition, it becomes more work, but it is also more important just to keep everything working in the best possible shape.

As a pain doctor, I often preach about exercising. It is one of the most important aspects of pain treatment. It is written about in most textbooks on pain. I used to talk about it less, but after having more problems with my own back, and seeing the effect on others who took exercise seriously, I began to be more vocal. The first step is committing to your health and to exercise. This means that you have to be dedicated to meeting a definite exercise goal and have a means to monitor whether you met the goal. A starting goal would be those by the American Heart Association for physical activity in adults. They include moderate to intense aerobic activity for 30 minutes, 5 days a week. Better, would be 25 minutes vigorous activity 3 days and moderate muscle strengthening 2 days a week.

What Counts as Exercise?

To count as exercise, it should be outside the realm of the activity that is being done for your employment. The reason is physical activity has a direct positive affect on the brain; maximize this by not distracting it from possible negative thoughts about work. One should also keep track of your exercise to see if you are meeting your goals. A fitness tracker, such as an app on your smartphone or a Fitbit, keeps one honest on whether you are meeting your goals.

I have had problems with low back pain. My lumbar spine has one very bad disc and severe spinal stenosis with pinching of the nerve roots. Once I became serious with a good exercise routine, management of my back pain improved. It is not easy to be consistent, but the reduced pain and better sleep is worth it. To get my exercise done, I need to do it before work, at the beginning of the day. Fortunately, I am a morning person, but I am awake before 5 a.m. to get it done. My goal daily is at least 30 minutes of moderate activity and 10,000 steps on my tracker.

The exercise routine I follow is during the week is 3 days of intense core and whole body strengthening with 2 days lighter core strengthening and intense aerobic activity. I exercise for about 45 minutes, combining strength and aerobic routines. On the weekends, one day usually I do a full strengthening routine with a full aerobic workout; the other day is light core and aerobic exercise. Every day I will do core strengthening, usually 10-20 minutes, with rubber tubing and floor exercise. Core exercises have greatly decreased the low back and leg pain, making it minimal most of the time. Aerobic conditioning keeps the overall endurance adequate to be active throughout the day.

If one wants to be healthy, one has to do the work to keep healthy. There is no free ride, not even for the doctor. There are sacrifices to be made to stay healthy, like getting up early in the morning. The pay off, less need to complain about your pain, fatigue, and health.

Can Exercise Help Relieve Pain?

August 20, 2014August 25, 2016 / Thomas Cohn, MD

A new study suggests that regular exercise can improve a person’s tolerance for pain and discomfort.

The study was conducted by researchers at the University of New South Wales and published earlier this month in Medicine & Science in Sports & Exercise. For their research, scientists recruited 24 healthy but inactive individuals. 12 of the people said they were inactive but were interested in exercising, while the other 12 said they preferred not to exercise.

After the groups were separated they each were put through similar tests to create a baseline pain threshold. This involved putting pressure on a person’s arm until they said the pressure went from unpleasant to painful. Researchers later put individuals through a second pain threshold test, this time asking users to squeeze a device while a blood pressure cuff tightened on their forearm until it became too painful.

After their pain threshold was documented, participants interested in exercise undertook a moderate stationary bike workout three times a week, for six weeks. Researchers noted an improvement in fitness levels as cycling workloads increased each week. The other group continued with their lives as they had prior to the study.

Results

Both groups returned to the testing lab six weeks after the study first began. Volunteers not interested in exercise showed no changes in their pain threshold, but participants in the exercise program saw a noticeable spike in pain tolerance. They experienced pain at the time point they had during the initial test, but they were able to withstand the pain for much longer at the end of the program.

“To me,” said Matthew Jones, lead researcher of the study, the results “suggest that the participants who exercised had become more stoical and perhaps did not find the pain as threatening after exercise training, even though it still hurt as much.”

Scientists have previously hypothesized that a person’s body will emit opitates, such as endorphins, during exercise to slightly decrease discomfort. This process is known as “exercise-induced hypoalgesia,” and usually occurs during a workout and lingers for about a half hour after the workout is completed.

The study didn’t examine the physiological principles at play, but Jones noted that the decision to use a predominately leg-focused workout and an arm-based pain threshold test suggests that “something occurring in the brain was probably responsible for the change.”

If pain is too crippling to begin an exercise regimen, a person may do more harm than good by trying to exercise through the pain, but if you can tolerate even a moderate amount of exercise, you may be able to increase your pain threshold. Consult your doctor if you have questions or concerns.

Related source: NY Times