Increasing Physical Activity Among Older Adults With Chronic Pain

A Massachusetts General Hospital researcher is developing tailored interventions to promote healthful behaviors in midlife and older adults with chronic pain, building on research that revealed acute pain could be a barrier to healthy behaviors in this population.

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"We found that if a person experiences acute increases in pain during physical activity, they will engage in lower levels of physical activity in the future," says Lisa LaRowe, PhD, a faculty member at the Mongan Institute Center for Aging and Serious Illness (CASI). "As a result, low levels of physical activity can lead to poorer long-term pain outcomes among midlife and older adults."

The Effect of Chronic Pain on Older Adults

Dr. LaRowe says chronic pain in midlife and older adults is associated with multiple detrimental health outcomes, including:

• Greater occurrence of psychopathology
• Restrictions in mobility and function
• Increased risk of falls

Regular physical activity in older adults has been shown to decrease chronic pain over time. Still, Dr. LaRowe says many people with chronic pain avoid exercise due to the acute increases in pain they experience during the activity.

"When a person first begins to exercise, they may experience acute increases in pain. That pain, unfortunately, becomes a barrier. Avoidance of activity-induced pain and subsequent physical activity can lead to greater pain severity, pain-related disability, and other negative health and aging-related outcomes," she notes.

Examining Activity-induced Pain Among Midlife Adults With Chronic Pain

Before joining the research faculty at Mass General, Dr. LaRowe completed an NIA-F32-funded postdoctoral fellowship in the Center for Health Promotion and Health Equity at the Brown University School of Public Health.

During her time at Brown University, Dr. LaRowe led an online study that was published in the Journal of Behavioral Medicine. The study examined increased pain among 178 midlife adults (aged 50-64) during physical activity to predict future physical activity participation.

More than half of the study participants reported increased pain during physical activity over the previous week. People who reported greater increases in pain during physical activity also reported enjoying physical activity less. That, in turn, was associated with a lower intention to exercise over the next week and lower total volume of physical activity reported at follow-up.

"We know that regular physical activity can improve chronic pain over time, so if we can find strategies that help this population cope with acute pain during exercise, it could lead to less chronic pain and better health outcomes down the road," says Dr. LaRowe. "Encouraging midlife and older adults to choose a physical activity they enjoy and allowing them to engage in self-paced exercise may help them to manage acute increases in pain during exercise."

Dr. LaRowe began exploring some of those strategies during her postdoctoral fellowship. She developed a study investigating whether self-paced exercise, compared to moderate intensity, decreases pain during exercise and subsequently improves adherence. Data collection for this study is still ongoing.

Developing Pain Management Strategies During Physical Activity in Older Adults

At Mass General, Dr. LaRowe hopes to build on the findings of her previous work and apply them to older adults. Since joining the research team in September 2022, she has begun to collaborate with fellow investigators, including Christine Ritchie, MD, MSPH, and Ana-Maria Vranceanu, PhD, who are conducting important work focused on improving health and function among older adults with chronic pain.

"There is a lot of research synergy that happens here at Mass General," she says. "I was drawn to Mass General, partly due to the incredible opportunities for interdisciplinary collaborations and the emphasis on a team science approach."

Dr. LaRowe says there are several pain management strategies she'd like to study to see if they can improve the well-being of older adults with chronic pain.

"I'd like to further explore whether physical activity adherence can be improved by allowing older adults with chronic pain to self-select their exercise intensity, instead of prescribing moderate-to-vigorous intensity exercise. I'm also interested in other health-related behaviors. For example, I want to continue the work I've previously done on substance use by further investigating the consequences of alcohol use in older adults with chronic pain," she notes. "I am eager to work with my colleagues to develop and implement biopsychosocial interventions to improve chronic pain and aging-related outcomes among the midlife and older adult patients we serve here at Mass General."

Learn about the Center for Aging & Serious Illness

Refer a patient to the Division of Palliative Care & Geriatric Medicine