Physical exercise: does it help in relieving pain and increasing mobility among older adults with chronic pain?

AIM To provide a physical exercise programme for older adults living in nursing homes. BACKGROUND Pain is common among older persons and for those already in long-term care and having difficulty in coping with pain will be at risk of further reducing their optimal independent function. DESIGN A quasi-experimental single group pretest-posttest design. METHOD Older persons from a nursing home were invited to join an eight-week physical exercise programme. Each session lasted an hour and sessions were conducted once a week by physiotherapist and nurses. Physical exercise programme consisted of stretching, strengthening, balancing, towel dancing and self-administered massage to various acupressure points. On completion of each session, older persons were given a pamphlet with pictures to illustrate the exercise of the day and they were encouraged to practise these exercises by themselves. Outcome measures including pain intensity, range of movement, activities of daily living and mobility were collected before and after the physical exercise programme. RESULTS There were 75 older adult participants (57 female and 18 male, mean age 85.14 SD 5.30). Seventy-three percent (n = 55) of them had pain in the previous three months and were referred as pain group, while 25% (n = 20) were no pain group. Pain scores of 4.89 (on a 10-point scale) indicated medium pain intensity before the intervention for the pain group; the location of pain was mainly in the knee, back and shoulder. On completion of the physical exercise programme, there was a significant decrease in pain intensity to 2.89 (SD 2.14) (p < 0.01). There was a significant increase in range of movement in the neck, shoulder, back, hip and knee rotation, flex and abduction (p < 0.01). Mobility level was significantly increased post intervention, yet activities of daily living remained unchanged. CONCLUSIONS The present study demonstrated the effectiveness of a physical exercise programme in relieving pain and enhancing functional mobility for older persons. Relevance to clinical practice.  It is important to educate older persons, especially those living in nursing homes, on the importance of engaging in regular physical exercise and maintaining mobility.

[1]  P. Schofield,et al.  Guidance for the assessment of pain in older adults: a literature review. , 2008, British journal of nursing.

[2]  P. Croft,et al.  The prevalence of pain and pain interference in a general population of older adults: cross-sectional findings from the North Staffordshire Osteoarthritis Project (NorStOP) , 2004, Pain.

[3]  A. Asghari,et al.  The prevalence of pain among residents of nursing homes and the impact of pain on their mood and quality of life. , 2006, Archives of Iranian medicine.

[4]  T. Wong,et al.  An experimental study on the use of manual pressure to reduce pain in intramuscular injections. , 2002, Journal of clinical nursing.

[5]  Mahoney Fi,et al.  FUNCTIONAL EVALUATION: THE BARTHEL INDEX. , 1965 .

[6]  R. Dworkin,et al.  Suicidal ideation, plans, and attempts in chronic pain patients: factors associated with increased risk , 2004, Pain.

[7]  L. Rubenstein,et al.  Primary and secondary prevention strategies in the older adult. , 1998, Geriatric nursing.

[8]  C. Crane,et al.  Suicidality in chronic pain: a review of the prevalence, risk factors and psychological links , 2006, Psychological Medicine.

[9]  W. Mechelen,et al.  The Functional Effects of Physical Exercise Training in Frail Older People , 2008, Sports medicine.

[10]  Li Wang,et al.  Predictors of Functional Change: A Longitudinal Study of Nondemented People Aged 65 and Older , 2002, Journal of the American Geriatrics Society.

[11]  Somnath Chatterji,et al.  Worldwide variability in physical inactivity a 51-country survey. , 2008, American Journal of Preventive Medicine.

[12]  U. Kujala,et al.  Evidence on the effects of exercise therapy in the treatment of chronic disease , 2009, British Journal of Sports Medicine.

[13]  J W Chung,et al.  The construction of a pain intensity verbal rating scale in Chinese. , 1999, Acta anaesthesiologica Sinica.

[14]  Raymond K Y Tong,et al.  A Pilot Study of Randomized Clinical Controlled Trial of Gait Training in Subacute Stroke Patients With Partial Body-Weight Support Electromechanical Gait Trainer and Functional Electrical Stimulation: Six-Month Follow-Up , 2008, Stroke.

