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Cancer Research UK (CRUK) recently launched a social media campaign aimed at raising awareness that obesity is the second biggest preventable cause of cancer, after smoking. I was alarmed. I then looked at the data supporting the claim and changed my mind. First up, it is important to realise that CRUK are only talking about preventable cancers. Fourteen factors have been identified, which are responsible for a total of 43 % of cancers in the UK. More globally, the World Health Organisation agrees that around 30-50% of cancer cases are preventable. This means that if you take a sample of 100 cases of cancer in the UK, on average, 43 of those cases could have been prevented were those people to have had optimal levels of the fourteen factors. 57 of those people, sadly, would have got cancer, no matter how healthy their lifestyle was, because their case was due to other factors, such as their genetics. Some slim people will be among these patients. This doesn’t mean that a slim person won't get cancer. It just explains how it is possible for overweight to be a cause of cancer, while slim people can still get cancer. CRUK’s claim failed to make clear that the majority of cancers are not known to be preventable, and in doing so, caused some confusion, so I have addressed this by drawing up a pie chart, using the same source data as CRUK, which as well as including the fourteen lifestyle factors, also includes the other "non-lifestyle" cancer cases, for which a preventable cause hasn't been identified.  I have indicated factors which increase risk with a “-” and which reduce risk with a “+”. Source: Parkin and Walker (2011). The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010. British Journal of Cancer. 105: S77–S81. Smoking was found to be responsible for 19.4 % of all new annual cancer cases in the UK (in 2010). That’s the big red chunk responsible for more cancers than any other preventable factor. Excess weight was responsible for a further 5.5%, the fairly sizeable orange slice of pie. But, CRUK have taken a small liberty with the data - dietary factors (suboptimal levels of fruit and veg, fibre, red meat and salt) sum to 9.2 % of cancers. By dividing them up into small slices, they have downplayed the relative importance of a healthy diet. Add insufficient exercise to the list and you are up at 10.2 %, and alcohol brings it to 14.2%. This means that diet and exercise are nearly three times as important as weight! Let’s redraw that pie chart.  I have indicated factors which increase risk with a “-” and which reduce risk with a “+”. Source: Parkin and Walker (2011). The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010. British Journal of Cancer. 105: S77–S81. Now diet and exercise become the second most important cause of preventable cancer (green slice), while overweight is demoted to a (still important) third place. CRUK are correct only insofar as the data support healthy weight being better than overweight. However, I hope that this persuades you that the person who eats healthily, avoids alcohol and keeps active, yet struggles to keep their weight down, is statistically far less likely to get cancer than the skinny couch potato who lives on bacon washed down with gin. The person who eats healthily, avoids alcohol and keeps active, yet struggles with their weight, is less likely to get cancer than the skinny couch potato living on bacon washed down with gin. CRUK have been accused of being judgemental about obesity. They are on a mission to educate people to empower them to make informed choices to reduce their own risk of cancer. 5.5 % may be a small fraction of the total, but that percentage relates to over 17,000 people per year in the UK. Over 17,000 individuals, each with families and friends. How could a responsible educator fail to make this point, for the sake of avoiding offence? I certainly hope that they had no ulterior motive to shame people who are overweight or obese. They do recognise that weight management is difficult in our environment, and are campaigning for changes which will help to make weight management easier, such restricting junk food advertising. However, given the relationship between diet, exercise and weight management, perhaps they could have promoted the more positive message, that an active lifestyle and healthy diet - lots of fibre, fruit and veg, avoiding salt, alcohol and red/processed meat - is the best thing you can do after not smoking to reduce your risk of cancer. Worrying about your weight should be a secondary concern when it comes to cancer. Cancer Research UK run the risk of encouraging unhealthy, fad diets By focussing on weight in their social media campaign, CRUK run the risk of encouraging unhealthy, faddy ways to lose weight, rather than sustainable, healthy choices. There is no conflict of the decision to make here, as staying active and keeping the identified dietary factors at optimal levels are consistent with advice to encourage weight management and more importantly, add up to a reduced overall risk of cancer.
