Only high levels of activity at least once a week appears to help ward off chronic musculoskeletal pain in the long-term

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Those hoping to avoid one of the worst side effects of aging – bone, joint and muscle pain that doesn’t go away – might need to exercise a lot harder and more often than previously believed.

According to a new study, only high levels of activity at least once a week – playing tennis, running, swimming, digging with a spade, or doing hard physical labor as part of your job – appears to help ward off chronic musculoskeletal pain in the long-term.

The study, led by Dr. Nils Niederstrasser at the University of Portsmouth, examined the data of 5,802 people aged 50 or more over ten years.

Nearly half – just over 2,400 – reported they suffered with musculoskeletal pain at the end of the ten-year period.

Dr. Niederstrasser says that “chronic pain is a huge problem at any age, and one of the main causes for people calling in sick at work or visiting A&E. It is one of the most widespread and complex problems in the medical community and leads, for many who suffer with it, to a lower quality of life and poor wellbeing.”

“It’s well known that pain tends to be more common as we age, so it’s vital we look at what might help prevent and reduce it.”

“The lack of longitudinal studies among older adults of the risk factors for chronic pain is alarming.”

“For many complex reasons, the solution to the problem of chronic pain in older people has proved elusive.”

The study is the first to examine the experience of chronic pain alongside gender, BMI, age and wealth over a long time period.

Report co-author Dr. Nina Attridge, also at the University of Portsmouth, said all activity helped lower the chances of suffering pain but, over time, only high levels of physical activity appeared to lower the risk of someone developing musculoskeletal pain.

She said being poor, being female and being overweight or obese were all found to independently be risk factors for suffering musculoskeletal pain.

She hopes the findings encourage those who design programs to help people avoid chronic pain to include regular vigorous physical activity, weight loss programs and find ways to address helping those on lower incomes.

For the study, moderate exercise included activities such as dancing, walking, stretching and gardening.

Mild activity included activities such as doing laundry, vacuuming and DIY.

Dr. Niederstrasser says that “Such activity – any activity – does help people stay well and feel better than not exercising, but mild exercise does not appear to have a long-term effect on the development of chronic pain.”

“Activity needs to not only be vigorous, it needs to be done at least once a week.”

“A person who cycles, for example, once a month and whose only other activity was light housework would still be classed as sedentary.”

The study found persistent pain was more common in women, possibly because of hormonal differences; in those who were obese or overweight, probably because extra weight adds a burden to the body’s joints; and in those who were less wealthy, possibly because higher disposable income may enable people to seek extra care, in addition to that covered by insurances or national health services, to treat ailments and injuries.


Chronic musculoskeletal pain (CMP) is a multifactorial condition that negatively impacts not only physical function, but also mental functioning and quality of life1. The National Livelihood Survey in Japan reported that low back pain, shoulder stiffness, and joint pain are the most common symptoms experienced by the general Japanese population2. Approximately 20–30% of the adult population has chronic pain3,4 and the socio-demographic factors associated with chronic pain include female sex and older age5.

The pathology of CMP involves intricately related biological and psychosocial factors because it has been linked to numerous physical and mental conditions4. Changes in these factors resulting from CMP include muscle weakness associated with reduced daily activity, somnipathy, malnutrition, drug dependence, dependence on family, isolation from family or society, decline in job performance, and economic burden6,7.

Pain conditions are reportedly responsible for 21% of years lived with disability (YLDs)8. CMP frequently occurs as a result of a disease or injury. However, it is not merely an accompanying symptom, but rather a separate condition in its own right, with its own medical definition and taxonomy9. In addition, pain catastrophizing is an important psychosocial predictor of the course and experience of chronic pain10, and it has been found to be inversely related to muscular endurance11.

This tendency has been proven to negatively impact the neuromuscular, cardiovascular, immune, and neuroendocrine systems12. Therefore, research on CMP treatments, which not only relieve pain but also improve physical and psychosocial factors, is important13.

Exercise therapy, encompassing a wide range of interventions such as general (aerobic) exercise, specific body region exercises for strengthening and flexibility, continuing normal physical activities, and increasing general physical activity levels, is a core treatment option for patients with CMP1. Exercise therapy is particularly important given that existing pharmacological options for chronic pain are often limited by side effects, abuse potential, and overall efficacy14.

There is little evidence supporting one particular type and amount of exercise for CMP15. Aerobic exercise has been shown to decrease pain sensitivity in patients with CMP16. However, a systematic review found that unlike in resistance training, aerobic exercise programs showed no effect in reducing chronic low back pain17.

Previous studies have demonstrated that combination exercise training, which involves aerobic and strength exercise training, is likely to provide the individual effects unique to aerobic exercise and resistance training, respectively18. Combined aerobic and resistance training can improve lean body mass, muscular strength, body composition, and glycemic control in older adults19,20,21.

Moreover, a meta-analysis showed that combination training has a greater effect on cognitive function in older adults than aerobic exercise training alone22. Circuit training is defined as the performance of 6–12 exercises in sequential order with little to no break between them23.

A novel type of circuit training program involves a combination of the two aforementioned training modalities, namely, a resistance training set followed immediately by an aerobic exercise interval (a simultaneous aerobic-resistance training method). The effects of circuit training on several chronic disorders have been reported, and positive effects have been demonstrated on body composition, including reductions in body fat and body mass index (BMI)24.

The aerobic-resistance circuit training program can elicit a greater cardiorespiratory response and similar muscular strength gains with less time commitment compared with a traditional resistance training program combined with aerobic exercise25. Moreover, this type of circuit training program was found to be feasible and safe in men with post-myocardial infarction26. The nature of circuit training may provide an effective, well-rounded exercise program to improve the overall fitness of older adults21.

There have only been few reports on the effects of aerobic-resistance circuit training on pain. Circuit training has been reported to decrease postoperative pain after total knee arthroplasty27 and pain perception in women with fibromyalgia28. Although these studies focused on postoperative pain and pain perception, the effect of aerobic-resistance circuit training for reducing CMP is still unknown.

Recent evidence also suggests that older women are more likely to live with chronic pain than older men9,29. In addition to a female preponderance for chronic pain, women consistently report lower pain thresholds, lower pain tolerance, and greater unpleasantness with pain with different analgesic sensitivity30.

Previous reports have indicated that there might be sex-specific mediators affecting the association of demographic variables with pain intensity and physical function, suggesting the need for a sex-specific approach when treating chronic pain31. This highlights that it is beneficial to focus on one sex only when examining the effects of exercise therapy, and since CMP is more common in women, there is a greater clinical need for treatment among women.

We hypothesized that aerobic-resistance circuit training would have positive effects on pain, pain catastrophizing, and physical function in women with CMP. To investigate this, the present questionnaire-based cohort study aimed to evaluate the effects of aerobic-resistance circuit training for 3 months in women with CMP who became new members of fitness facilities.

reference link: https://www.nature.com/articles/s41598-021-91731-0


Original Research: Open access.
Associations between pain and physical activity among older adults” by Nils Georg Niederstrasser et al. PLOS One

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