Can Physical Activity and Exercise Alleviate Chronic Pain in Adults? A Cochrane Review Summary With Commentary, 2019, Puljak et al

Sly Saint · Aug 31, 2019

Moved from this thread:
Survey of activity pacing across healthcare professionals informs a new activity pacing framework for chronic pain/fatigue, 2019, Antcliff et al
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Can Physical Activity and Exercise Alleviate Chronic Pain in Adults?
A Cochrane Review Summary With Commentary
June 2019 - Volume 98 - Issue 6 - p 526–527

The population analyzed in this study was adults 18 yrs or older, experiencing chronic noncancer pain caused by rheumatoid arthritis, osteoarthritis, fibromyalgia, low back pain, intermittent claudication, dysmenorrhea, mechanical neck disorder, spinal cord injury, postpolio syndrome, and patellofemoral pain for at least 3 mos (12 wks) in any body site. The intervention under evaluation was physical activity or exercise as a stand-alone treatment (aerobic, strength, flexibility, range of motion, and core or balance training programs, as well as yoga, Pilates, and tai chi).
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Physical function (objectively or subjectively measured): Physical function was reported as the primary outcome measure in 8 of 21 reviews; 14 reviews showed that the intervention resulted in a statistically significant benefit compared with the control. However, even these statistically significant results had only small to moderate effect sizes. Large effect sizes were reported by only one review, but the evidence included in that review was judged as being low to very low quality by the original review authors.
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Adverse events, potential harm, and death: Eighteen of 21 reviews reported data for adverse events. Most of the adverse events were increased soreness or muscle pain, which reportedly subsided within a few weeks of the intervention. Only one review reported death separately; based on the available evidence, the intervention was protective against death, but this result did not reach statistical significance.
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What Were the Authors' Conclusions?
The authors concluded that the quality of the evidence examining physical activity and exercise for adults with chronic pain is low, which is largely due to small sample sizes and potentially underpowered studies. There is some evidence of benefit on pain severity and improved physical function after an exercise intervention in this patient population although the effect sizes were small to moderate. The effect on quality of life was variable. Available evidence supports that none of the analyzed interventions caused harm to the participants. Of note, evidence was only available for people with mild to moderate pain (moderate is greater than 3/10 or 30/100 on a pain scale), with only one review reporting on studies that addressed moderate to severe pain (severe pain is greater than 6/10 or 60/100). Therefore, it is unclear whether this evidence is applicable to patients with severe chronic pain.
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We suggest that rehabilitation professionals continue to offer physical activity and exercise (aerobic, strength, flexibility, range of motion, and core or balance training programs, as well as yoga, Pilates, and tai chi) for improving pain, physical function and quality of life in adults with chronic pain.
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https://journals.lww.com/ajpmr/Full...sical_Activity_and_Exercise_Alleviate.14.aspx

eta:

Sly Saint said: ↑

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my polite way of saying WTF.
So it's perfectly OK to continue to put patients through more pain (as it 'only' took a few weeks to get over) knowing full well that it doesn't actually help their condition.

Jonathan Edwards · Aug 28, 2019

Sly Saint said: ↑

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This seems to be a review of a Cochrane review of Cochrane Reviews.
Jumbling exercise therapy for lots of different conditions together is a complete waste of time.
The conclusion indicates just how empty the exercise is. Nobody doing a review of a drug would suggest going on using something where the evidence is close to zero.

rvallee · Aug 28, 2019

Physical function (objectively or subjectively measured)
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How about just objectively? Why even bother with subjective measures if physical function is evaluated. It can be measured objectively, unlike pain level self-reports. Physical function isn't some aspiration "I wish I could do that", it supposed to measure what people are actually able to perform.

Of note, evidence was only available for people with mild to moderate pain (moderate is greater than 3/10 or 30/100 on a pain scale)
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Is that really the standard scale? I consider 3/10 to be mild pain. I wish I had a 3/10 level of pain at most. Is it a scale with adverbs? Mild pain, moderate pain, severe pain, very severe pain, phantasmagorically severe pain, plaidly severe pain?

We suggest that rehabilitation professionals continue to offer physical activity and exercise (aerobic, strength, flexibility, range of motion, and core or balance training programs, as well as yoga, Pilates, and tai chi) for improving pain, physical function and quality of life in adults with chronic pain.
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Not "in adults with stable, low levels of chronic pain"? Words matter. This reads like it applies to all levels of pain. This is the thing most people will read and it will tell them that it applies to all adults with chronic pain. Members of Cochrane reviews, WTF?

effect sizes were small to moderate
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Given the scale scale used, I guess that means at most 3/10. That's not moderate, that's very low. When it's necessary to redefine the meaning of words to push your conclusions, what exactly are you doing here?

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