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 When starting a new exercise programme, many people put their faith in exercise professionals to help them meet their goals and form new habits. Bad technique or inappropriate exercise choices can derail those plans, by being ineffective, dangerous, or both. Qualified instructors are trained to deliver safe, effective and appropriate exercises to their clients. However, in the UK, fitness instruction is not a regulated profession. Anyone can legally set up and teach a fitness class, or call themselves a personal trainer or Pilates teacher. Although they are unlikely to get insurance without appropriate qualifications, they won’t be prosecuted for earning a living by running classes or posting workouts online. The main problem with unqualified teachers is that they have not necessarily learned an appropriate level of anatomy and physiology for the exercises that they are teaching, so they may not be aware of what to look out for to ensure that you are exercising safely and effectively. But that's not all. They may give - with all the best intentions - false or misleading information based on their own experiences, which may not apply to everyone. They may not have been taught how to coach and motivate, risking leaving you confused and disheartened. They may not have had First Aid training. As fitness instructors progress through the levels of qualifications, they are increasingly able to accommodate people with injuries or medical conditions which need extra care. But note where the professional scope ends. As I am always at pains to point out, although your fitness routine may support your general wellbeing and recovery from injury, the fitness instructor’s job is to accommodate your injury (perhaps in conversation with your physiotherapist, or other medical professional) to allow you to exercise safely, and not to diagnose, treat or prescribe. Unqualified instructors are not bound by this professional code.  A simple way to tell whether your teacher is qualified is to check if your instructor is a registered exercise professional. REPs, the Register of Exercise Professionals, was developed to protect the public from trainers who do not hold appropriate qualifications and to recognise the qualifications and skills of exercise professionals. REPs members must keep their skills up to date with continuing professional development on approved courses.
Not all qualified fitness professionals choose to be on the exercise register, so for non-members, here’s what you need to look out for: a group exercise teacher or gym instructor should hold a minimum qualification of a Level two certificate; personal trainers, yoga and Pilates teachers should be qualified to Level three. For exercise referral for specific medical conditions, you should look for a level 4 specialist qualification (Level 3 for pre- and post-natal). If you are unsure about whether the qualification that your instructor holds are valid and trusted, you can search the Register of Regulated Qualifications. Regrettably, some institutes offer certificates for superficial online courses without adequate assessment procedures. These will not be listed on the Register. Finally, remember that a person’s body is not their fitness qualification. There are plenty of excellent instructors out there who aren’t supermodels. Genetics, diet, age and medical history all play a part in the appearance of your body, and having a lean torso is no indication of whether a person is able to teach exercise. Many moons ago, as a young woman who was starting to take part in martial arts competitions, I took a fancy to the notion that I should probably “do Pilates or Yoga or something.” So it was that I went along to the village hall to take part in my first Pilates class. I was the youngest by a good three decades. Full of the arrogance of youth I was expecting to be some kind of gift to Pilates. Easy. But there I was, supposedly in peak condition, stuck doing exercises that I felt were doing nothing for me, while the harder exercises - which the older participants accomplished with ease - were completely inaccessible to me. There seemed to be nothing in between. I went to Yoga instead - in a more humble frame of mind - and didn’t return to Pilates for another seven years.  This yogi didn't just wake up one morning and find he could do this. I hope. Image licensed CC-BY-SA-4.0 Today, I would like to discuss how we can use progressions to form a bridge between the basic and the more advanced versions of any exercise. If we are to progress and improve our movement, we need to find our personal sweet spot for every exercise - where we are challenged, but can perform the exercise with good technique. We don't just have levels 1, 2 and 3, but instead a countless range of possibilities are open to us. These principles can be applied to any form of exercise. To vary the intensity of an exercise we can adjust:
Because we have so many tools in our exercise kit, it should be possible to find a version of each exercise that will challenge you and which you can perform safely. In the video below I demonstrate how just using two of these principles - lever length and base of support - can progress a simple exercise into a more advanced one through a series of small steps. You would typically progress through these stages over the course of a few weeks or months. It may be that, due to injuries or your body composition, for example, that some versions of a particular exercise will always be unsuitable for you; however, there is always something we can do to make an exercise effective and challenging. Finally, don't be shy to tell your instructor if an exercise isn't working for you - their job is to tailor exercises for you and ensure that you can execute them safely and effectively. I spent the weekend at a reunion with some old friends. On the Saturday morning, I rose early to go for a short run. One of my friends expressed concern that, although I may look fit and healthy now, I could pay the price in future with joint problems from running, and that she knew several people who were highly active in their youth, but in later middle-age suffered from arthritis and required joint replacement. People often come to the conclusion that running causes bad knees, after meeting older runners who suffer from knee pain, but another thing that happens during decades of running is ageing - and this will happen whether you run or not!  CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0 Over a twenty year period, Professor James Fries of Stanford University studied a cohort of 538 runners (aged 50+ at the start of the study) and discovered that the runners developed fewer disabilities, enjoyed a longer span of active life and were half as likely as non-runners to have died during the study period. They had no more arthritis than non-runners. This may seem to defy common sense - surely joints wear out? - but cartilage needs motion and stress to stay healthy. Synovial fluid is stored in cartilage, and when the joint is used, the synovial fluid excretes from the cartilage and delivers nutrients and lubrication to the joint. Furthermore, impacts of 4.2 G or above have been found to strengthen hip bones - this can be achieved by running at a speed of a 10 minute mile (9.6 kph or 6:15 min/km), while slower speeds (more achievable for many people) can maintain existing bone strength.
