Defense Date

6-28-2019

Graduation Date

Fall 12-20-2019

Availability

Immediate Access

Submission Type

dissertation

Degree Name

PhD

Department

Biological Sciences

Committee Chair

Benedict J. Kolber

Committee Member

Matthew C. Kostek

Committee Member

Kimberly A. Szucs

Committee Member

Sarah K. Woodley

Committee Member

Allyson F. O'Donnell

Keywords

exercise, exercise dosing, chronic pain, treatment, non pharmacological, intervention, meditation, mindfulness, meta-analysis, chronic low back pain

Abstract

Chronic pain includes debilitating conditions affecting large populations of people throughout the world. These diseases are further complicated by comorbid psychological disorders which make chronic pain conditions difficult to treat. Nonpharmacological treatment options have more recently become an important mainstay of effective therapies and are currently being used to supplement or replace traditional pharmacological treatment methods. Exercise-based therapies in particular are of interest due to their demonstrated success in reducing pain symptoms as well as improving psychological outcomes. Dose is an important factor in being able to effectively prescribe treatments in the context of specific exercise interventions and specific pain populations. Finally, in an effort to synergize the effects of multiple therapy modalities (i.e. aerobic exercise and psychological interventions), integrative approaches have become of key interest in multidisciplinary pain treatment plans. Our efforts have sought to characterize the effect of exercise dosing and the role of integrative nonpharmacological programs in treating chronic pain. Our approach involved (1) examining different variables of exercise dose using a meta-analytical approach to determine which component was the most likely to influence pain effect in chronic pain groups, (2) testing multiple doses of the frequency aspect of exercise dosing in a cohort of healthy humans to determine the best dose for analgesic benefits, (3) testing the outcomes of integrating the exercise program with a psychological intervention in a cohort of chronic low back pain patients. (1) In our meta-analysis studies, we analyzed existing data, examining exercise dose defined by minutes of exercise per week (time), frequency of exercise bouts per week, number of weeks that the intervention lasted (duration) and estimated intensity of the exercise. Our analysis revealed significant positive correlations with exercise duration and analgesic effect in the context of chronic neck pain studies. Multiple linear regression modeling allowed us to predict increasing the frequency or bouts of exercise sessions per week had the greatest influence on increasing pain effect size. (2) We then tested the effect of different doses (frequencies) of walking exercise in a cohort of healthy female subjects. Forty females were allocated into 4 groups: control (no exercise), low dose exercise, moderate dose exercise and a high dose of exercise. Moderate and high dose groups of exercise had the greatest improvements in pain ratings, suggesting that the low dose was insufficient to provide analgesia, and the high dose was no more beneficial than the moderate dose. (3) Lastly, we integrated the moderate dose of exercise used in the previous study with mindfulness meditation and tested the impact of this combined therapy in a group of chronic low back pain patients. Thirty-eight adults completed meditation and exercise treatment (MedExT) or an audiobook control condition over a four-week period. Post-intervention, MedExT participants exhibited significant improvements in disability compared to the control group and showed increased mindfulness and improved ratings of low back pain. Overall, our results suggest that increasing the frequency of exercise dose is a critical component in exercise prescription and that integrative nonpharmacological therapies are effective in decreasing symptoms in a chronic pain group.

Language

English

Additional Citations

Kostek, MC, Polaski, AM, Kolber, BJ. Ramsey, AM, Kranjec, A, Szucs, KA. 2016. A protocol of manual tests to measure sensation and pain in humans. J Vis Exp. DOI:10.3791/54130.

Polaski AM, Phelps AL, Kostek MC, Szucs KA, Kolber BJ. 2019. Exercise-induced hypoalgesia: A meta-analysis of exercise dosing for the treatment of chronic pain. PLoS ONE. DOI:10.1371/journal.pone.0210418.

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