Taking the fun out of Exercise (is Medicine) (N=1)

Exercise is medicine (EiM) has gained a significant amount of attention since its launch by the American College of Sports Medicine in 2007. A global health initiative that has since been adopted by many other countries throughout the world to address the growing problem of chronic disease and inactivity.

According to the World Health Organisation chronic disease such as Diabetes, Heart Disease, Cancer, chronic lung disease and stroke collectively account for 70% of deaths worldwide (http://www.who.int/ncds/introduction/en/). Chronic musculoskeletal pain continues to increase with low back pain ranked highest and other musculoskeletal disorders ranked 6th for years lived with disability (Vos et al., 2012).

The concept of EiM is not new. It has been around for centuries (Tipton, 2014). Yet there is something off about the concept of EiM. Are Physiotherapists making a change by encouraging exercise as part of a treatment protocol? Is it being over-prescribed or inappropriately reasoned? Has Biomedicalism spread it’s patho-anatomical feelers into something that should be rewarding, social and most of all fun (Williams, Hunt, Papathomas, & Smith, 2017)? Yes of course you’re bloody intrigued! I want to have a crack at exploring these questions.

Look at any EiM research study (and shit there’s a lot of it!), they all share a similar message that exercise is good for us. Through a musculoskeletal lens it has mechanotransductive and chemotransductive effects in that it builds, adapts and increases the resilience of our tendons/bone/muscle (Khan & Scott, 2009; Warden & Thompson, 2017). Exercise research identifies many positive benefits of EIM as a treatment for chronic disease including Cancer (Dodd, Cho, Miaskowski, Krasnoff, & Bank, 2010; Lemanne, Cassileth, & Gubili, 2013; Mishra et al., 2012; L. Pedersen et al., 2016; Schmitz et al., 2010; Spence, Heesch, & Brown, 2010; Winzer, Whiteman, Reeves, & Paratz, 2011) Heart Disease (Anderson et al., 2016; Artero et al., 2012; Lee et al., 2014; B. K. Pedersen & Saltin, 2015; Sattelmair et al., 2011) Osteoarthritis (Fingleton, Smart, & Doody, 2016; Fransen et al., 2015; B. K. Pedersen & Saltin, 2015; Quicke, Foster, Thomas, & Holden, 2015; Van Ginckel et al., 2010) Diabetes (Aune, Norat, Leitzmann, Tonstad, & Vatten, 2015; Gebel et al., 2015; Hemmingsen, Sonne David, Metzendorf, & Richter, 2017; Lee et al., 2014; B. K. Pedersen & Saltin, 2015) Obesity (Atlantis, Barnes, & Singh, 2006; Ismail, Keating, Baker, & Johnson, 2012; Ross, Freeman, & Janssen, 2000; Shaw, Gennat, Rourke, & Mar, 2009; Tomiyama, 2014) and Chronic Musculoskeletal Pain (Bidonde et al., 2017; Busch et al., 2013; Daenen, Varkey, Kellmann, & Nijs, 2014; Khan & Scott, 2009; Rio et al., 2013; Vaegter, 2017; Vaegter, Handberg, & Graven-Nielsen, 2014).


The EiM movement began in the United States in 2007 (Segar, Guerin, Phillips, & Fortier, 2016; Tipton, 2014) but EiM can be traced back to antiquity (Tipton, 2014). The drive behind EiM was to recognise the health benefits of exercise and to encourage all health professionals to advocate exercise to address the growing chronic disease epidemic. Physiotherapy naturally, should be at the centre of this drive.

Strangely, as more and more research highlights the health benefits of short and long term commitment to exercise it appears that this is not making the impression it was meant to (Kamerow, 2015). People just don’t appear to reciprocate when told to engage in exercise. The issue according Segar et al., (2016) is that exercise is no less a behavioural science than a medical one or as Williams et al., (2017) explains ‘the EiM initiative thereby ignores any societal aspects of sport and exercise participation leaving the individual solely accountable for being physically active’

There is absolutely no doubt that exercise has many benefits, yet there are still questions hovering as to why people don’t engage in exercise.

Do Physiotherapists know how much is enough?

