Physical Activity

Physical Activity, Pacing, and Exercises

The Importance of Physical Exercise

When living with chronic pain it can be easy to stop participating in activity and exercise. Inactivity causes us to gradually lose strength and flexibility. We then find ourselves out of the habit of exercising, which ultimately causes pain levels to increase. Regular physical activity that is planned, structured, and repetitive will aim to improve or maintain physical fitness. 

In this module you will learn about:

  • How physical activity can help with pain management
  • How to identify what type of physical activity to focus on – utilizing the goal-setting and self-management tools

Physical activity when it hurts

  • There are no rules as to which type of exercise is best.
  • The best exercise is the one you will stick to!
  • It is important to check with your healthcare provider before starting a new exercise program.
    • Your primary care provider can tell you if there are any medical concerns 
    • Physiotherapists, chiropractors, athletic therapists can help with determining exercises given your condition


  • Short term discomfort

    • When you are living with persistent pain, exercise often results in more discomfort in the short term.
    • This is normal, and does not mean that exercise will not help in the long term.
    • Exercise does not need to specifically target the painful areas to be effective.
    • Sometimes general aerobic exercise (i.e., walking, cycling) is the best place to start in order to release endorphins and improve mood and sleep, and to reduce stress levels. 
  • Does pain = injury?

    • Chronic pain changes the nervous system- pain can become an unreliable indicator of underlying injury.
    • Avoiding pain altogether leads to a decline in functional activity and in turn, opportunities for movement.
    • Therefore, the approach of using pain as your guide is not necessarily helpful.
    • Similarly, the “no pain no gain” approach tends to result in setbacks. Needing to rest for 3 days after pushing yourself does not allow for steady improvement and might lead to avoidance. Use a time-based pacing approach. This puts YOU in control, instead of the pain. Think of the turtle and the hare; slow and steady progress will move you towards the desired outcome.
  • "No Pain, No Gain"

    • Pushing yourself too hard and then needing to rest for 3 days after does not allow for steady improvement and might lead to avoidance.
    • Use a time-based pacing approach.
    • This puts YOU in control, instead of the pain.
    • Think of the turtle and the hare; slow and steady progress will move you towards the desired outcome.
  • Where to start

    • Many people find that exercising in the pool is a good place to begin.
    • The water reduces the weight felt on joints, the warmth soothes and relaxes muscles, and the resistance provides a good opportunity for muscle strengthening.

Key concepts:

  • The best exercise is the one you will stick to.
  • It is important to talk to your healthcare provider and get on an exercise plan that works for you

Physiotherapy for Chronic Pain 

  • Physiotherapy is a profession that aims to restore function, health, and quality of life
  • Physiotherapists are regulated health professionals who specialize in:
    • Assessing mobility and impairments
    • Prescribing preventative and therapeutic treatments
    • Promoting independence
    • Collaborating with patients and families 
    • Providing education

  • Physiotherapy treatments may include:
    • Personalized exercise therapy
    • Education & health promotion
    • Soft tissue and manual therapy techniques
    • Electrotherapy (i.e. TENS), acupuncture
    • Posture education
    • Relaxation exercises

Physiotherapy & chronic pain?

Exercise is a very important tool for chronic pain self-management. It is hard to know where to start and what is safe for you to do.

Physiotherapy for chronic pain is most beneficial when it:

  • Focuses on increasing physical activity levels
  • Supports positive coping skills
  • Reduces fear and avoidance of movement
  • Does not focus only on passive therapies (i.e., heat, machines, hands on therapies)
  • Considers your goals and values in life

Key Concepts:

  • Physiotherapists can provide advice on exercising safely despite the pain
  • Exercise can be safe and is recommended for chronic pain
    • often improves pain over time
    • helps to calm the nervous system 
    • linked to better overall physical and mental health

Different types of exercises


  • Aerobic exercise (cardiovascular)

    • Helps in the production and release of endorphins – your body’s natural painkillers.
    • Endorphins act by blocking pain signals and also play a role in helping you to relax by decreasing anxiety and stress levels.
    • Aerobic exercise includes activities such as walking, stationary bicycling, swimming, pool exercises, skiing
  • Resistance exercise or strength training

    • Helps us grow stronger.
    • By increasing your muscle strength, you may be better able to tolerate activity and improve your function.
    • Strength exercises include: mat exercises, resistance with weights, thera-bands, machines
  • Flexibility