The small nugget of truth, from which the larger myth has emerged, is that running when you are injured can lead to arthritis, and if you already have osteoarthritis and bone-to-bone contact, running could make it worse. Chris Troyanos, certified athletic trainer and the medical coordinator for the Boston Marathon offers some great advice: "Inherently, running is good and healthy for most people, but it's a matter of how you get started in it, and it's a matter of slow progression. However, there are body types out there that are not conducive to running. For example, people who are excessive pronators have the inside part of their feet drop inward more than it should when they're running. That causes stress on the feet and knees, so their bodies are naturally not great shock absorbers. People who have hyperextending knees ... are also going to have trouble running. Those who have some of these issues can run, but they may not be able to run more than a mile or two. When you're looking at starting a running program, one you might want to start with a walking program first, then make the leap to an easy running program. As you go through these steps of increasing your activities, it's important to listen to your body. If you are getting knee pain when you go from 5 to 7 miles a day, that could be your threshold for you. If you have any type of existing pain or discomfort in your legs, it's not smart to keep running." Making sure that you can maintain good running form by taking a holistic approach to your health - maintaining a healthy weight, a strong core, good alignment and flexibility will also help to ensure that you are doing more good than harm when you pound the pavements. And on that note, running on softer surfaces can also help to reduce impact - though watch your footing on natural surfaces! Listen to your body. If you run and it doesn't cause you joint pain, then you have no need for a nagging doubt that you will regret your choice decades down the line. If you used to run and now you have joint problems, there is no need to blame yourself. If anything, you may congratulate yourself for possibly having delayed their onset.  If anything epitomises the saying "Easier said than done", it would be "Eat less, move more". It's well established that we live in an obesogenic environment - that is to say, that our society is structured in such a way as to promote weight gain. We don’t even know how fat we were sixty years ago, because it was such an unimportant problem that statistics on obesity were not collected. Not so today, when a majority of adults (58% of women, 68% of men) in the UK are either overweight or obese. We know that the solution is to eat less, and to move more. However, have we in fact been eating more and moving less? And how can we achieve that elusive ideal to reverse the trend?