Healthcare is changing. Research is identifying that many treatments that are used by health and medical professionals are no more effective than no treatment or placebo. Take physiotherapy for example. The profession continues to use orthodox treatments like ultrasound, acupuncture, manipulative therapy and massage all of which show poor efficacy as single use interventions and in the long term for treating musculoskeletal conditions (A D Furlan, Imamura, Dryden, & Irvin, 2008; Andrea D Furlan et al., 2005; Green, Buchbinder, & Hetrick, 2003; S Rubinstein, Van Middelkoop, Assendelft, DeBoer, & Van Tulder, 2011; SM Rubinstein, Terwee, Assendelft, de Boer, & van Tulder, 2012).

A recent study of Australian Physiotherapists found that they demonstrated poor knowledge of physical activity guidelines and that physical activity was infrequently promoted (Freene, Cools, & Bissett, 2017). I am very intrigued to see what the outcome would be in other countries. One of the recommendations of the paper was to provide training to physiotherapists in ‘physical activity counselling and behaviour change’. Hmmmm, counselling and behaviour change? Now if I’m not mistaken that’s psychosocial factors. Ah, the pieces are slowly coming together. Interestingly, the same was said about Doctors in an editorial in the BMJ (MacAuley, Bauman, & Frémont, 2015). It seems doctors are confident in their knowledge about prescribing exercise, but they just weren’t prescribing it enough.

So yes, I am asking physiotherapists to down their hammer and chisel (not permanently) and to broaden their world view beyond medicine and into areas of counselling, behaviour change, philosophy, socio-cultural and socio-economics to enhance our critical thinking and clinical reasoning skills, beyond inductive or hypothetico-deductive reasoning (here). Through adopting a more humanistic approach to exercise and our reasoning processes we may be able to gain a foothold in the real-time contextually changing kaleidoscope of people’s lives and then determine why, how and when exercise will be of value to them.

Are we reasoning exercise appropriately? 

I would say no at this stage. It seems that we do know that exercise is good but according to Freene, Cools, & Bissett, (2017) as a profession we may not know what the minimum recommended amount is in relation to the guidelines. My other query is whether we are really reasoning exercise appropriately? Are we just giving it to people because we know that it’s good? Are we taking the time to listen to the person’s story and deconstructing it into a causal mind map (here) that could provide a more comprehensive formulation of what the person needs? Does it fit into their world view?

Let’s look at an example – a mid 30s male patient comes to see you with a 1 year history of knee pain of insidious onset, they are overweight, exercise very little and have a history of type II diabetes. He has had an x-ray of his knee which shows no arthritic changes, yet he is concerned that they might end up like their father “who’s knees are stuffed”. He doesn’t particularly warm to working out in gyms because he finds them intimidating, but he does walk to work every day. He works in a warehouse which involves repeated kneeling and lifting, his boss is not particularly empathetic making masculine comments about being tough, his diet is poor tending to eat what he can whilst on the go at work and having large portions at home with a mixture of macro and micro-nutrients, yet tending to opt for carbohydrate rich foods. He and his partner have 2 children (6 and 9), and the older child has recently been disruptive at school, they live in a low socio-economic demographic and want to raise their children in a quiet rural town. His partner is expecting their third child and works part-time, she also lives with back pain. They struggle financially, yet they do receive a child benefit but this is not enough to cover their needs. They own a car which has recently failed its warrant of fitness. The patient doesn’t sleep very well, having frequent bouts of insomnia +/- disruption of knee pain. The patient scored high on a pain catastrophizing scale, low self-efficacy score and also high on a pain anxiety symptoms scale for avoidance and physiological anxiety.

So quite a lot going on here. Saying to this patient if you lost some weight this would help your knee pain is likely going to result in you losing the patient (or a smack in the face!) and telling them to exercise more may also result in the same outcome.

