Summary: A new study found that though doctors frequently recommend physical activity for managing chronic pain, patients fail to follow the recommendations. This is because patients have hidden fears regarding physical activity, like those living with knee osteoarthritis. These hidden fears and false beliefs prevent them from engaging in physical activity.
It is a well-established fact that most people living with chronic pain are quite likely to benefit from physical activity. When living with chronic pain, engaging in moderate-intensity exercise for 30 minutes a day or even more is good. This can help you relax, enhance health, and reduce pain sensation. It may even help reverse certain health issues.
However, people with chronic pain may not engage in physical activity for various reasons. They might find it difficult to train due to the pain. They might have certain fears that their pain may get worse. Or they may even have certain misconceptions that physical activity is going to make things worse.
So, take the example of osteoarthritis, the most common joint disorder in older adults. It is more likely to affect larger weight-bearing joints, especially knee joints. Studies show that regular exercise is one of the best ways to overcome pain in the condition and prevent disease progression. However, few people diagnosed with the condition engage in physical activity regularly.
Why do people with knee osteoarthritis avoid exercise?
The study published in the journal PAIN examined the impact of negative attitudes and beliefs regarding osteoarthritis (OA), pain, and activity on physical activity levels in individuals with knee osteoarthritis (KOA).
Normally, these attitudes are checked using surveys where people report their own thoughts. However, the researchers wanted to see if there were hidden attitudes that people might not be aware of or willing to admit.
To do this, they created a test called the Implicit Association Test (IAT). This test looked at how people associated images of knee movement (activity) or resting (sitting/standing) with feelings of safety or danger. The researchers thought that people with KOA would see activity as more dangerous compared to those without knee pain or those with pain in other parts of their legs. They also thought these hidden attitudes wouldn’t match up very well with what people said about their pain and activity beliefs in surveys.
A total of 558 people took part in the study by completing an online survey. There were three groups:
- 223 people with painful KOA (157 women, average age 64.5 years)
- 207 pain-free people (157 women, average age 49.3 years)
- 99 people with pain in their legs but not KOA (74 women, average age 47.5 years)
The results showed that people with and without limb pain had a hidden link between danger and activity. However, this link was much stronger in those with KOA (score of 0.36) compared to those without pain (score of 0.13) and those with non-KOA limb pain (score of 0.11). The difference was significant (P < 0.001 for the pain-free group and P = 0.004 for the non-KOA pain group).
Additionally, when they compared these hidden attitudes with the survey answers, the connections were weak or not significant. This meant that the hidden attitudes were capturing something different from what people reported in the surveys.
The study concluded that people with painful KOA have strong hidden beliefs that activity is dangerous. These hidden attitudes are different from what they say in surveys. Understanding these hidden attitudes might help explain why people with KOA are less active and could lead to better ways to help them stay active.
Frequently asked questions
Is exercise good for chronic pain?
Yes. Most people living with chronic pain benefit from physical activity. Moderate-intensity exercise for 30 minutes a day, or more, helps you relax, improves overall health and turns down pain sensation, and it can even help reverse certain health problems. The hard part is not knowing this. The hard part is doing it when pain, fear or wrong beliefs about movement keep you in the chair.
Is exercise good for knee osteoarthritis pain?
It is one of the best tools there is. Osteoarthritis is the most common joint disorder in older adults and hits large weight-bearing joints, especially the knees. Studies show regular exercise is one of the best ways to overcome the pain and slow the disease. Yet few people diagnosed with knee osteoarthritis exercise regularly, and this study points to hidden fear as part of the reason.
Why are people with chronic pain afraid to exercise?
Some find training hard because of the pain itself. Others fear the pain will get worse, or believe that activity is going to make things worse. In this study of 558 people, those with painful knee osteoarthritis carried a much stronger hidden link between activity and danger (a score of 0.36) than pain-free people (0.13) or people with other leg pain (0.11).
Can you be afraid of exercise without knowing it?
Yes. Researchers used an Implicit Association Test that paired images of knee movement or rest with feelings of safety or danger. The hidden attitudes it measured matched people’s own survey answers weakly or not at all. So a patient can honestly say they are not afraid of moving and still carry a deep sense that activity is dangerous, and that buried belief may help explain why they stay inactive.
Source:
Pulling, B. W., Braithwaite, F. A., Mignone, J., Butler, D. S., Caneiro, J. P., Lipp, O. V., & Stanton, T. R. (2022). People with painful knee osteoarthritis hold negative implicit attitudes towards activity. PAIN, 10.1097/j.pain.0000000000003210. https://doi.org/10.1097/j.pain.0000000000003210
Dr. Gurpreet Singh Padda, MD, MBA, MHP
