Regular activity builds confidence, reduces fears about doing activities and improves patients’ abilities to manage their pain. It can be reassuring for those with pain to know that regular activity will be beneficial for them, even if it was not a regular part of their lives before the pain arrived.
Feeling physically stronger with more vitality helps the patient and their brain recognise they are not stuck in the revolving cycle of pain, disability and dependence.
Your role is explore options for regular activity with the patient.
You can do this by:
- Talking about what getting more active and fitter means – it doesn't have to mean running 10km in lycra! Small regular bouts of activity gradually increasing are just as effective – and the patient is more likely to stick at it.
- Ensuring that you have introduced and discussed the concepts of pacing and goal setting.
- Talking about different types of fitness and the kinds of activities that can help.
Action to take
Talk about different types of fitness
For example, an action plan to get fitter could include ideas like these:
To loosen muscles and ligaments that have tightened due to inactivity
Helps improve posture
Ideas and resources
Gentle stretches e.g. ARUK keep moving booklet
NHS Live Well exercises for flexibility
NHS fitness studio videos
Gentle Yoga or Pilates
To build stronger muscles and joints
Makes climbing stairs and getting out of chairs easier
Ideas and resources
NHS Live Well exercises for balance, strength and chair-based options
NHS fitness studio wake-up workout
Tai Chi programmes (evidence finds reduced falls and improved balance)
Building up to being able to do more without feeling pain or tiredness
Ideas and resources
Walking – local groups, easy park run
Swimming – aquafit activities
Static/ road cycling
Dancing to fun music
Talk to your patient about how to stay motivated
Here are some tips you could share:
- Pace and get the challenge level right at the beginning – don’t start with something too difficult
- Be ready and organised e.g. get trainers out the night before
- Identify people to work with who can offer encouragement when it is a more difficult day
A note about pain and exercise – grading
Patients may have been told, or given the impression, that they should let their pain guide how much they should exercise. This often means they do little or no activity when experiencing chronic pain because it hurts. Whilst this may be the case in acute pain, it is definitely not the case in chronic pain. It is really important to explicitly discuss this and emphasise a steady graded increase in activity. Any activity that is enjoyable and can be done easily and regularly means success is more likely.
What grading exercise really involves:
- Identify the baseline distance/length of stretch that starts to increase pain levels
- Halve this and have a rest at the midpoint of the activity
- Gradually build up distances or time lengths
- Ensure it is enjoyable and so likely to be done regularly
For example, if pain starts to increase after walking the distance between four lamp posts, on day one walk to two lamp posts, have a rest and then complete the walk by walking back. Each week, use pacing skills to increase the distance.
Identify your local resources for increasing exercise and building activity levels
- Do you have a display in the surgery or on your website?
- Could you train your reception team in signposting these resources?
Resources for your patient
Summary of key points
- Regular activity builds confidence, reduces fears about doing activities and improves patients’ abilities to manage their pain
- The concept of grading exercise can help to build your patient’s confidence and ensure that they enjoy being regularly active
- It is important to explain that pain does not mean damage or harm. It is over reactive movement, stretch and touch sensors conveying unhelpful messages of danger to the brain when none exists