Moving Forward with Physical Activity: Self-Management of Chronic Pain among Women

Differences in Resilience Mechanisms and Physical Activity among Women Experiencing Chronic Pain with Higher or Lower Resilience

BACKGROUND

Chronic pain is a public health issue, with women being disproportionately impacted. Progressing from light physical activity to the recommended moderate to vigorous intensities is effective for chronic pain self-management, yet participation is low among women experiencing chronic pain. Researchers studying resilience approaches to chronic pain contend that women with higher resilience, or functioning well despite adverse life stressors including chronic pain, should have better resilience mechanisms and more physical activity participation. The purpose of this work was to examine whether women experiencing chronic pain, reporting higher versus lower resilience, differed in resilience mechanisms (pain acceptance, self-regulatory efficacy to overcome pain and related barriers to activity, and self-regulatory efficacy to schedule and plan activity) and physical activity (light, moderate-vigorous).

METHODS

Adult women experiencing chronic pain (N = 269; M_age = 38.35, SD = 13.13 years) completed an online survey assessing study variables.

RESULTS

A multivariate analysis of covariance comparing participants with higher (n = 131) and lower (n = 138) resilience, controlling for age and pain intensity, was significant (p < .001; η²_partial = .17). Participants with higher resilience reported significantly higher pain acceptance, self-regulatory efficacy beliefs, and moderate-vigorous physical activity (p's < .01; η²_partial = .03 to .14, small to large effects). Light activity did not differ.

CONCLUSIONS

Novel findings illustrated that participants with higher resilience exhibited more favorable resilience mechanisms and participation in the recommended moderate-vigorous activity. If intervening among women with lower resilience to improve their resilience mechanisms and moderate-vigorous activity is effective, then intervention adoption and delivery across communities could promote improved pain self-management among women.

A proof-of-concept study on the impact of a chronic pain and physical activity training workshop for exercise professionals

OBJECTIVES

Physical activity is essential for long-term chronic pain management, yet individuals struggle to participate. Exercise professionals, including fitness instructors, and personal trainers, are preferred delivery agents for education and instruction on chronic pain, physical activity, and strategies to use adherence-promoting behavioral skills. However, exercise professionals receive no relevant training during certification or continuing education opportunities to effectively support their participants living with chronic pain. Based on the ORBIT model for early pre-efficacy phases of development and testing of new behavioral treatments, the present Phase IIa proof-of-concept study was conducted. The purpose was to examine the impacts of a newly developed chronic pain and physical activity training workshop on psychosocial outcomes among exercise professionals. Outcomes included knowledge and attitudes regarding chronic pain, attitudes and beliefs about the relationship between pain and impairment, and self-efficacy to educate and instruct participants with chronic pain.

METHODS

Forty-eight exercise professionals (M _age=44.4±11.0 years) participated in a three-hour, in-person workshop that was offered at one of four different locations. Participants completed pre- and post-workshop outcome assessment surveys.

RESULTS

Mixed MANOVA results comparing time (pre- versus post-workshop) by workshop location (sites 1 to 4) illustrated a significant within-subjects time effect (p<0.001). All outcomes significantly improved from pre- to post-workshop (p's<0.001), demonstrating large effect sizes (partial eta-squared values ranging from 0.45 to 0.59).

CONCLUSIONS

Findings offer early phase preliminary support for the effectiveness of the chronic pain and physical activity training workshop for exercise professionals. Based on ORBIT model recommendations, findings warrant future phased testing via a pilot randomized clinical trial as well as testing for impacts that trained professionals have on activity adherence among their clients living with chronic pain. Eventual workshop adoption by exercise professional certification organizations would ensure widespread and sustainable access to qualified exercise professionals to help individuals engage in physical activity. By increasing the capacity of available exercise professionals to deliver effective support, active individuals could better manage their chronic pain and live well.

Differences in adaptive and maladaptive psychosocial responses to chronic pain among adults with varying physical activity levels

Aim

Chronic pain is a global public health problem that detrimentally impacts people's health and well-being. Physical activity is beneficial and a recommended self-management strategy for adults living with chronic pain. Yet, many of them struggle to meet the public health recommendation of 150+ minutes/week of moderate-vigorous physical activity. Identifying modifiable factors related to physical activity participation is needed. Adaptive (i.e., self-regulatory efficacy to overcome pain and related barriers [SRE-pain], psychological flexibility) and maladaptive (i.e. pain anxiety) responses were the modifiable factors examined in the present study. The purpose was to investigate whether adults living with chronic pain who were sufficiently active, insufficiently active or inactive significantly differed in their adaptive and maladaptive responses to chronic pain.