There is more to just addressing the biological in this situation. This person is struggling with regulating their lifestyle. It appears they are under quite a lot of distress and the financial, environmental, work, social aspects are compounding the problem. It is evident that psychosocial factors are predictors of pain and disability in a number of pain presentations including the knee, shoulder and lumbar spine (Chester, Jerosch-Herold, Lewis, & Shepstone, 2016; Costa, Maher, McAuley, Hancock, & Smeets, 2011; Doménech, Sanchis-Alfonso, & Espejo, 2014; Graves, Fulton-Kehoe, Martin, Jarvik, & Franklin, 2012; Jarvik et al., 2005; Menendez, Baker, & Oladeji, 2015; Piva, Fitzgerald, Wisniewski, & Delitto, 2009) and as such are crucial to identifying causal factors to the patient’s presentation.

Furthermore, there is evidence to suggest that exercise if not appropriately tailored to the individual could have a negative effect. I’m not talking muscle strains here I’m talking neurophysiological changes that occur or are perpetuated as a result of increased allostatic load (Aartun et al., 2015; Murison, 2016; Na & Oliynyk, 2011; Pickering, Vojtovich, Tower, & A Davies, 2013; Soligard et al., 2016; Staud, Robinson, & Price, 2005). Now this may be a stretch to castigate exercise, however I’m making this point because exercise needs to be reasoned appropriately like any other intervention. I’m not detracting that it is an important part of maintaining a healthy lifestyle but as we are all too familiar one size does not fit all.

Taking the fun out of it

Exercise as a concept has nuances of discourse and application. As we have already explored EiM can be viewed as a therapeutic tool to increase tissue resilience and general health. Exercise should be a ‘creative learning, fun and engaging activity’ however EiM has political agenda it is viewed as a ‘preventative and outcome driven health strategy’ aimed at easing the strain on stretched healthcare services (Nicholls, Jachyra, Gibson, Fusco, & Setchell, in press).

EiM has certainly achieved its premise of being ‘perceived as medicine’. The biomedicalisation of exercise has caused an understanding that exercise will cure disease or illness (Williams et al., 2017). This polarized view of exercise being viewed as the answer to a lot of health problems can lead to ambivalence, confusion and lack of motivation. People are bombarded by media campaigns, tabloid reports and health magazines overwhelmed by medicalised health messages and health initiatives and yet it seems they fail to see the value in exercise.

Perhaps this is the problem? Unfortunately, it seems that cure is not always a realistic outcome. Many chronic diseases do not result in cure and the best possible outcome is to learn to live well. Thus, bringing creativity and enjoyment back into exercise may help to reduce any false hope, stress, anxiety and/or depression that could potentially come with such a journey of uncertainty with chronic disease.

Exercise can be painful

Despite the positive effects of exercise in chronic disease (Pedersen & Saltin, 2015) and the effects exercise has on endogenous pathways (Jones, Booth, Taylor, & Barry, 2014; Lemley, Hunter, & Bement, 2015; Smith et al., 2017; Vaegter, 2017), some pain conditions do not receive the same benefits, this includes fibromyalgia (Lannersten & Kosek, 2010; Staud et al., 2005) low back pain (Daenen et al., 2014) Chronic Fatigue Syndrome (Daenen et al., 2014) Osteoarthritis (Petursdottir, Arnadottir, & Halldorsdottir, 2010) chronic whiplash (Smith et al., 2017). Pain flare ups are also common when exercising, this can be associated with biological changes in the nerve system (Moseley & Vlaeyen, 2015; Woolf, 2011) and if there are psychosocial factors that have not been identified flare ups can be a real hindrance. Furthermore, prolonged and repeated periods of pain flare ups can induce further fear and anxiety either from the belief of further damage (Vlaeyen et al, 2013) or because of anxiety to pain itself (McCracken, Zayfert, & Gross, 1992).

I want to plug another blog at this point. mycuppajo.com is a blog about Joletta Belton’s experiences with learning to live well with pain. The post I want to bring into sharp focus is her blog on shame http://www.mycuppajo.com/shame/.

Joletta writes about her experiences of attempting to control her pain, pushing through, losing her identity as a firefighter and all the while it wasn’t exercise that gave her wiggle room it was understanding what pain was, the affective side of pain, the social side of pain that broadened her view on life and facilitated an engagement with exercise that was pleasurable not painful.


