Is exercise the new snake oil? or just a dirty word? | HealthSkills Blog – by Bronnie Thompson – Aug 2020
This is a great article explaining that while exercise is generally “good for you”, it does very little to relieve pain and disability. The studies that supposedly prove this are problematic and cited more than they deserve to be.
Exercise can do all these wonderful things – help you lose weight, reduce heart disease, moderate insulin and blood glucose levels, improve your mental health, and yes! reduce pain and disability when you’re sore. (check this list out)
The claims sound suspiciously similar to the claims made by old snake oil merchants.
Qualitative researchers have often investigated how people with pain view exercise:
- “I get the comments that “It is not dangerous” and that “you are not going to be worse.” I do not believe it is dangerous … but actually it happens that I become worse after .… I know that the pain will increase.
This is just how I feel: most exercise isn’t “dangerous”, just painful both during and afterward and even worse the morning after.
- And they … talk to me about pain that is not like my pain.”
Most doctors don’t really have a clue about persistent pain. They know about acute pain, but it’s impossible to imagine how pain changes over time as the nervous system adapts to the constant “noise” of pain signals.
Doctors talk authoritatively to their pain patients but have not earned the authority to tell us, instead of listening to us, what treatment works for our malady.
- “any minimal physical activity, standing still in one spot, is torture”
I just experienced this a few days ago when walking extremely slowly with a friend who has been debilitated by chronic kidney disease. It felt like I had to wait after each step.
Without the relief of regular motion, that waiting was putting steady pressure into my right hip and provoking more and more deep pain. It just kept getting worse, worse than it’s ever been, until I finally had to leave my friend on the sidewalk to rush back to the house, take a pain pill, and lie down.
I’m so grateful that I can still get opioids for episodes like this: inexplicable and extreme pain from unknown causes.
“I don’t have any desire to exercise. A lack of motivation, even apprehension”
I certainly understand this apprehension; we risk pain with everything we do, not just exercising. I expect a doctor would view this as a “bad attitude” and my fears about aggravating my pain could be derided as mere “catastrophizing”, but pain patients have to struggle with this all the time.
- It’s not that I don’t want to it is just that I cannot. I am unable to
I’ve often wondered what we mean when we say “I can’t do this because it hurts too much”. If we were being chased by a tiger, of course, we could do that and much more, but without such a powerful motivator, it seems impossible to surmount the pain.
So, at what point should we say we cannot?
For me, there’s a limit to the pain I’m willing to endure and a limit to the amount of energy I can devote. It’s always a tradeoff and never predictable.
Sometimes I can practically run up the slope to the car here, other times I have to stop once or twice to rest and allow the horrific muscle burn to subside. There seems to be no rhyme or reason to this great variation over days and even hours.
- “Sometimes I try to exercise and then I’m in pain, looking back had I known it would hurt I would probably not have done it”
I try to be aware of how I’m using my body and do my best to maintain proper posture and avoid repetitive movements, but sometimes, especially if I’m having fun or if others are involved, I forget, or I decide the tradeoff is worth the experience I’m having.
Sometimes I feel the next day’s agony was “worth it”, sometimes not. Again, it’s totally unpredictable.
At the same time as these negative views, many participants in qualitative studies report that they use “movement” as a key strategy for their daily management.
This is certainly true for me and I’ve been slacking terribly lately. I used to set a repeating timer to get up and walk up the stairs every half hour or hour, but now I’m ignoring the notifications.
I’m pretty sure it’s the corona-stress that’s getting to me, smothering my energy, dialing up my pain. I was doing great the first couple of months, fine for the next couple of months, but now I’m worn out.
With the burden of both physical disability (pain, weakness, lack of coordination) and verging on mental disability (anxiety, depression), I am NOT resilient. I don’t think anyone can expect us to be resilient when we use so much energy managing our chronic illness and pain; there’s just nothing left over.
Now one very important point about exercise, and one that’s rarely mentioned, is how little exercise actually reduces pain – and disability.
