Why We Choose Not To Exercise

October 29, 2018 / Thomas Cohn, MD

Exercise for healthy individuals is often challenging, and if you have chronic pain, even the thought of exercise can leave you riddled with anxiety and the worry of more pain. In an article recently published in the New York Times, it describes a new neurologic study that finds our brains are wired to tell our bodies to be mostly sedentary. It may be that we are suppose to be less active to conserve our energy.

The study was interesting, examining what motivates us to be active. Most people want to be active but find excuses not to be active. Common excuses we all know, like it takes too much time or that one is tired. Exercise takes commitment and often is at an inconvenient time either early in the morning or after work. Neither time seems enjoyable, especially when you could be doing more enjoyable things, like eating or sleeping.

Exercise Motivations

The New York Times study took healthy young people and then monitored how their brains reacted to visual representations of either physical activity or sedentary things like resting on the couch. The study looked at the brain activity while watching a variety of these images. While watching physical activity, the brain needed to use multiple areas to process the information. When sedentary types of activity, appeared the brain waves were much calmer. The implication was that the brain prefers the calm activities like laying on a couch or in a hammock. The conclusion the authors propose based on monitoring 29 people is that we are hard wired to be sedentary.

Exercise is clearly more work than just sitting around and not being active. The benefits are rarely seen right away and usually are difficult to decipher until time has passed. It is much easier to sit and watch television, sleep or enjoy a big meal. To benefit from exercise one must take a long look at the advantages. For those with chronic pain, exercise keeps the muscles loose and strong, and gives the person the endurance to get through the day. For many, exercise decreases the pain one has overall and keeps them functional in daily activities. The most common response for those who consistently exercise is that I am going to hurt regardless if I do or do not exercise, and without it I would likely not be able to move well at all, so I might as well exercise.

Maybe we have brains that are wired to enjoy restful activity over physical activity. The body, however, is designed for being active. The most appropriate saying that applies is “use it or lose it”. As a pain physician and someone who does have chronic pain, I can hurt and slowly lose function or choose to be active and maintain as much ability as I can. It is a choice to be active, it takes work, and it is not fun, but it pays off in the ability to maintain function.

Could Music and Art Lower Chronic Pain Risk?

August 14, 2018 / Thomas Cohn, MD

If you’re a frequent reader of this blog, you know that we like to pitch certain conservative treatment options for chronic pain. Activities like controlled exercise, stretching techniques and a healthy diet can help to control chronic pain and decrease your likelihood of flare ups. But what if other activities could provide similar benefits? Activities like going to a concert or checking out an art exhibit?

According to a new study published in the Journal of Pain, adding some culture to your regular routine could help to reduce your likelihood of chronic pain. For their study, researchers looked at data from a 10-year study that tracked the progression of pain in more than 2,600 older adults living in England. None of the participants were experiencing pain at the beginning of the study, but after 10 years, more than 42 percent said they experienced moderate to severe chronic pain.

Chronic Pain and Culture

Some of the findings were not all that surprising. Researchers found that individuals with poor sleep patterns, those who had mental health problems and those who were poorer and less educated were more likely to suffer from chronic pain. But one aspect they found interesting was the association between participation in cultural or social events and the development of chronic pain. Researchers noticed that stretching and endurance training were more likely to reduce the risk of developing chronic pain when those activities were paired with participation in cultural and social events.

“This study also found evidence that psychosocial factors may be protective against the development of chronic pain, in particular engagement in cultural activities such as going to museums, art galleries, exhibitions, concerts, the theatre or the opera,” wrote lead author Daisy Fancourt, PhD, a senior research associate at University College London. “It is notable that the odds ratios for cultural engagement were directly comparable with those of vigorous physical activity, suggesting a reduction of 25-26% in risk of chronic pain incidence.”

Why The Reduction In Chronic Pain?

So why do researchers believe that chronic pain likelihood may be reduced by visiting a museum or checking out a summer concert? According to them, the event is likely paired with some gentle physical activity, which can be beneficial for your body, as well as psychological benefits that come from social engagement and positive cultural experiences.