So, is exercise medicine? Yes, but it is so much more. It’s recreation, activity, fun, engagement, social, relaxing. Clinicians should be encouraging it but should also be reasoning when it’s appropriate, how it is dosed and being creative to suit the values of the person.

Thanks for having a read.




Christmas message

I want to thank everyone for your support over 2017. It has been a real rollercoaster for my partner and I with her cancer diagnosis. Strangely, coming to terms with the thought of yesterday you had cancer, today all appears back to normal best put the washing on is a somewhat surreal experience. None the less we are looking forward to a bright start in 2018, which has already delivered some exciting news!

Have a Happy Christmas and a wonderful New Year! Looking forward to bring ing you more blogs in 2018.





Aartun, E., Boyle, E., Hartivigsen, J., Ferreira, P. H., Maher, C. G., Ferreira, M. L., & Hestbaek, L. (2015). Vigorous physical activity increases the risk of spinal pain in Danish adolescents: A two-year prospective cohort study. BMJ Open Sport & Exercise Medicine.

Anderson, L., Thompson, D., Oldridge, N., Zwisler, A.-D., Rees, K., Martin, N., & Taylor, R. (2016). Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database of Systematic Reviews, (1), 10–13. https://doi.org/10.1002/14651858.CD001800.pub2

Artero, E. G., España-Romero, V., Lee, D. C., Sui, X., Church, T. S., Lavie, C. J., & Blair, S. N. (2012). Ideal cardiovascular health and mortality: Aerobics center longitudinal study. Mayo Clinic Proceedings, 87(10), 944–952. https://doi.org/10.1016/j.mayocp.2012.07.015

Atlantis, E., Barnes, E. H., & Singh, M. A. F. (2006). Efficacy of exercise for treating overweight in children and adolescents: A systematic review. International Journal of Obesity, 30(7), 1027–1040. https://doi.org/10.1038/sj.ijo.0803286

Aune, D., Norat, T., Leitzmann, M., Tonstad, S., & Vatten, L. J. (2015). Physical activity and the risk of type 2 diabetes: A systematic review and dose-response meta-analysis. European Journal of Epidemiology, 30(7), 529–542. https://doi.org/10.1007/s10654-015-0056-z

Bidonde, J., Busch, A., Schachter, C., Overend, T., Kim, S., Goes, S., … Foulds, H. (2017). Aerobic exercise training for adults with fibromyalgia. Cochrane Database Systematic Review, (6). https://doi.org/10.1002/14651858.CD012700.Copyright

Busch, A. J., Webber, S. C., Richards, R. S., Bidonde, J., Schachter, C. L., Schafer, L. A., … Overend, T. J. (2013). Resistance exercise training for fibromyalgia. Cochrane Database of Systematic Reviews, (December). https://doi.org/10.1002/14651858.CD010884

Chester, R., Jerosch-Herold, C., Lewis, J., & Shepstone, L. (2016). Psychological factors are associated with the outcome of physiotherapy for people with shoulder pain: a multicentre longitudinal cohort study. British Journal of Sports Medicine. https://doi.org/10.1136/bjsports-2016-096084

Costa, L. D. C. M., Maher, C. G., McAuley, J. H., Hancock, M. J., & Smeets, R. J. E. M. (2011). Self-efficacy is more important than fear of movement in mediating the relationship between pain and disability in chronic low back pain. European Journal of Pain, 15(2), 213–219. https://doi.org/10.1016/j.ejpain.2010.06.014

Daenen, L., Varkey, E., Kellmann, M., & Nijs, J. (2014). Exercise, not to Exercise or how to Exercise in Patients with Chronic Pain? Applying Science to Practice. The Clinical Journal of Pain, 0(July 2015), 1–22. https://doi.org/10.1097/AJP.0000000000000099

Dodd, M. J., Cho, M. H., Miaskowski, C., Krasnoff, J., & Bank, K. A. (2010). A Randomized Controlled Trial of Home-Based Exercise for Cancer-Related Fatigue in Women during and after Chemotherapy with or without Radiation Therapy. Cancer Nurs, 33(4), 245–257. https://doi.org/10.1097/NCC.0b013e3181ddc58c.A