If anything epitomises the saying "Easier said than done", it would be "Eat less, move more" Are we eating more? The surprising answer is that we don’t have the data to know for certain. The National Food survey, and its successor, the Living Costs and Food Survey have been collecting data on household food consumption across the UK since 1940. These have shown a steady decline in reported calorie consumption since the mid-1960s. However, there are two major problems with the dataset: one is under-reporting, and the other is that it does not include data from food eaten outside the home. The latter has increased dramatically over this time period, with Brits eating out twice a week by 2016. So, while it is possible that we are eating less than we used to, the likelihood is that we are consuming more, but we don’t know how much. Home cooked food isn’t the problem. You’d have to prize my dishwasher and washing machine out of my cold, dead hands Are we moving less? British women reported spending three hours per day on household chores in the 1950s, plus an hour walking, burning off 1,512 calories from this work, compared to around 556 calories from daily activities today. Men generally had more physically demanding jobs, to which they typically walked or cycled. Now, you’d have to prize my dishwasher and washing machine out of my cold, dead hands, but unless this reduction in activity is matched by either exercise or a reduction in food consumption, it is inescapable that the consequence will be weight gain. Furthermore, even with all these labour-saving devices, more households are employing cleaners. More than half of workers in England and Wales reported driving to work in the 2011 census. This means that we have to formalise exercise, and remaining active relies more on motivation than necessity. However, it’s not all doom and gloom. When we didn’t have a choice about being active, our activities were often dull, repetitive and potentially lead to aches and pains. Little wonder that we embraced labour saving devices. However, we replaced them with sedentary activities, such as TV - or in many cases, longer working hours in our desk jobs. If we are to burn off our daily calorie consumption, we face a choice of reintroducing physical activity into our daily lives, or replacing our sedentary time with exercise. We can exercise in our preferred ways, perhaps the thrill of sport, the joy of dance or the feeling of the wind in our hair as we walk, cycle or run for leisure. We can balance our bodies and minds with yoga and Pilates*. We have freed up the time to exercise in our own ways While working for short-term diets, the calories-in, calories-out model is an inadequate solution for people to sustainably manage their weight because it doesn’t address the environment in which we live. Lifestyle changes to increase physical activity, such as a change in commuting method, and/or a long-term commitment to regular sport or exercise can help to counter the reduction in calorie expenditure from labour-saving devices and more sedentary jobs. Reserving eating out for treats, rather than to save on cooking, will also help to reduce the excess in caloric consumption. Addressing emotional reasons for overeating is a subject for another day, but certainly a complex factor for many people. It’s not about counting calories, but about making healthy changes that are sustainable in the long term. *A slightly political message is unavoidable here. I wrote the previous paragraph with a slight cringe, aware that this is a privilege denied to many. Overweight children are more likely to become overweight adults. According to the Office for National Statistics, by the end of primary school, obesity levels among children in the most deprived areas are more than double the obesity levels in the least deprived areas. So, while you as an individual can modify your behaviour to manage your weight, as a society in which economic inequality is still prevalent, obesity is likely to be an ongoing problem. The popularity of brain training is testament to the belief that the brain is like a muscle - use it or lose it. One effective way to flex your cognitive muscles is by learning new languages*. Bi-or multilingalism can help to improve concentration, cognition in later life, and even increase the size of certain brain areas. Onset of Alzheimer’s disease was found to be delayed in bilinguals by roughly 4 to 5 years. Language acquisition really is like a workout for the brain. Now is the best time there has ever been to learn new languages A longstanding regret of mine was that, in spite of being half-Polish, I never learned the language. Having previously made several failed attempts, I am now finding success. The internet and ease of travel have opened up new methods and opportunities for language learning and I believe that now is the best time there has ever been to learn new languages. We can’t all immerse ourselves for months in another country, so here are some of the best tools I have found: Duolingo is a tidy little free app, which teaches you languages as a game. You set yourself targets for how many experience points (XP) you gain in a day, from a basic 1 XP to an ‘insane’ 50 XP per day. You have a cute owl called Duo coaching you on your way, and you can compete with your friends for the most points, or the longest unbroken streak of daily practice. Audio Courses (eg. Pimsleur/Michel Thomas/Innovative language) get you to speak from the first lesson, and are time efficient, as you can get on with small chores while you learn. They give a sense of how to construct sentences, but the scope of vocabulary is limited so they need to be supplemented with other methods. My local library offers audio courses in a wide range of languages, so it's worth checking out what you can access from your own public library. Language exchange websites (eg. iTalki, Speaky and Conversation Exchange) connect you with speakers of other languages. Within hours of signing up to Speaky, I met several native speakers. The app allows you to correct each other's mistakes without disturbing the flow of the written conversation. Priceless. But also free.  My first conversation in Polish was an excruciating embarrassment I am fortunate enough to live in a global city, where I meet people from all over the World. Although I worry that they find it a burden, my foreign friends seem delighted when I make my bumbling attempts to converse in their language. My first conversation in Polish was an excruciating embarrassment, even though it was with one of the loveliest, least judgemental people you could hope to meet. I blushed bright red, and stammered a few, exceedingly poor sentences. But, it set me on a path so that a couple of weeks later, I was able to enjoy a lengthy Polish conversation without resorting to English. I’m still talking with the accuracy of a toddler, but am undoubtedly progressing.
