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Exercises in pain



An assessment is essential to gain a full understanding of the patient’s beliefs and attitude to exercise.  Having pain for some time can lead to anxiety about physical activity because of negative experiences around exercise. 

It is important to listen to the concerns of the patient and to understand the nature and level of exercise that would be appropriate for each individual.

Reassurance and validation will ensure that each person is able to agree and commit to a goal of increased activity.


A clear explanation of the aims of exercise is given at an early stage. Improvement in function and quality of life should be the purpose of an exercise programme; reduction in pain cannot be guaranteed and should therefore not be offered as an achievable outcome.

If the patient has become aware of a reduction in physical capacity this is a starting point for addressing activity. Chronic pain sufferers have a tendency to ‘boom and bust’ activity; doing more on a day when they have less pain and then having days of reduced activity and increased pain. Over time this can lead to lower levels of physical fitness. Understanding these patterns of behaviour helps with engagement in alternative exercise/activity; levelling out peaks and troughs and leading to improved function over time.

Starting to Exercise

Discovering from each individual what activities have been enjoyed in the past will give guidance as to what might acceptable exercise options to begin with. Motivation and adherence to exercise will be higher when the activity is pleasurable, meaningful and offers satisfaction. This is true of most people and is more important where pain is an additional factor.

If someone does not enjoy gym activities but does like to walk; goals related to walking should be encouraged. Not all activity options are suitable for all patients.

It is important to work on goals that are achievable; this can mean starting at a very low level and building up slowly. Guidance should be given as to what exercise to do, for how long and how frequently. An individualised exercise plan can be tailored to fit in with energy levels and lifestyle especially where fatigue is an additional limiting factor

For some people exercise in groups can be an excellent means of support. Exercise options such as Tai Chi and Hydrotherapy can offer a gentle introduction to movement and exercise in a group setting. Groups can enhance motivation and improve exercise adherence. 

Return to activity and exercise takes encouragement, practice and gradual change.