Doménech, J., Sanchis-Alfonso, V., & Espejo, B. (2014). Changes in catastrophizing and kinesiophobia are predictive of changes in disability and pain after treatment in patients with anterior knee pain. Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA, 22(10), 2295–2300. https://doi.org/10.1007/s00167-014-2968-7

Fingleton, C., Smart, K., & Doody, C. (2016). Exercise-induced Hypoalgesia in People with Knee Osteoarthritis with Normal and Abnormal Conditioned Pain Modulation. The Clinical Journal of Pain, 0(0), 1. https://doi.org/10.1097/AJP.0000000000000418

Fransen, M., Mcconnell, S., Ar, H., M, V. D. E., Simic, M., & Kl, B. (2015). Exercise for osteoarthritis of the knee ( Review ) SUMMARY OF FINDINGS FOR THE MAIN COMPARISON. The Cochrane Library, (1). https://doi.org/10.1002/14651858.CD004376.pub3.www.cochranelibrary.com

Freene, N., Cools, S., & Bissett, B. (2017). Are we missing opportunities? Physiotherapy and physical activity promotion: a cross-sectional survey. BMC Sports Science, Medicine and Rehabilitation, 9(19), 1–8. https://doi.org/10.1186/s13102-017-0084-y

Furlan, A. D., Imamura, M., Dryden, T., & Irvin, E. (2008). Massage for low-back pain. Cochrane Database Syst Rev, (4), CD001929. https://doi.org/10.1002/14651858.CD001929.pub2

Furlan, A. D., van Tulder, M. W., Cherkin, D., Tsukayama, H., Lao, L., Koes, B. W., & Berman, B. M. (2005). Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews, (1). https://doi.org/10.1002/14651858.CD001351.pub2

Gebel, K., Ding, D., Chey, T., Stamatakis, E., Brown, W. J., & Bauman, A. E. (2015). Effect of moderate to vigorous physical activity on all-cause mortality in middle-aged and older Australians. JAMA Internal Medicine, 175(6), 970–977. https://doi.org/10.1001/jamainternmed.2015.0541

Graves, J. M., Fulton-Kehoe, D., Martin, D. P., Jarvik, J. G., & Franklin, G. M. (2012). Factors Associated With Early Magnetic Resonance Imaging Utilization for Acute Occupational Low Back Pain. Spine, 37(19), 1708–1718. https://doi.org/10.1097/BRS.0b013e31823a03cc

Green, S., Buchbinder, R., & Hetrick, S. (2003). Physiotherapy interventions for shoulder pain. Cochrane Database of Systematic Reviews (Online), (2), CD004258. https://doi.org/10.1016/S0031-9406(05)60024-7

Hemmingsen, B., Sonne David, P., Metzendorf, M.-I., & Richter, B. (2017). Dipeptidyl-peptidase (DPP)-4 inhibitors and glucagon-like peptide (GLP)-1 analogues for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk for the development of type 2 diabetes mellitus. Cochrane Database of Systematic Reviews, (5), 10–13. https://doi.org/10.1002/14651858.CD012204.pub2

Ismail, I., Keating, S. E., Baker, M. K., & Johnson, N. A. (2012). A systematic review and meta-analysis of the effect of aerobic vs. resistance exercise training on visceral fat. Obesity Reviews, 13(1), 68–91. https://doi.org/10.1111/j.1467-789X.2011.00931.x

Jarvik, J. G., Hollingworth, W., Heagerty, P. J., Haynor, D. R., Boyko, E. J., & Deyo, R. A. (2005). Three-year incidence of low back pain in an initially asymptomatic cohort: clinical and imaging risk factors. Spine, 30(13), 1541–1548; discussion 1549. https://doi.org/10.1097/01.brs.0000167536.60002.87

Jones, M. D., Booth, J., Taylor, J. L., & Barry, B. K. (2014). Aerobic training increases pain tolerance in healthy individuals. Medicine and Science in Sports and Exercise, 46(8), 1640–1647. https://doi.org/10.1249/MSS.0000000000000273

Kamerow, D. (2015). Why don’t people exercise, even a little? British Medical Journal, (June).