There are myriad language learning podcasts out there. My favourites are those which are simply people talking slowly and clearly about interesting subjects, such as RealPolish, and the “News in easy French.” No languages other than the target language are used, but transcripts are available. I haven’t mentioned textbooks yet, because the biggest factor affecting success must surely be motivation. Grammar can be overwhelming and boring for beginners. Once you’ve reached the point where you have sufficient vocabulary to express yourself, but your errors are holding you back from being well understood, you will be interested to find out why your chosen language expresses itself in such a way. Maybe. It’s not an easy process; language learning takes time and effort. But the rewards are huge. Your brain will thank you (!) and even a basic grasp of a local language will make a huge difference when you travel overseas. So, if you are thinking of brushing up on your school French, or trying out a whole new language - go for it! There’s never been a better time. *I can’t resist mentioning that Physical exercise is also important Choosing a mat can be a bit of a minefield. Here is a guide to help you choose and care for your Pilates mat. I recently surveyed my customers about their mats, and the conclusion I drew was that it isn’t necessary to spend a large amount of money on a mat for Pilates. A budget of £15 to £20 will give you a large choice of mats that are fit for purpose. The main factors to consider when choosing a mat for Pilates are thickness (≥10 mm is ideal for Pilates) and grip. You don't want to be slipping along your mat in side bend! So, if there is an opening in the packaging, poke your finger in to see if it offers grip, or if you are buying online, look out for what the reviewers mention about grip. Generic 'fitness mats' don't always offer a good non-slip surface. Another consideration is length. Some mats are as short as 132 cm. A rule of thumb is to get a mat that is approximately the same length as you are. I am 170 cm tall (5'7") and have a 172 cm mat. Taller people need longer mats, or to accept that they may have to overreach the mats onto the floor for some exercises. Many people use yoga mats for their Pilates classes. They are easy to balance on and offer good grip. If you practice both Pilates and yoga, they will serve you well. Pilates mats are thicker to offer better cushioning, which is particularly helpful for for kneeling, side-lying and rolling work. Rolling involves impact on your spine, and a yoga mat on a hard floor can be quite severe. If you practice Pilates over a carpeted floor you may get away with it, otherwise, folding your mat in two will offer more cushioning. You can then unfold the mat as needed for other exercises, though be aware that too much folding and unfolding may interrupt the flow between exercises. What about 'eco' mats? Some stores sell environmentally friendly mats that avoid synthetic materials. There are websites which claim that yoga mats made from synthetic materials (PVC) are toxic. My advice is DO NOT EAT your yoga mat. I was given a second-hand standard mat at roughly the same time as I bought a natural rubber and jute mat. The natural rubber mat (pictured) never offered the same quality of surface as the synthetic mat, and became unusable after a few years; whereas the PVC mat is in as-new condition (also pictured). If you plan to use your mat for many years, the benefit of using natural materials must be weighed against the environmental cost of regular replacement. If you have a synthetic mat that you no longer use, please find a good home for it, as they don't break down in land fill sites. If you are a die-hard eco-warrior (for which I salute you) then get a second hand mat - ask around your friends for an unwanted one, or look on Freecycle, Gumtree, eBay etc. for a nearly new mat. See below for tips on how to clean it before use. Avoid natural rubber mats if you have a latex allergy. You may wish to consider how to carry your mats. Most mats roll up and often come with a carry strap. If your mat didn't come with one, you can make your own. Other mats fold, and can be carried in a plastic bag. Wherever possible, I cycle to my Pilates classes, so I made an extra deep pannier bag to contain my mat.  Left to right: rubber and coir yoga mat, pvc yoga mat, fitness mat 10mm, Pilates mat 16 mm. While purple is de rigueur in my classes, other colours are available! Looking after your mat - new and old
When your mat is new it may have a ‘new mat smell’. This will pass after a few uses, but if you get the opportunity to roll it out for an airing (ideally outside, or in a room with open windows, if the weather allows) before your first class, you will find it more pleasant. Also, it will have been rolled up tightly since it was manufactured, so unrolling will help it to release and lie flat. You may need to alternate the direction that your mat is rolled in between uses, to further help flatten it. Regularly cleaning your mat will keep it pleasant, maintain its grip and increase its longevity. You can extend the time between washes by covering the mat with a towel during use (particularly if you sweat a lot during your practice), washing your hands without applying hand cream before use, and wearing socks. An occasional quick wipe down with a damp j-cloth and a thorough air will keep it fresh, but every now and again, a deep clean is needed. Some yoga mats are machine washable, but pilates mats won’t squish into a machine, so I prefer to soak mine in a warm bath with a little laundry liquid, sponge it down to clean, change the water to rinse it, and hang it on the line to dry. Be aware that the mat absorbs A LOT of water, which doesn’t wring out, so it will be heavy and it will drip. I let it drip in the bath for a half hour or so before I even contemplate taking it out. It’s best done in the morning on a clear day, so it has time to dry thoroughly in the sunshine. Then leave it over an airer for as long as possible. Never put your mat away when it is damp - it will quickly deteriorate. Look after your mat well, and it will last you for years. And in case you are wondering, if your mat has two different faces, the ribbed goes side up, smooth side to the floor!  A debate that always rages in fitness circles centres around what is the best form of exercise. If you run, should you do short sprints, or aim for ultra-marathons? Is weight training better than cardio, or vice versa? Is stretching a waste of time? Interval training or steady state? Today, I’m going to share with you the definitive answer to this question. This applies whatever age you are, and whatever your capabilities. The answer is: whatever exercise you actually do, and continue to do, is the best form of exercise.
