Summary: A new study found that doctors often recommend physical activity for managing chronic pain. Yet patients do not follow the advice. The reason is hidden fear of movement, as in people with knee osteoarthritis. These hidden fears and false beliefs keep them from being active.
It is a known fact that most people with chronic pain are quite likely to benefit from physical activity. If you live with chronic pain, moderate exercise for 30 minutes a day or more is good for you. It can help you relax, build health and turn down pain. It may even help reverse some health problems.
But people with chronic pain may stay inactive for many reasons. The pain may make it hard to train. They may fear their pain will get worse. Or they may wrongly believe that being active will make things worse.
Take osteoarthritis, the most common joint disorder in older adults. It is more likely to affect the large joints that carry your weight, above all the knees. Studies show regular exercise is one of the best ways to beat the pain and stop the disease from getting worse. Yet few people with the condition exercise on a regular basis.
Why do people with knee osteoarthritis avoid exercise?
The study ran in the journal PAIN. It looked at people with knee osteoarthritis (KOA). It asked how negative beliefs about osteoarthritis (OA), pain and activity shape how active they are.
These beliefs are usually checked with surveys where people report their own thoughts. But the researchers wanted to find hidden beliefs. These are beliefs people may not know they hold, or may not want to admit.
To do this, they built a test called the Implicit Association Test (IAT). It showed images of a moving knee (activity) or of resting (sitting/standing). Then it looked at how people linked each image with safety or danger. The researchers predicted that people with KOA would see activity as more dangerous. They expected this compared to people with no knee pain or with pain in other parts of the leg. They also predicted these hidden beliefs would not match well with what people said in surveys.
In all, 558 people took part by filling out 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)
People with and without limb pain both had a hidden link between danger and activity. But the link was much stronger in people with KOA (score of 0.36). It was weaker in people without pain (score of 0.13) and in people with other 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).
The team also compared the hidden beliefs with the survey answers. The links were weak or not significant. So the hidden test was picking up something the surveys missed.
The study concluded that people with painful KOA hold strong hidden beliefs that activity is dangerous. These hidden beliefs differ from what they say in surveys. Knowing about them may help explain why people with KOA move less. It could also lead to better ways to keep them active.
Frequently asked questions
Is exercise good for chronic pain?
Yes. Most people with chronic pain gain from physical activity. Moderate exercise for 30 minutes a day, or more, helps you relax. It builds health and turns down pain. It can even help reverse some 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. It hits the large joints that carry your weight, above all the knees. Studies show regular exercise is one of the best ways to beat the pain and slow the disease. Yet few people with knee osteoarthritis exercise regularly. 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. Some believe activity will make things worse. This study had 558 people. Those with painful knee osteoarthritis had a much stronger hidden link between activity and danger (a score of 0.36). Pain-free people scored lower (0.13), and so did people with other leg pain (0.11).
Can you be afraid of exercise without knowing it?
Yes. Researchers used an Implicit Association Test. It paired images of knee movement or rest with feelings of safety or danger. The hidden beliefs 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. Yet deep down they still feel activity is dangerous. 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