Khan, K. M., & Scott, A. (2009). Mechanotherapy: how physical therapists’ prescription of exercise promotes tissue repair. British Journal of Sports Medicine, 43(4), 247–252. https://doi.org/10.1136/bjsm.2008.054239

Lannersten, L., & Kosek, E. (2010). Dysfunction of endogenous pain inhibition during exercise with painful muscles in patients with shoulder myalgia and fibromyalgia. Pain, 151(1), 77–86. https://doi.org/10.1016/j.pain.2010.06.021

Lee, D. C., Pate, R. R., Lavie, C. J., Sui, X., Church, T. S., & Blair, S. N. (2014). Leisure-time running reduces all-cause and cardiovascular mortality risk. Journal of the American College of Cardiology, 64(5), 472–481. https://doi.org/10.1016/j.jacc.2014.04.058

Lemanne, D., Cassileth, B., & Gubili, J. (2013). The Role of Physical Activity in Cancer Prevention, Treatment, Recovery, and Survivorship. Oncology-New York, 27(6), 580–585.

Lemley, K. J., Hunter, S. K., & Bement, M. K. H. (2015). Conditioned pain modulation predicts exercise-induced hypoalgesia in healthy adults. Medicine and Science in Sports and Exercise, 47(1), 176–184. https://doi.org/10.1249/MSS.0000000000000381

MacAuley, D., Bauman, A., & Frémont, P. (2015). Exercise: not a miracle cure, just good medicine. BMJ (Clinical Research Ed.), 350(4), h1416. https://doi.org/10.1136/bmj.h1416

McCracken, L. M., Zayfert, C., & Gross, R. T. (1992). The pain anxiety symptoms scale: development and validation of a scale to measure fear of pain. Pain, 50(1), 67–73. https://doi.org/10.1016/0304-3959(92)90113-P

Menendez, M. E., Baker, D. K., & Oladeji, L. O. (2015). Psychological Distress Is Associated with Greater Perceived Disability and Pain in. Journal of Bone and Joint Surgery, 97(24), 1999–2003. https://doi.org/10.2106/JBJS.O.00387

Mishra, S. I., Scherer, R. W., Geigle, P. M., Berlanstein, D. R., Topaloglu, O., Gotay, C. C., & Snyder, C. (2012). Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database of Systematic Reviews, 8(8), CD007566. https://doi.org/10.1002/14651858.CD007566.pub2.Copyright

Moseley, G. L., & Vlaeyen, J. W. S. (2015). Beyond nociception: the imprecision hypothesis of chronic pain. Pain, 156(1), 35–38. https://doi.org/10.1016/j.pain.0000000000000014

Murison, R. (2016). The Neurobiology of Stress. The Neuroscience of Pain, Stress, and Emotion: Psychological and Clinical Implications. Elsevier Inc. https://doi.org/10.1016/B978012800538500002-9

Na, H.-K., & Oliynyk, S. (2011). Effects of physical activity on cancer prevention. Annals of the New York Academy of Sciences, 1229(1), 176–183. https://doi.org/10.1111/j.1749-6632.2011.06105.x

Nicholls, D. A., Jachyra, P., Gibson, B., Fusco, C., & Setchell, J. (n.d.). Keep fit : Marginal ideas in contemporary therapeutic exercise.

Pedersen, B. K., & Saltin, B. (2015). Exercise as medicine – Evidence for prescribing exercise as therapy in 26 different chronic diseases. Scandinavian Journal of Medicine and Science in Sports, 25. https://doi.org/10.1111/sms.12581

Pedersen, L., Idorn, M., Olofsson, G. H., Lauenborg, B., Nookaew, I., Hansen, R. H., … Hojman, P. (2016). Voluntary running suppresses tumor growth through epinephrine- and IL-6-dependent NK cell mobilization and redistribution. Cell Metabolism, 23(3), 554–562. https://doi.org/10.1016/j.cmet.2016.01.011

Petursdottir, U., Arnadottir, S. A., & Halldorsdottir, S. (2010). Facilitators and Barriers to Exercising Among People With Osteoarthritis: A Phenomenological Study. Physical Therapy, 90(7), 1014–1025. https://doi.org/10.2522/ptj.20090217

