Physical activity has been recognized as an important aspect of patient care for nearly 50 years (1) and has been shown to improve pain significantly in older patients (1). Bortz's "disuse syndrome" suggests that physical inactivity can predictably lead to deterioration of multiple body and organ-specific functions (2). Physiological changes such as osteoporosis, degenerative joint disease, obesity, and muscle atrophy, which may contribute to pain syndromes, are combated with exercise. In fact, immobility and bed rest longer than 2 days have never been shown to be beneficial and, on the contrary, appear to be detrimental in the geriatric patient population (1).
Clinical trials involving older patients with chronic musculoskeletal pain have shown that moderate levels of training on a regular basis are effective in improving pain and functional status. Training in the form of endurance exercises, strengthening programs (3), and the martial arts has been demonstrated to prevent the physiological changes associated with pain.
Endurance training includes aerobic activities such as walking, jogging, running, cycling, and swimming. Regular aerobic exercise is generally believed to raise the pain threshold by stimulating the release of endogenous opioids (4). In addition, the weight loss associated with these activities has been shown to reduce the severity ofjoint pain significantly. Swimming and pool exercises cause less joint stress and, when done in a heated pool, may actually provide analgesia. For an aerobic exercise program to be effective, however, it must be well tolerated. The activity must use large muscle groups, incorporate repetitive muscle contractions, and elevate the resting heart rate to the target heart rate for at least 20 minutes (5). Target intensity in the geriatric patient has been effective at 40% of maximum (5).
The exercise prescription should include the warm-up, the conditioning period, and the cool down. Specifications should include activity, frequency, duration, intensity, and precautions. Of course, exercise with an acutely inflamed or significantly swollen joint should be deferred until the inflammation has subsided.
Strength training may also have significant protective benefits in the prevention of pain. Strength training may occur with the use of free weights, therabands, or other resistive exercise equipment. Patients in their 90s have shown significant gains in muscle strength, size, and functional mobility (6). Progressive resistive exercises have been responsible for marked improvements in pain management and functional ability (7-9). Caution must be used with isometric exercise (i.e., muscle contractions without joint movement). Although this form of exercise is particularly useful in providing improved endurance and tone without stressing joints, it may transiently increase the blood pressure by as much as 20 mmHg with sustained contractions.
Initial training usually requires 8 to 12 weeks of supervision by a knowledgeable professional who can focus on the specific needs of older adults with musculoskeletal conditions. Best results are realized when the program is maintained indefinitely to prevent deconditioning and deterioration. Although the role of a structured therapeutic exercise program in the treatment of acute low back pain may be questioned, several authors noted that exercise programs promote flexibility, strength, and generalized conditioning, which may play a significant role in pain management (10,11). Activity alone may play a preventive role in pain simply by preventing the physiological changes that occur to produce pains.
Tai chi, with its focus on breathing and flowing gestures, is often described as "meditation in motion" (12). It emerged sometime between the 1300s and the 1600s in China. Some say it was developed by monks, others by a retired general. They agree its ancient roots are in the martial arts, but tai chi movements are never aggressive. They are based on shifting body weight through a series of light, controlled movements that flow rhythmically into one long, graceful gesture. The sequences have poetic names, such as "waving hand in the cloud" or "pushing the mountain," and can be quite beautiful to an observer (13).
Although there are no good, controlled studies that proved tai chi specifically benefits people with arthritis by reducing pain or inflammation, there is a study from 1991 that evaluated its safety for patients with rheu matoid arthritis (14). It concluded that 10 weeks of tai chi classes did not make joint problems worse and said the weight-bearing aspects of this exercise have the potential to stimulate bone growth and strengthen connective tissue.
It is widely thought that mind-body alternatives, such as tai chi and meditation, that focus on psychological as well as physical function could be beneficial when used with conventional medications. However, scientific investigation of the therapeutic values of tai chi is still lacking.
Was this article helpful?