Sure, in trials, some exercise types may be more effective at, say, weight loss, or controlling blood pressure. But a six week supervised trial doesn’t reflect the reality of your life. There may be exceptions if you have a very specific goal, such as a sports tournament to train for, or losing weight for a wedding. But in reality, these goals are only ever short term, and what counts in terms of fitness is long term sustainability. This week, an article was published in the British Medical Journal which looked at mortality rates across a range of sports for over 80,000 British adults over the course of two decades. Participants were asked about exercise participation during the previous four weeks, in terms of exercise type, intensity, frequency and duration. A significant reduction in all cause mortality was associated with racquet sports (47%), aerobics (27%), swimming (28%) and cycling (15%); whereas no association was found for running and football/rugby when compared to non-exercisers. Some newspaper headlines implied that this meant that tennis is superior to other forms of exercise. However, there is no need to swap your running trainers for tennis shoes. There are a few theories as to why a protective effect was not found for running and football. The survey participants involved in these sports happened to be younger, so there were not enough deaths to see a statistically meaningful difference; seasonality may have affected the accuracy of reported activity levels; or participants may have switched to spectating as they aged. Certainly, none of the activities were found to have increased the risk of death, and many other studies have found that runners live longer. Furthermore, while mortality provides an unambiguous measure, the authors noted that it fails to measure more subjective benefits, such as social or mental wellbeing, which may come from these activities. It’s interesting to note that cycling (which included cycling for sport as well as cycling for transport) was associated with a 15 per cent reduction in all-cause mortality - suggesting that adults who are wary of cycling should consider that not cycling is associated with a greater risk of death! Of course, the risk to you will be affected by factors such as the road layout and driver awareness in your area, so everyone needs to weigh up the pros and cons for themselves. Whatever exercise you love doing - or whatever you can bear to keep doing long term - that’s the best exercise for you.  When we experience pain, it’s tempting to retreat into bed, but sometimes it can make the problem worse. In fact, people who exercise are able to manage their pain much better than those who don’t. There are several ways in which exercise can help in pain management, and each is due to effects in the body or in the brain.