Pickering, A. M., Vojtovich, L., Tower, J., & A Davies, K. J. (2013). Oxidative stress adaptation with acute, chronic, and repeated stress. Free Radical Biology & Medicine, 55(213), 109–18. https://doi.org/10.1016/j.freeradbiomed.2012.11.001

Piva, S. R., Fitzgerald, G. K., Wisniewski, S., & Delitto, A. (2009). Predictors of pain and function outcome after rehabilitation in patients with patellofemoral pain syndrome. Journal of Rehabilitation Medicine, 41(8), 604–612. https://doi.org/10.2340/16501977-0372

Quicke, J. G., Foster, N. E., Thomas, M. J., & Holden, M. A. (2015). Is long-term physical activity safe for older adults with knee pain?: A systematic review. Osteoarthritis and Cartilage, 23(9), 1445–1456. https://doi.org/10.1016/j.joca.2015.05.002

Rio, E., Kidgell, D., Moseley, L., Pearce, A., Gaida, J., & Cook, J. (2013). Exercise to reduce tendon pain: A comparison of isometric and isotonic muscle contractions and effects on pain, cortical inhibition and muscle strength. Journal of Science and Medicine in Sport, 16, e28. https://doi.org/10.1016/j.jsams.2013.10.067

Ross, R., Freeman, J. A., & Janssen, I. (2000). Exercise Alone Is an Effective Strategy for Reducing Obesity and Related Comorbidities. Exercise and Sport Sciences Reviews, 28(4), 165–170.

Rubinstein, S., Terwee, C., Assendelft, W., de Boer, M., & van Tulder, M. (2012). Spinal manipulative therapy for acute low-back pain. Cochrane Database of Systematic Reviews, (9), 10–13. https://doi.org/10.1002/14651858.CD008880.pub2.Copyright

Rubinstein, S., Van Middelkoop, M., Assendelft, W., DeBoer, M., & Van Tulder, M. (2011). Spinal manipulative therapy for chronic low-back pain. The Cochrane Collaberation, (9), 2011–2013. https://doi.org/10.1002/14651858.CD008112.pub2.Copyright

Sattelmair, J., Pertman, J., Ding, E. L., Kohl, H. W., Haskell, W., & Lee, I. M. (2011). Dose response between physical activity and risk of coronary heart disease: A meta-analysis. Circulation, 124(7), 789–795. https://doi.org/10.1161/CIRCULATIONAHA.110.010710

Schmitz, K. H., Courneya, K. S., Matthews, C., Demark-Wahnefried, W., Galvão, D. A., Pinto, B. M., … Schwartz, A. L. (2010). American college of sports medicine roundtable on exercise guidelines for cancer survivors. Medicine and Science in Sports and Exercise, 42(7), 1409–1426. https://doi.org/10.1249/MSS.0b013e3181e0c112

Segar, M. L., Guerin, E., Phillips, E., & Fortier, M. (2016). From a Vital Sign to Vitality: Selling Exercise So Patients Want to Buy It. Current Sports Medicine Reports. https://doi.org/10.1249/JSR.0000000000000284

Shaw, K. a, Gennat, H. C., Rourke, P. O., & Mar, C. Del. (2009). Exercise for overweight or obesity ( Review ). Cochrane Database of Systematic Reviews, (1), 1–3. https://doi.org/10.1002/14651858.CD003817.pub3.Copyright

Smith, A., Ritchie, C., Pedler, A., McCamley, K., Roberts, K., & Sterling, M. (2017). Exercise induced hypoalgesia is elicited by isometric, but not aerobic exercise in individuals with chronic whiplash associated disorders. Scandinavian Journal of Pain, 15(November 2016), 14–21. https://doi.org/10.1016/j.sjpain.2016.11.007

Soligard, T., Schwellnus, M., Alonso, J.-M., Bahr, R., Clarsen, B., Dijkstra, H. P., … Engebretsen, L. (2016). How much is too much? (Part 1) International Olympic Committee consensus statement on load in sport and risk of injury. British Journal of Sports Medicine, 50(17), 1030–1041. https://doi.org/10.1136/bjsports-2016-096581