    • Allowing your joints to move more freely through their entire range of motion. 
    • Flexibility and mindful movement exercises include Yoga, Qi Gong, Tai Chi, Pilates
  • Balance

    • Exercise that help with improving balance and control reduce the chances of falling and being injured.
    • Balance focused exercises include: dance and balance boards
  • Mixed exercises

    • You can find an exercise program that does a little bit of a lot of different kinds of exercises 
    • Mixed: Group fitness classes, combination aerobic & strength, water aerobics, spinning

Key concepts:

  • Physical activity is an important component of managing persistent pain.
  • Aerobic or cardiovascular exercise stimulates the production and release of endorphins, your body’s natural painkillers.
  • Resistance exercise or strength training increases muscle strength improving tolerance to certain activities. 
  • Regular generalized physical activity has countless benefits including greater flexibility, improved balance, increased energy levels, and improved sleep.
  • With gradual exposure and slowly increased daily activity, you will notice your pain threshold improve and better overall general conditioning.


  • Use your largest muscles when lifting/carrying

    • Use your leg muscles to bend instead of your back muscles
    • Carry bags on your arm instead of in your hand to decrease pressure on small joints
  • Get close to your work

    • Use a book stand to minimize bending your neck
    • Us a chair or stool when working in the kitchen for long periods
    • When lifting heavy objects, make sure the object is close to your body
  • Maintain a wide base of support

    • Use supportive footwear
    • Keep your legs wide when standing to increase stability
  • Use the least amount of effort to complete tasks

    • Carry groceries in a luggage cart
    • Buy clothes that don’t need ironing
    • Alternate high-energy tasks with low-energy tasks (work 50 minutes, rest 10 minutes)
  • Stretch and change positions frequently (every 10-15 minutes)

    • Keep yourself moving throughout the day


Setting activity goals

  • There is a “therapeutic window” of exercise that will be challenging enough to benefit you, without causing a flare.
  • Finding your “window” can take a few tries.
  • It is best to start a little below your known limit in order to start with success, but you must have a plan to progress forward.
  • Goals should be SMART (Specific, Measureable, Attainable, Relevant, and Time-oriented) and not vague.
    • Writing down your goals will make you more likely to stick to them.
    • If you rate your confidence 8 out of 10, this is a good sign that you have chosen an attainable goal.
    • If you choose exercises that relate to things that you value, you will be more likely to follow through.


Download our SMART Goal Action Plan worksheet to help you set a goal!


There are many options when it comes to finding a type of exercise that is the right fit for you. 


Key concepts:

  • When dealing with a chronic pain condition, engaging in exercise often results in short-term discomfort, with long-term benefits.
  • The exercise does not need to specifically target the painful region to be effective.
  • General aerobic exercise such as walking, cycling, or swimming can have significant benefits on mood, sleep, stress levels, and muscle conditioning,
  • Try to establish your “therapeutic window” of exercise that will be challenging enough to benefit you, without causing a flare by setting SMART goals.



Regular physical activity has been shown to be effective for improving pain and has general benefits on overall physical and mental health.

When it comes to engaging in physical activity, you should use the following suggestions as a guide:

  • Do not plan to avoid pain altogether.
  • Do no push through high levels of pain at all costs.
  • You are in control, not the pain.
  • Use SMART goals for a clear progression over time.
  • Exercise can improve your mood, fitness, function, and sleep.
  • Exercise can reduce your fear of movement.




  1. Butler D & GL. Moseley (2003). Explain pain. Noigroup Publications
  2. Exercise is Medicine Australia, (updated 2014). Chronic Pain and Exercise. Retrieved from
  3. Geneen L. J. & al. (2017, January). Physical Activity and Exercise for Chronic Pain in Adults: an Overview or Chochrane Reviews. Retrieved from;jsessionid=6C26390A7E06FE6147D1E7205746A961.f02t03
  4. Government of Western Australia Department of Health, (updated 2017). Movement with Pain.
  5. Retrieved from
  6. Moseley GL (2010). Painful yarns. Noigroup publications
  7. Sapolsky RM (2009). Why zebras don’t get ulcers 3rd ed. Henry Holt Publishing
  8. Wall P (2000). Pain: the science of suffering. Columbia University Press

76 Grenville St. Toronto, ON M5S 1B2 Canada

TAPMI Hub Clinic

Phone: 416-323-6269 Office Fax: 416-323-2666 Hours: 8:00 a.m. – 4:00 p.m. Monday – Friday


Dr. Tania Di Renna, Medical Director Sandra Robinson, Administrative Director