Adherence to Physical Activity among Midlife Adults with Chronic Pain: The Role of Acute Increases in Pain during Physical Activity

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Project Summary/Abstract Over 25% of midlife adults suffer from chronic pain, and promotion of physical activity (PA) among this population is essential to increasing quality of life and function at older age. Exercise programs have increasingly been offered in healthcare systems, however, adherence to exercise prescription is poor, with attrition rates as high as 50%. One of the major challenges to increasing PA among adults with chronic pain is that up to 70% experience increased pain during activity. Although increased pain during PA has frequently been cited as a major barrier to PA, additional work is needed to establish PA-induced pain as a key mechanism explaining nonadherence to PA among midlife adults with chronic pain. The proposed study will leverage an ongoing RCT by our research team (R01AG069349), which aims to test the effects of a recommendation for self-paced PA (i.e., PA of a self-selected intensity) versus prescribed moderate intensity PA on PA behavior among midlife adults using ecological momentary assessment (EMA) methodology. We will capitalize on this infrastructure to test two novel research questions among the subset of participants who endorse chronic pain: (1) Does increased pain during PA predict subsequent PA behavior? and (2) Does a recommendation for self-paced (vs. prescribed moderate intensity) PA reduce PA-induced pain, and subsequently increase future PA behavior? Indeed, self-paced PA may reduce PA-induced pain by providing the opportunity to reduce PA intensity when pain begins to increase. We will leverage this experimental manipulation (i.e., randomization to self-paced vs. prescribed moderate intensity) to use an experimental medicine approach to test whether manipulation-driven reductions in PA-induced pain (test of target engagement) increase subsequent PA behavior (test of target validity). We will also explore the more distal effects of PA on chronic pain severity and indices of successful aging at a six-month follow-up assessment. The applicant’s long-term goal is to conduct research focused on promoting adherence to healthful behaviors among individuals with chronic pain, and this study represents an important next step in a systematic line of research that has the potential to inform clinical practice. This award will allow the applicant to receive specialized training in the development/provision of physical activity promotion interventions, the healthy aging process, and the collection/analysis of intensive longitudinal and ambulatory assessment data. This award will also facilitate further development of the applicant’s research program via completion of manuscripts, presentation of research findings at scientific meetings, and development of additional research questions. Brown University is the ideal research/training environment for this project, as the applicant will have extensive opportunities for collaboration and training with expert behavioral medicine researchers. The hands-on training and pilot data obtained through this project will improve the applicant’s ability to obtain a competitive academic research position and increase potential for a productive research career.