Physical Activity for Pain Prevention

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疼痛与体育锻炼Physical Activity for Pain Prevention


Pain, especially chronic pain, remains an important medical and socioeconomic problem affectingpopulations from childhood to the elderly and is responsible for a significant proportion of healthcareresource utilization worldwide [9,15,16,19]. Chronic musculoskeletal pain conditions such as low backand neck pain are the most prevalent and the most costly in terms of daily and work related disability[4,15].

The literature provides robust evidence that, in general populations, physical activity and exercises havebroad economic as well as health benefits due to their impact on the musculoskeletal, cardiovascularand central nervous system [7,22].. Conversely, insufficient physical activity is detrimental to health andhas been identified as a risk factor for noncommunicable diseases (including chronic pain) [20] and thefourth leading risk factor for global mortality [8,14]. Although physical inactivity was initially consideredto be a characteristic of older populations, it is common in all ages [10].

Physical activity has been defined by the World Health Organization (WHO) as “any bodily movementproduced by skeletal muscles that requires energy expenditure” [26]. Exercise is defined as “planned,structured, and repetitive bodily movements that are performed to improve or maintain one or morecomponents of physical fitness” [26]. Multiple guidelines advocate physical activity and exercise aseffective treatment interventions to reduce pain and fatigue, and improve patients’ function in a widevariety of chronic pain conditions including chronic neck pain, osteoarthritis, headache, fibromyalgia,and chronic low back pain [13]. Regular physical activity and exercise may help in the prevention of pain.One recent systematic review found moderate-quality evidence supporting the effectiveness of anexercise program for reducing the risk of a new episode of neck pain [5]. There is also evidence thatexercise (combined with education) reduces the risk of an episode of low back pain [25]. Indeed,patients with acute or sub-acute pain might be an important target group for intervention aiming toprevent a large individual and economic impact.

For healthcare providers, recommending physical activity is known to reduce pain intensity anddisability as well as provide a range of other benefits including improvements in strength, flexibility, andendurance, a decrease in cardiovascular and metabolic syndrome risk, improved bone health, andimproved cognition and mood [18]. Physical activities and exercises may also be considered as avaluable mental health promotion strategy in reducing the risk of developing mental health disorders,which are frequently associated to chronic pain [2,6,21].Thus, when prescribing physical activity health care providers should [3,7,24]:

 Consider not only biomedical aspects, but also psychological and social aspects. Make it individualized, enjoyable, and related to the patient’s goals. Provide supervision according to specific needs to improve adherence to physical activity /exercise. Personalise patient education to include information about the impact of physical activity /exercise on the body, the benefits, including addressing misconceptions about physical activity /exercise and pain. Recognise and address barriers to compliance with physical activity / exercise that includeindividual barriers (pain intensity, movement-related fear and avoidance, low levels of healthliteracy, depression) as well as environmental barriers (lack of access to a place to exercise, lackof time to exercise, and lack of support for exercise. Prime patients and move them along the stages of behavioral change to ensure therapyadherence and success can be achieved.

Box 1. Summary of exercise and physical activity recommendations for pain.Prevention of persistentpain [5,11,25]Exercises are effective (combined with education) in secondary preventionof low back and neck painBenefits of exercise andphysical activity [12]Improve: level of functioning in daily and work-related activities mental health physical fitness health-related quality of life strength flexibility
 enduranceFacilitators and barriersto exercise [18]Facilitators: Capacity of organization Engagement of health care providers Communication Previous experience of being physically activeBarriers:• Lack of access to a place to exercise• Lack of time to exercise• Lack of communication• Lack of support for exercise• Lack of sufficient supervisionStrategies to engage in aphysical activity or exerciseprogram [1,17,23]Adopt biopsychosocial model of healthExerciseIndividual exercise prescriptionGroup exercise sessionsPerformance enhanced by video-taping exerci
Address maladaptive beliefs:Understand the fears and maladaptive beliefs, educate on impact ofexercise, address barriers to exerciseOffer support regarding education, encouragement, advice andprescription

Exercise characteristics
Level of supervision: One‐on‐one supervision, Group supervision Home exercise programWHO recommendationChildren and youth aged 5–17:Should accumulate at least 60 minutes of moderate- to vigorous-intensityphysical activity daily.Adults aged 18–64:Should accumulate at least 150 minutes of moderate-intensity aerobicphysical activity throughout the week or do at least 75 minutes of vigorousintensity aerobic physical activity throughout the week or an equivalentcombination of moderate- and vigorous intensity activity.Aerobic activity should be performed in bouts of at least 10 minutesduration.Muscle-strengthening activities should be done involving major musclegroups on 2 or more days a week.Adults of the 65 years and above:Should accumulate at least 150 minutes of moderate-intensity aerobicphysical activity throughout the week or do at least 75 minutes of vigorousintensity aerobic physical activity throughout the week, or an equivalentcombination of moderate- and vigorous-intensity activity.Aerobic activity should be performed in bouts of at least 10 minutesduration.Muscle-strengthening activities, involving major muscle groups, should bedone on 2 or more days a week.When older adults cannot do the recommended amounts of physical activitydue to health conditions, they should be as physically active as their abilitiesand conditions allow.*More details on WHO website:https://www.who.int/dietphysicalactivity/pa/en/

Healthcare providers should use each patient consultation as an opportunity to discuss the physical andmental health benefits of physical activity. When necessary, and where available, patients shouldengage with appropriately-trained healthcare practitioners who can assist with the development ofprogressive and sustained program of physical activity.

REFERENCES
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AUTHORSFelipe Reis, PhDProfessorPhysical Therapy Department,Instituto Federal do Rio de Janeiro (IFRJ)Rio de Janeiro, BrazilBrona M. Fullen, PhDAssociate ProfessorUCD School of Public HealthPhysiotherapy and Sports ScienceDublin, IrelandREVIEWERSJo Nijs, PhD, MT, PTProfessorVrije Universiteit BrusselBrussels, BelgiumMari K. Lundberg, PhD, RPTAssociate ProfessorKarolinska InstitutetStockholm, Sweden

©Copyright 2020 International Association for the Study of Pain. All rights reserved.IASP brings together scientists, clinicians, healthcare providers, and policymakers tostimulate and support the study of pain and translate that knowledge into improvedpain relief worldwide.