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Three happy exercise studies for pain patients

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

It is known: exercise is basically hurting yourself until you build up an immunity to hurting yourself. (I’ve tried and failed to find the source of that quote. It probably has several origins, one of those “shower thoughts” that gets repeated endlessly. Someone probably first cooked it up 4000 years ago in India.)

Exercise as therapy for painful problems and injury rehab — “corrective” exercise, intended to directly or indirectly help us with specific problems, like a tendinitis or back pain — does not have a great track record. In fact, it probably isn’t any better than any of the other frustratingly unimpressive treatments done to patients rather than by them, like acupuncture or ultrasound or spinal manipulation. Skeptics have been pointing this out for years: exercise may not “fix” anything but a lack of fitness, and a lack of fitness is not a cause pain.

Not directly anyway. Not in the short term.

But exercise in general? As a “tonic” that improves health in a many ways, almost certainly boosting your “immunity” to chronic pain or failed healing ? Exercise remains rather amazing for that. It probably does improve your odds in all kinds of good ways over time. Like these three ways, highlighted by three new scientific studies…

Exercise Study #1: Reducing inflammation with long-term daily exercise

Klasson et al is a good new trial linking long-term daily physical activity to clear reductions in systemic inflammation (as measured by major biomarkers). They found “evidence for both systemic metabolic effects via thyroid hormones and in specific systems via reduced inflammation and immune cell counts.” This is a promising clue for many people with unexplained chronic pain who feel “inflamed” a lot. Some of them probably are, and doing as much exercise as you can is one of the only evidence-based strategies for solving that over the long haul (along with avoiding junk food and sleep loss and other lifestyle medicine basics).

But note that dosage is critical! The people who have the most to gain may also have the lowest thresholds for overdoing it, because “exercise intolerance” (a pathologically poor reaction to exercising) often goes along with “feeling inflamed.” If your goldilocks zone is not roughly where it should be for your age and fitness level, adjust accordingly.

Intense but short workouts, just once or twice per day, can be surprisingly beneficial.

Exercise Study #2: Lower mortality from mini workouts

Ahmadi et al did one of those morbid mortality studies, a big one cross-referencing deaths with fitness gadget data for tens of thousands of people. People died less if they did frequent small doses of vigorous exercise — less than 2-minute sessions, and only one or two per day. Intense and regular, but just little blasts of action. The benefits became measurable at 15-minutes per week, and continued to improve up to a total of an hour per week (or 4 mini workouts per day).

Four mini workouts per day sounds easy, almost like a slam dunk — and it definitely is easier than getting to the gym for 30-minutes per day. But it’s trickier than it sounds! I have tried to hit this goal a few times in recent years, and always failed. It’s a tricky habit for me to build.

(Note that “all-cause mortality” definitely overlaps with the “reduced systemic inflammation” measured by Klasson et al. Taming inflammation was probably partly how mortality was reduced.)

Exercise Study #3: More lifting heavy things, less dying

Webber et al also studied death rates, but in this case they were looking at the effect of muscle strengthening specifically on mortality — an emphasis on wearing out muscles relatively quickly by lifting heavy things, as opposed to huffing and puffing aerobically. Yet again, a benefit was found: a robust drop in mortality, about 20% lower mortality in people who did 2–6 weekly sessions compared to none or one.

Any caveats? Well, duh

This all sounds rather amazing, but Dr. Thomas Schwenk pointed out the major concern for Journal Watch (regarding Webber et al.):

“As always with studies like this, unmeasured confounding probably explains part of these rather dramatic relative reductions in mortality.”

Just so. People who exercise frequently are probably better off in many ways, and so that may account for some of the impressiveness of the data. Still, this topic has been studied a lot and in many ways, and the good-news theme is overwhelming.