A systematic review of systematic reviews from the Cochrane collaboration found that most studies included people with mild-to-moderate pain (less than 30/100 on a VAS) but the results showed pain reduction of around 10mm on a 0 – 100mm scale. In terms of physical function, significant improvements were identified but these were small to moderate in size.
Most studies are quite small, which can lead to over-estimating the benefits, while biases associated with randomisation, blinding and attrition rate/drop-outs, adherence and adverse effects.
Before anyone starts getting crabby about this blog post, here are my key points (and why I’ve taken this topic on!):
- Over-stating the effects of exercise won’t win you friends.
- Exercise and physical activity can be done in a myriad of wonderful ways,
- The reasons for doing exercise are enormously variable.
- Without some carryover into daily life (unless the exercise is intrinsically pleasurable), exercise is a waste of time.
This is a wonderful and thoroughly researched article and definitely worth reading in full: Is exercise the new snake oil? or just a dirty word? | HealthSkills Blog
It has consistently driven me crazy for decades when I read about anything touted as a “miracle cure” for just about anything. I’ve had migraines since the mid 70s, so I’ve seen literally thousands of “miracle migraine cures” trumpeted. Ain’t. No. Such. Thing. For any complex, chronic condition, certainly something as wildly variable as chronic pain. Ironically, the ONLY thing I found in decades of trying & dozens of meds, procedures, etc etc that helped reduce the frequency & severity of my migraines was exercise –lots & lots of regular, high-intensity exercise. Fortunately, I loved it. But every time I had a week-long migraine or another bout of bronchitis, I’d have to recover from the loss of exercise time; I am very, very familiar with the pain of reworked muscles versus the pain of injury. Then came lower back/SI damage & CRPS after thoracic surgery & mystery GI agony, & I learned of life with pain that never took a break, as at least the migraines did/do.
I still move as much as I can, as much as I can force myself to do. I also get hideous & long-lasting back pain if I walk slowly, or limp even a tiny bit (my feet are a mess, also). So the locals see me when I’m able to walk my dog, striding evenly & quickly along the street, & deduce that there can’t be anything wrong with me. They never notice the days on end that I don’t walk & the poor dog is stuck with the yard.
I was such a gym rat & exercise fiend that I still retain some muscle mass & tone even now –which means, of course, that when I tell doctors that I can’t really exercise any more b/c of pain, they assume I’m lying about that, too (I’m trying to find again a couple studies that showed that even years after one had to stop exercising, more muscle tone & mass remained than was formerly realized).
We can’t win no matter what…if we do manage to exercise, it’s supposed to “fix” our pain completely so we don’t need pain meds. If we can’t exercise, we’re lying/catastrophizing/lazy/giving in to our pain so we don’t deserve pain meds –we just need to exercise. And people wonder why chronic pain patients “complain” of intolerable stress & medical PTSD.
I’m in the same situation you are: people only see me when I’m having a good day or am sufficiently medicated. Only my hubby sees how much time I spend lying on the couch, how much I squirm at my desk, how much effort it takes and how much I hurt as I bicycle past people who only see an athletic woman riding by effortlessly…
If you can find those articles please send them to me. My bike crash in 2015 put me on the bench for a whole year, but the first time I got back on the bike after that, it felt like I’d been riding every weekend all along – I wish!
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I try to find those articles, but it’s been …quite a few months & I’m having trouble hitting upon the right combo of search terms. But surely I’ll get ’em one of these days, & will send ’em along!
The issue of people noticing things when they’re right there but never noticing their absence is either an interesting psychological study or a maddening social fact, depending upon the real-life relevance, isn’t it? It’s like the old “full moon” myths…people notice things that happen during a full moon, but when the same things happen in any other phase…who notices quarter moon weirdnesses? Nobody. Only Sherlock was impressed by the dog that failed to bark in the night…or the woman who failed to exercise. Damn few Sherlocks around these days.