“This study is the first to explore simultaneously potential physical and psychosocial protective factors for the development of chronic pain in older adults. Our results demonstrate that both vigorous weekly activity and regular cultural engagement appear to reduce risk of incident chronic moderate-severe pain,” the researchers concluded.

Although the study was observational in nature, it points to an interesting correlation. Get outside, explore new places and find an enjoyable cultural experience, and you may be able to reduce your chronic pain risk. A visit to the museum shouldn’t be your only treatment technique, but when added to a regular care plan, it may have some rewarding effects!

The Overall Health Benefits Of Exercise

April 6, 2018 / Thomas Cohn, MD

Exercise isn’t just a way to stay in shape or calm inflammation, it also has enormous benefits for our overall health. In fact, new research shows that it doesn’t really matter whether your walk or run, so long as you are getting regular exercise.

According to new research, if you want to improve your overall health and reduce your risk of all-cause mortality, make sure you get some type of exercise on a regular basis. It doesn’t really matter whether it’s bi-weekly kickboxing classes or a 30-minute walk around the neighborhood with your dog, so long as you’re moving and working muscle groups.

The findings come on the heels of a study of more than 4,800 adults by the Journal of the American Heart Association. For their study, researchers sorted activity into two different categories – total minutes of activity per day and total minutes of intense or concentrated activity.

The Benefits Of Activity

You may assume that individuals who participated in more concentrated exercise would fare better than individuals who just walked or moved around, but that wasn’t really the case. The study found that neither type of activity had a significant edge over the other. According to researchers, individuals who clocked roughly 30 minutes of moderate to vigorous exercise a day were significantly less likely to die from any cause than people who got none. Participants who exercised an hour or more each day fared even better.

“The key message based on the results presented is that total physical activity (i.e., of any bout duration) provides important health benefits,” the study authors wrote.

Cardio workouts not only help with your overall health, but they can provide some other benefits as well, like increased blood flow, enhanced memory and improved mood. The overall message from the study is that the more you move, the healthier you are likely to be.

Staying Healthy and Fit as We Age

February 26, 2018 / Thomas Cohn, MD

Staying fit and being healthy as we get older usually requires work. There’s always the tale of someone who smoked a pack of cigarettes a day, drank a six pack every night, ate whatever they wanted, sat on the couch and lived to ninety years. A few people having amazing genetics and nothing affects them, but this is not the norm. Most people need to take an active approach to life including fitness, diet, rest, and stress. Health is about paying attention to our lives and reducing harm as well as maintaining our bodies and minds.

Your Body is Like A Car

My favorite analogy is that our bodies start out like new cars and generally are like that until we reach adulthood. A new car needs fuel and very little maintenance to keep it running well. If you do not wreck it, the car will run smoothly for our younger years. As the car ages, more and more routine maintenance is needed and as it gets older, major overhauls are sometimes necessary. When we are young, we feed the body and let it run and generally it will be healthy. As a young adult, we need to start doing some general health care such as monitoring our cholesterol and blood pressure, and start purposefully watching things like what we eat, our exercise, and make sure we sleep and reduce our stress. After we turn fifty, technically the body is in old age range, and maintaining our health is needed to keep us running smoothly.

In the 1800’s, the average life expectancy was between forty and fifty years of age. Death was due to injury, trauma, infections, heart problems, cancer and multiple other issues of the time. Since then we have learned how to stay alive such that the modern life expectancy has risen to about 80 years. The caveat however is the body has not evolved much in the last 150 years, so it takes much more work to keep an old body healthy.

How to Stay Fit

Staying fit and healthy does take some work and affects a variety of aspects of your life. If it were easy and simple, everyone would know the secrets and live long without problems. The reality is that it does take effort to be healthy, and everyone is throwing in advice on ways to live. The books, diets, pills, retreats, and machines available for a price to make you live longer and happier are countless. Understanding our history can possibly help us understand our needs into the future.

