For many people with chronic pain, exercise can play an important part in alleviating, or at least controlling, the discomfort. But how and where to work out can be a daunting decision, given the multitude of gyms and fitness centers available in most communities.
Often, your doctor simply may suggest you should exercise. But that is just the beginning of the process, and you should ask for a detailed exercise prescription before you begin any workout regimen.
Exercise RX is important
“I talk to a lot of people who said their doctor told them exercise more so they went to the nearest gym and found a really nice trainer who gave them a plan,” said Maggie Buckley, a Northern California volunteer patient advocate with PainCommunity.org. “But they didn’t ask their doctor for a referral to an exercise professional such as a physical therapist, occupational therapist or exercise physiologist, so they didn’t know what to work on first and ended up hurting themselves or not reaching their goals.”
Consulting with your physician and support team will help you sort out your options. For example, if a part of your plan depends on water aerobics, a fitness center of some type may be your only viable option.
“You need to get clearance to exercise from your doctor and know what is contraindicated for your condition,” said Shane Paulson, MA, EPC, a board certified exercise physiologist and CEO of PhysioLogic Human Performance Systems of Hutchinson, Minnesota, which provides exercise physiology-based programs and services. “We’ll work with you and your doctor to figure out what kinds of exercises are best, given what needs to be accomplished, and how to work around any physical barriers that may be present.”
For many patients, obtaining an exercise prescription comes at a visit after completion of prescribed physical therapy sessions, so it may or may not be covered by insurance. Check with your insurance provider to confirm coverage. You should have an exercise prescription in hand before starting any program and have it updated at least once a year as your body and needs change.
“Talk to your medical team about what you need to do and how you need to do it,” said Buckley. “Each person will have different needs and different limitations. So it is important that you understand why you are doing the exercises and what you are going to accomplish.”
Finding a place to exercise
After these discussions, the next consideration is whether you need to join a gym at which to exercise. For some people, a little space in their homes is all they need.
“I am not so much worried about the gym as I am about whether the expense, time and effort of going to a fitness center is even necessary,” said Chris Nesbitt, MPT, a physical therapist at the Shepherd Pain Institute in Atlanta. “Some people get into the frame of mind that they need to make this big gesture in order to get better, when the main thing is to do the exercises, get the joints moving and strengthen your muscles.”
The decision must be based on the best way to motivate you not only to start a program but also to keep it up. Obviously, a gym membership does no good and wastes money if you don’t use it. On the other hand, if it is too easy to find a reason to not work out at home, a gym membership might be the best investment you can make in your future. It really depends on what motivates you.
If exercising at home isn’t viable because of your temperament or the need for certain types of equipment, you will need to find a fitness center that has the equipment required to fulfill the exercise prescription.
Exercise centers usually have personal trainers available to help with developing individual programs. However, there is a very wide variation in training and expertise among personal trainers — and many differences in what they might know about the needs of those with chronic pain. For this reason, it often is best to have your exercise prescription in hand and ask the staff for the best way to accomplish it within their facility.
“Finding the right contact at the gym is also important,” said Buckley. “You will need someone to answer your questions about the equipment and other available resources, such as classes.”
Often, your medical team will have general knowledge of what is available at many of the facilities in your area. Local chapters of health organizations such as the Arthritis Foundation also can be good sources of information.
“You may need specialized equipment that is not be available in every facility,” said Nesbitt. “There may be a concern about what planes of motion you move in, or you may need things that are adapted for wheelchairs.”
What Kind of gym?
Once the medical questions are answered, you can begin to consider what type of fitness center to join.
“You have to know what you are looking for in a gym,” said Nesbitt. “Few people with chronic pain would be looking at the sexy singles gym as a first-line place to go. You may want a facility that is more family oriented or one that separates the members by gender.”
How far along you are in your exercise program also may help guide you to an appropriate facility. If you recently have been discharged from a rehabilitation regimen, you may want to go to a medical fitness center (MFC) owned by or affiliated with a local hospital. These often are staffed by people with medical training, such as exercise physiologists or physical therapists.
“In my experience, starting first with a medical fitness center helps you gain confidence in using the equipment,” said Buckley. “As you gain a better understanding of what is going on with your body, you might consider progressing to a regular gym and feel more comfortable going to a facility in your hotel when traveling.”
MFCs have some services from which even the most experienced exerciser may benefit. Because of their hospital affiliations, these facilities are more likely to offer additional instruction in areas such as nutrition or your specific disease process. You also may be able to meet and exchange tips with others who have similar conditions.
“At a hospital-based fitness center, you are more likely to interact with and see people who share your specific problem,” noted Nesbitt. “There are very important social aspects that often aren’t addressable at traditional gyms.”
Location, location, location
As with many other aspects of life, an important consideration is location. How long it takes to get to and from a workout facility can be an important variable in how consistent you are in attendance.
Are you likely to exercise often if the round trip takes 90 minutes? Consider other errands you might be able to do while you are out. A center that is an hour away actually may be better if your bank, supermarket or a family member is along the route. It would be harder to skip a workout if you also are accomplishing other important things on the same trip.
Atmosphere and staff considerations
Consider the atmosphere of the facilities you are touring. You may be more motivated by a gym made up of members exercising for the fun of it. For others, the higher energy of a place that caters to the more competitive or athletically inclined could motivate them to stay with the program.
The staff’s interaction with you is another factor to assess. There are widely varying exercise facilities with an equally wide variety of staff personalities.
“Some staff think that exercise has to be rigorous and high intensity, and that actually can be a bad thing in treating chronic pain,” said Paulson. “If you are in a gym where you are being told to work through pain, that is the first red flag. In chronic health conditions, the gain comes without the pain.”
Even if you have your exercise prescription in hand, you will still have interactions with the gym staff. Ask about the qualifications of those who will be supervising your use of their facilities and offering suggestions as you go along.
The title of personal trainer means very little by itself. There is no nationally recognized certification procedure, so anyone can call him- or herself a personal trainer — whether after taking a weekend course or upon completion of a college degree. Although the credentials of the trainer may be less important if you already have your exercise prescription in hand, it is still good to know the depth of knowledge the staff is bringing to you, especially when it comes to physiology.
“Ask if they have a degree in exercise science or a certification as a strength and conditioning specialist or athletic trainer,” said Nesbitt. “They will have a background in how to progress exercises appropriately, but you still will need to question them to make sure they understand the condition that sent you to them and what you are trying to accomplish.”
Cost and savings
The cost of joining a fitness club is another important consideration. Ways to subsidize the price of membership may be available.
“Some health insurance companies will subsidize gym memberships for their members,” said Buckley. “Call their customer service numbers or check their websites for more information.”
Employers are recognizing the benefits exercise programs can have on their bottom line by lessening health-care costs, the cost of covering for employees who are out sick and the cost of employee turnover. Ask your company’s human resources department or employee health nurse about any available programs to subsidize gym membership.
In some cases, an employer or health insurance provider may pay for or discount membership fees for only certain gyms that may not be among your top choices. It will be up to you to decide if the cost saving is more important than your other considerations.
“The key is finding the one thing, be it gym membership or something else, that is most likely to get you moving and keep you moving,” said Nesbitt. “The bottom line: What will make it most likely that you will do this consistently?”
Want to learn more about exercising with pain? Read “Exercise 101: Finding the Right Exercises for Pain Relief” and “Exercise & Arthritis.”