Methods

Adults with self-reported chronic pain for 6+ months (N = 318) completed an online survey that measured physical activity, psychological flexibility, SRE-pain and pain anxiety. Sufficiently active (n = 139), insufficiently active (n = 91) and inactive (n = 88) groups were identified.

Results

A significant multivariate analysis of covariance (MANCOVA) (p < .001) with univariate follow-up tests illustrated that the sufficiently active individuals reported the highest psychological flexibility and SRE-pain compared to insufficiently active and inactive individuals (p's < .001). Overall, sufficiently active participants responded the most adaptively and least maladaptively to their pain, followed by the insufficiently active. Inactive participants responded the most maladaptively.

Conclusion

Identifying differences in adaptive and maladaptive responses to pain highlights possible modifiable factors to target in future physical activity intervention research that focuses on improving chronic pain self-management.

Understanding Physiotherapists' Intention to Counsel Clients with Chronic Pain on Exercise: A Focus on Psychosocial Factors

Purpose: Twenty percent of Canadians experience chronic pain. Exercise is an effective management strategy, yet participation levels are low. Physiotherapists can be key to counselling clients to engage in long-term unsupervised exercise. Yet, investigations that identify psychosocial factors related to physiotherapists' intention to counsel are lacking. The purpose of this study was to examine whether physiotherapists' knowledge of chronic pain, beliefs about pain, and self-efficacy to counsel on exercise predicted their intention to counsel clients with chronic pain on exercise. Method: Practicing physiotherapists (N = 64) completed an online survey that assessed their knowledge of chronic pain, beliefs about pain, self-efficacy, and intention to counsel. A two-step hierarchical multiple regression predicted intention. Step 1 controlled for years of practice, and Step 2 included study variables significantly correlated with intention. Results: Beliefs about pain (r = -0.35, p < 0.01) and self-efficacy (r = 0.69, p < 0.01) were significantly correlated with intention. The overall regression model was significant, F _3,60 = 18.73; p < 0.001. Self-efficacy was the sole significant predictor, t ₆₀ = 5.71, p < 0.0001, sr ² = 28%. Conclusions: Self-efficacy may facilitate physiotherapists' intention to counsel on exercise for chronic pain. If shown to be a causal factor, interventions that target a change in physiotherapists' self-efficacy should be pursued.

Chronic Pain, Physical Activity, and All-Cause Mortality in the US Adults: The NHANES 1999-2004 Follow-Up Study

PURPOSE

The purposes of this study were (1) to examine the relationship between chronic pain and the risk of all-cause mortality and (2) to explore the role of physical activity (PA) in this relationship.

DESIGN

Prospective cohort study.

SETTING

The National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2004.

PARTICIPANTS

A total of 7384 adults aged ≥40 years old.

MEASURES

Chronic pain and PA were assessed based on the responses to miscellaneous pain and leisure-time PA questionnaires collected during the household interview. The 2011 mortality data from the National Center for Health Statistics were linked to the NHANES participants.

ANALYSIS

Cox proportional hazard analyses after accounting for the complex sampling design of the NHANES.

RESULTS

After adjusting for several key covariates including sociodemographic variables, chronic health conditions, and unhealthy lifestyle behaviors, individuals with localized or widespread chronic pains showed greater risk of all-cause mortality when compared to individuals with no chronic pain (hazard ratios [HRs] = 1.26 and 1.41, respectively). However, the association was attenuated by further adjustment of PA levels, where engagement of PA ≥150 min/wk was associated with reduced risk of mortality regardless of chronic pain conditions (P for trends between <.001 and .028). The joint analysis further demonstrated that individuals with localized or widespread chronic pains who had PA ≥150 min/wk had lower risk of mortality (HRs = 0.53 and 0.58, respectively) when compared to those without chronic pain who reported no leisure time PA.

CONCLUSION

This study highlighted the important role of PA in reducing the risk of mortality for individuals with chronic pain. Further public health efforts to promote PA in this vulnerable population group are required.

Exploring the emotional experiences of young women with chronic pain: The potential role of self-compassion

Chronic pain is multidimensional and includes an emotional dimension in addition to the physical and cognitive dimensions. Self-compassion, being touched by and open to one's own suffering, has been identified as a useful resource during difficult experiences. The purpose of this narrative inquiry was to explore the role of self-compassion in the emotional experiences of women with chronic pain. Seven women participated in focus groups, reflective photo voice and one-on-one interviews. Three collective narratives were generated highlighting the women's sources of emotional pain and suggesting self-compassion as a constructive approach to manage the emotional dimension of chronic pain.