Exercise is one of the most basic concepts. In the past, we did not sit at desks all day. Rather, we were very active and often constantly moving. Since our sources of survival and income have changed, our amount of activity and movement has plummeted. As we age, exercise to maintain our bodies are essential. Daily stretching for 10 minutes or more is necessary to keep the flexibility of muscle and joints and the health of these tissues. Stretching markedly reduces stiffness and associated pain from muscles, ligaments and joints.

Strengthening is the next pillar needed to maintain the health of muscles as well as bones and other structures in the body. Light strengthening three times a week for 20-30 minutes is needed to maintain muscle and bone health as well as to reduce injury from unexpected events like falls. Lastly, the body needs aerobic conditioning to maintain health including for the heart, blood pressure, muscle endurance, weight control, and to reduce pain from increased endorphin levels and stress reduction. The overall recommendation from the American Heart Association is 30 minutes of exercise 5 times a week, from a simple walk to an intense workout.

Diet and Sleep

Our diet is the fuel that runs our bodies. If we put the wrong fuel in our cars, they won’t run, and it is the same with our bodies. It is becoming clearer that our nutrition plays a huge role in our health. As a doctor, unfortunately we learn very little in out training about diet and nutrition. Curiosity about the subject has slowly been very enlightening. Eating better does take more planning and understanding, especially about processed food, sugars, fats, carbohydrates, and other essential nutrients. Spending some time to read and understand healthy diets helps improve the ability to control the fuel entering your body. Even an old doctor can educate himself; using my drive time to work and back, I am spending time listening to courses on nutrition.

Sleep is one subject we know we need but understand very little about. The purpose of sleep, how much we need, and whether the measures we have are helpful and accurate is debatable. Children need more sleep than adults, and adults often need more than we get nightly. Somewhere over seven hours is recommended every night for adults. Sleep is used by the brain to restore functions, to clean up waste products and to rest the whole body. What constitutes as “quality sleep” is not very clear and those sleep trackers that monitor body motion at night are not accurate, according to most experts. Feeling well rested the next day is probably a reasonable sign of adequate rest.

Lastly, having good mental health is necessary to stay fit. Society tends to ignore our mental health needs. Good mental health is needed to stay physically healthy. The body is dependent on the brain for good function. Emotional health is the part that emanates from the brain that allows us to function well physically. When we are stressed, anxious, depressed, or suffering psychologically, we often cannot put in the energy to maintain physical well being. Once we improves our psychological state, we often can focus our energies to pay attention to the rest of our life. Whether it is meditation or medication that is necessary for good emotional health, without paying attention to our psychological selves, maintaining good physical health is difficult.

Staying healthy and fit as we age requires work on our physical and mental well being. There are multiple pillars that keep up our health and as we age we need to pay more attention to these important aspects of our lives. From sleep, rest, exercise, diet and mental health, they all provide strength and structure to keep going as we age.

Being Accountable For Your Health

September 21, 2015 / Thomas Cohn, MD

Taking control of your health requires daily management, and it’s not always easy to do on your own. Sometimes help comes in the form of a gym buddy, but recently we’ve seen a rise in the number of people who wear a fitness tracker to help them track their activity, which is a great start towards a healthy lifestyle. That’s because people who wear some sort of fitness tracker tend to exercise more regularly and they are more accurate in reporting the time and amount of exercise. In the end, it all comes down to holding ourselves responsible for our health, but if these devices can help you stick to a schedule, it seems well worth the investment.

The boom in activity trackers hopefully will lead to higher rates of compliance with fitness. For my patients with pain, those who have included the use of a fitness tracker to monitor activity have been more consistent in exercise. They have also tended to be more motivated in performing an exercise routine, use less medication and have better control of symptoms.

One of the most important actions necessary to control pain is exercise. One needs to perform muscle strengthening and aerobic conditioning on a regular basis to control symptoms. Working with a physical therapist to learn how to perform the correct exercise is a good start, and after learning how to exercise appropriately, consistently being active is critical. The use of an activity tracker can significantly help a person stay the course of appropriate exercise.

The cost of a good fitness tracker runs about $100. As medicine goes, this is a relatively cheap investment into your own health. If pain is a factor in your health, get a fitness tracker, use it and get active.