Spence, R. R., Heesch, K., & Brown, W. J. (2010). Exercise and cancer rehabilitation: A systematic Review. Cancer Treatment Reviews, 36(2), 185–194. https://doi.org/10.1088/0031-9120/36/6/301

Staud, R., Robinson, M. E., & Price, D. D. (2005). Isometric exercise has opposite effects on central pain mechanisms in fibromyalgia patients compared to normal controls. Pain, 118(1–2), 176–184. https://doi.org/10.1016/j.pain.2005.08.007

Tipton, C. M. (2014). The history of “Exercise Is Medicine” in ancient civilizations. AJP: Advances in Physiology Education, 38(2), 109–117. https://doi.org/10.1152/advan.00136.2013

Tomiyama, A. J. (2014). Weight stigma is stressful. A review of evidence for the cyclic Obesity/weight-based stigma model. Appetite, 82, 8–15. https://doi.org/10.1016/j.appet.2014.06.108

Vaegter, H. B. (2017). Exercising non-painful muscles can induce hypoalgesia in individuals with chronic pain. Scandinavian Journal of Pain, 15, 60–61. https://doi.org/10.1016/j.sjpain.2016.12.005

Vaegter, H. B., Handberg, G., & Graven-Nielsen, T. (2014). Similarities between exercise-induced hypoalgesia and conditioned pain modulation in humans. Pain, 155(1), 158–167. https://doi.org/10.1016/j.pain.2013.09.023

Van Ginckel, A., Baelde, N., Almqvist, K. F., Roosen, P., Mcnair, P., & Witvrouw, E. (2010). Functional adaptation of knee cartilage in asymptomatic female novice runners compared to sedentary controls. A longitudinal analysis using delayed Gadolinium Enhanced Magnetic Resonance Imaging of Cartilage (dGEMRIC). Osteoarthritis and Cartilage. https://doi.org/10.1016/j.joca.2010.10.007

Vos, T., Flaxman, A. D., Naghavi, M., Lozano, R., Michaud, C., Ezzati, M., … Moradi-Lakeh, M. (2012). Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: A systematic analysis for the Global Burden of Disease Study 2010. The Lancet, 380(9859), 2163–2196. https://doi.org/10.1016/S0140-6736(12)61729-2

Vlaeyen, J., Morley, S. J., Linton, S. J., Boersma, K., de Jong, J., (2013). Pain Related Fear: Exposure-Based Treatment of Chronic Pain. IASP Press. Washington. USA.

Warden, S. J., & Thompson, W. R. (2017). Become one with the force: optimising mechanotherapy through an understanding of mechanobiology. British Journal of Sports Medicine. https://doi.org/10.1136/bjsports-2017-097634

Williams, T. L., Hunt, E. R., Papathomas, A., & Smith, B. (2017). Exercise is medicine? Most of the time for most; but not always for all. Qualitative Research in Sport, Exercise and Health. https://doi.org/10.1080/2159676X.2017.1405363

Winzer, B. M., Whiteman, D. C., Reeves, M. M., & Paratz, J. D. (2011). Physical activity and cancer prevention: a systematic review of clinical trials. Cancer Causes & Control, 22(6), 811–826. https://doi.org/10.1007/s10552-011-9761-4

Woolf, C. J. (2011). Central sensitization: Implications for the diagnosis and treatment of pain. Pain, 152(SUPPL.3), S2–S15. https://doi.org/10.1016/j.pain.2010.09.030







2 responses to “Taking the fun out of Exercise (is Medicine) (N=1)”

  1. unconventional wisdom Avatar

    Would be interested to get your thoughts on my post about kinesiophobia (click on ‘unconventional wisdom’ above to view it). I can’t help feeling that activity avoidance is very much misunderstood (as anxiety as opposed to a natural and reasonable aversion to unpleasant experiences), but glad you mentioned some of the issues around exercise towards the end and that it may not always confer great benefits for every condition.

    Liked by 1 person

  2. Blurring the lines: Physio, OT, exercise & context Avatar

    […] know (because we are bombarded by it) there are many benefits to exercise, I’ve written about it here and here. We also know it doesn’t really matter what kind of exercise you do for pain or […]


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