Physical therapy and exercise: Impacts on pain, mood, cognition, and function

Pain is multidimensional, common, complex, costly, and challenging. It has a pervasive effect on the individual with frequent co-occurrence of mood disorders, cognitive problems, movement dysfunction, activity limitation, fatigue, and clusters of comorbid health problems. The extent to which these problems are separate entities, different expressions of a central pain problem, or a consequence of pain or of physical inactivity is unclear. Regardless, the allostatic load associated with pain is cumulative and substantive. Physical activity appears to be a positive mirror image of pain. Strong evidence supports the positive and generalized role of physical activity/exercise to improve pain, mind (emotions and cognitions) movement, and social function. However, there appears to be no evidence supportive of any specific type of exercise or activity regimens. Unfortunately and regardless of proven health benefits, many individuals have difficulty initiating and/or maintaining exercise programs or even assuming a more active lifestyle. People with pain, depression, and psychomotor slowing have even greater challenges to overcome. Effective physical therapies for patients with pain require the therapist to understand the complexity of the problem of pain and its pervasive impact, in order to help individuals with pain, mood, movement and cognitive disorders address and overcome perceived barriers to and challenges of exercise. This must be done in the context of social and environmental determinants of health and health behavior change.