[15]  Rachael Smith,et al.  Validation and reliability of the elderly mobility scale , 1994 .

[16]  Clark Gl,et al.  SEVERAL METHODS OF TREATING DISTAL PHALANGEAL FRACTURES. , 1965 .

[17]  J. W. Chung,et al.  The psychometric properties of Chinese pain intensity verbal rating scale , 2003, Acta anaesthesiologica Scandinavica.

[18]  D. Clark,et al.  'Total pain', disciplinary power and the body in the work of Cicely Saunders, 1958-1967. , 1999, Social science & medicine.

[19]  T. Koepsell,et al.  Association of the built environment with physical activity and obesity in older persons. , 2007, American journal of public health.

[20]  W. Jacob Filho,et al.  Effect of an exercise program on functional performance of institutionalized elderly. , 2004, Journal of rehabilitation research and development.

[21]  T. Wong,et al.  Prevalence of pain in a community population. , 2007, Pain medicine.

[22]  Joel Stein,et al.  High-Intensity Resistance Training Improves Muscle Strength, Self-Reported Function, and Disability in Long-Term Stroke Survivors , 2004, Stroke.

[23]  Jersey Liang,et al.  Interdisciplinary intervention for hip fracture in older Taiwanese: benefits last for 1 year. , 2008, The journals of gerontology. Series A, Biological sciences and medical sciences.

[24]  M H Branson,et al.  Active life expectancy. , 1983, The New England journal of medicine.

[25]  Li Wang,et al.  Exercise Is Associated with Reduced Risk for Incident Dementia among Persons 65 Years of Age and Older , 2006, Annals of Internal Medicine.

[26]  B. Resnick.  Testing a model of exercise behavior in older adults. , 2001, Research in nursing & health.

[27]  B. Ferrell,et al.  Pain in the Nursing Home , 1990, Journal of the American Geriatrics Society.

[28]  E. Rydwik,et al.  Physical training in institutionalized elderly people with multiple diagnoses--a controlled pilot study. , 2005, Archives of gerontology and geriatrics.

[29]  M. Ribbe,et al.  Pain in European long-term care facilities: Cross-national study in Finland, Italy and the Netherlands , 2010, PAIN.

[30]  S. Willich,et al.  Qigong and exercise therapy for elderly patients with chronic neck pain (QIBANE): a randomized controlled study. , 2009, The journal of pain : official journal of the American Pain Society.

[31]  J. Kayser-Jones,et al.  Aging, health, and physical activity in Korean Americans. , 2007, Geriatric nursing.

[32]  C. Hui-Chan,et al.  Does the use of TENS increase the effectiveness of exercise for improving walking after stroke? A randomized controlled clinical trial , 2009, Clinical rehabilitation.

[33]  L. Callahan.  Physical activity programs for chronic arthritis , 2009, Current opinion in rheumatology.

[34]  Hideyo Yoshida,et al.  Randomized controlled trial of exercise intervention for the prevention of falls in community-dwelling elderly Japanese women , 2004, Journal of Bone and Mineral Metabolism.

[35]  P. Connelly.  The Management of Chronic Pain in Older Persons , 1998, Geriatrics.

[36]  M. Bishop,et al.  Influence of pain and depression on fear of falling, mobility, and balance in older male veterans. , 2007, Journal of rehabilitation research and development.

[37]  Maria A. Fiatarone Singh.  Exercise for Disease Prevention in the Geriatric Population , 2001 .

[38]  B. Ferrell.  Pain Management in Elderly People , 1991, Journal of the American Geriatrics Society.

[39]  C. Christmas,et al.  Exercise and Older Patients: Guidelines for the Clinician , 2000, Journal of the American Geriatrics Society.

[40]  K. Rosengren,et al.  The effect of tai chi on knee osteoarthritis pain in cognitively impaired elders: pilot study. , 2009, Geriatric nursing.

[41]  L Prosser,et al.  Further validation of the Elderly Mobility Scale for measurement of mobility of hospitalized elderly people , 1997, Clinical rehabilitation.