Improving biomechanical factors, such as muscle strength, flexibility and joint alignment, is thought to have an important role in management of chronic painful joint conditions, such osteoarthritis. A systematic review* of trials investigating the effectiveness of exercise for knee arthritis - a common cause of chronic pain - found that both aerobic exercise and muscle strengthening exercise were effective for pain relief. Another systematic review found that exercise reduced reported pain levels by 12 points on a scale of 0-100, with an accompanying small reported improvement in overall quality of life. A subset of studies followed up between two and sixth months later found that the improvement was sustained. Back pain - the leading cause of work absence and disability - is more complex, as the physical causes are sometimes interleaved with emotional causes, such as stress or depression. This is where the brain comes in - exercise is uniquely placed to reduce stress and alleviate depression at the same time as improving physical factors. Exercise produces endorphins, which interact with the opiate receptors in the brain to reduce our perception of pain in a similar way to drugs such as morphine and codeine but without the risk of addiction. It is particularly effective in social exercise activities, compared to similar solo training (laughter in social situations has a similar effect). Well-meaning friends will tell you to “take it easy” when you have back pain, and at one time doctors even prescribed bed rest, which is fine for a few days after a pulled muscle, but if we rest too much, the supporting muscles of the back will begin to weaken, potentially reducing recovery, and if we miss out on our regular social activities for too long, our mood may be adversely affected. Those of you who do Pilates will not be surprised to learn that in a randomised controlled trial, Pilates has been shown to alleviate chronic low back pain. However, a systematic review found that other prescribed exercise training also helped with low back pain, and there was no evidence to demonstrate that Pilates was superior. However, I would argue that the accessibility of Pilates and its integration into daily life gives it a very important place in the prevention and management of back pain. More generally, exercise improves mood, and people who are in a better mood report less pain and demonstrate increased pain tolerance. In other words, it takes more pain for you to feel uncomfortable. Even if you are not suffering pain, it is self-evident that improved mood is a good thing. So, before you reach for the painkillers and wrap yourself in a duvet, just think about when you’ll be getting out of there, and how you’re going to move yourself when you do. And even if you can’t go all out with your regular exercise regime, keep moving, keep socialising, and laugh. *I have referred mainly to systematic reviews here, because individual studies can have misleading results, due to small sample sizes and potentially weak methodologies. Systematic reviews pool together the results of the best studies in a meta-analysis to find the overall picture.  Last week I discussed the soreness that you may get after exercise. This week, I’m turning my attention to using exercise to relieve pain. You may have been lucky enough to catch the BBC One programme “The Doctor Who Gave Up Drugs” with Dr. Chris van Tulleken. If you did, you’ll have seen the almost miraculous transformation of Crystal, a young lady crippled with chronic, severe, nonspecific back pain. Crystal had been prescribed high doses of painkillers for the previous three years, yet the pain still severely restricted her movement, and she was unable to take part in the daily activities of life and work. Years of limited movement had weakened her muscles, worsening the pain further. She had visited various medical specialists, but as the cause of her pain was yet to be identified, she was managing her condition with painkillers. I use the word “manage” with reluctance. In practice, the painkillers were not helping - the long-term efficacy of both prescription and over the counter painkillers is dubious, and the side effects of continued use are many, and well established. Furthermore, they do nothing to address the cause of the pain, so once the effectiveness has started to wane, the sufferer is left not only with their pain, but now also dependent on the painkillers. Dr van Tulleken sent Crystal to a Kung fu master, as a slow and controlled method of exercise. Here is a clip of her first session:  http://www.bbc.co.uk/programmes/p047z3rp You can see Crystal's efforts to mask her pain in her restricted facial movements - and that’s before she tries moving her limbs, when the true extent of her pain becomes clear. Twelve weeks and lots of Kung fu later, Crystal was moving well, and had ceased taking painkillers. Although the programme didn’t go into detail, those 12 weeks were no walk in the park. Crystal had to withdraw from her drugs - a tapered reduction supervised by her doctor - and she worked through a lot of pain before she improved. To what extent her pain had diminished wasn’t made clear, but in a way, that’s not as important as the fact that she was now managing her condition, and had regained her life. Crystal's remission will depend on lifelong continued exercise, whether that is through Kung fu, or other disciplines. It sounds like a huge commitment, but the alternative is a bleak outlook of dependency and pain. She demonstrated the determination and resilience that make me optimistic for her future.
The point made by Dr van Tulleken was that there is insufficient support for sufferers of chronic pain to use exercise as a safe and effective alternative to medication. Telling patients to exercise is all well and good, but without intensive support, it is hard to see how a sufferer of chronic pain could bring themselves to exercise, and keep at it, long term. We see pain as a warning sign that we are hurting ourselves - as it often is. But there are also situations when we have to accept pain as part of a process of recovery. Without specialist support - and I myself am not qualified to advise on what pain is safe to work through - it is instinctive to stop. Furthermore, some types of pain have been shown to be unresponsive to exercise. Where you have been advised by your doctor to keep moving in spite of pain, it can be helpful. For example, attempting to protect arthritic joints by not moving them may lead to a loss of range of movement, and long-term worsening of the condition. However, I will only encourage you to move through pain under the guidance of your medical professional. Likewise, if you are taking painkillers long term, please do not stop or reduce your treatment without first consulting your doctor. A single case study will never satisfy the scientist in me, so next week I will cover the mechanisms of pain management through exercise and the evidence base behind it. |
AuthorFitness and Pilates instructor with a passion for science. Archives
February 2020
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