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Write to reply: HCM letters
"Prescribing exercise will always be preferential to prescribing painkillers, given the risks associated with their long-term use"
I’m very pleased to see that NICE has acknowledged the power of exercise in managing pain (see page 48). The evidence is clear and strong that activity is beneficial in almost every long-term condition, many of which have accompanying chronic pain.
Encouragement is vital as well, so whether that’s online, through apps or in person through social prescribing, combining exercise with reassurance is the way forward.
This is quite a change of tack for NICE as, traditionally, painkilling drugs have been the first things to be prescribed.
I welcome seeing exercise on prescription being recommended in this way. It’s a great step forward in the industry’s push to have exercise prescribed routinely for all long-term conditions.
Strong evidence
Both the evidence summarised in the 2015 Report of the Academy of Medical Royal Colleges, called Exercise, the Miracle Cure, and the evidence base since 2015 have been reviewed by the team here at EXi, along with the 963 systematic reviews on pain and exercise published in the last five years.
We found that while the NICE guidelines are encouraging, more research needs to be done in this promising field.
The EXi app includes fibromyalgia and chronic pain as two specific conditions for which prescribed exercise can help, based on 24 systematic reviews. The app takes people through a very specific and slow graduation at a low intensity, with the programme designed to guide them in regular exercise, even when they’re away from the gym.
Chronic pain by definition is ongoing, so prescribing exercise that can be done for a prolonged period of time will always be preferential to prescribing painkillers, given the risks associated with their long-term use.
– Sir Muir Gray, Chief knowledge officer, EXi
"Prescribing exercise will always be preferential to prescribing painkillers, given the risks associated with their long-term use"
– Sir Muir Gray, Chief knowledge officer, EXi
The Waterside Hotel and Leisure Club has invested in upskilling PTs and instructors, in partnership with Your Personal Training, to create a long-COVID rehab hub for Greater Manchester. With the North-West hard hit by the pandemic, people in this part of the UK are disproportionately likely to be classed as ‘extremely clinically vulnerable’.
Along with 11 others, I was put through the CAWS UK training, which focuses on the rehabilitation of people with long-COVID who need a more bespoke approach.
I have one client who still experiences breathing difficulties five months after infection and the CAWS training prompted me to look more deeply into breathing methods, especially those linked with anxiety and relieving stress stimuli.
I started using parasympathetic breathing with my client, including diaphragmatic breathing and controlled exhalation. This helped with the acute onset symptoms of stress and anxiety around breathing.
Secondly, I added some pursed lip breathing, concentrating on deep inhalation, to expand my client’s lung capacity and to increase oxygen proliferation through their alveoli. This will help with the chronic fatigue many COVID-19 sufferers have sustained. Finally, we focused on the role CO2 plays. I applied this mainly with breath-hold work and nasal breathing. This produces nitric oxide and slows the rate of breath during exercise, allowing the body to feed oxygen more efficiently, which again decreases stress and fatigue.
The goal here is holistic, so although I’d tracked each session with a pulse oximeter and followed a slow progression, the breathing exercises are built on feedback from the client. These breathing methods, incorporated with the other CAWs modalities, have seen her able to work up to a point where she can do full one-to-one sessions again, allowing her more rapid, whole-body recovery.
Your Personal Training is reviewing demand from the Manchester pilot and looking to work with operators to upskill more PTs to create further COVID hubs in other parts of the UK.
Customers will need to be eased back from COVID-19, and a vast range of specific health issues need to be addressed by trained experts, including fatigue, dizziness, cardiovascular and muscle deterioration.
A six-week GP referral is not necessarily going to be appropriate or long enough for some long-COVID sufferers to recover. In these situations, personal training is a long-term solution to a long-term health problem.
