People with chronic pain are told to exercise constantly, and rarely told what the evidence actually says or how to do it on a day when the pain is up. The honest summary is more encouraging than "push through" and more modest than "exercise cures pain".
What the evidence says
An overview of 21 Cochrane reviews across ten chronic pain conditions concluded that physical activity and exercise is an intervention with few adverse events that may improve pain severity and physical function, and consequent quality of life. The authors were candid that the quality of much of the evidence was low and that the size of the benefit was uncertain (Geneen et al., Cochrane 2017). NICE’s chronic pain guideline recommends offering a supervised group exercise programme to people with chronic primary pain, taking their preferences and abilities into account (NICE NG193).
Three things follow. Exercise is worth doing. It is unlikely to make things worse when it is suited to you. And "suited to you" is doing a lot of work in that sentence — which is where your own record comes in.
Why fixed plans fail people with pain
A plan written three weeks ago does not know how you slept or what today’s pain is. On a bad day it offers two options — do the session as written, or skip it and mark the day as failed — and over a month that second option quietly ends the habit. The alternative is to decide the session after checking in, and to treat a lighter version as a legitimate one. That is the whole idea behind adaptive training in HAVYT.
| Check-in says | The session becomes | Still counts? |
|---|---|---|
| Ordinary day | As planned | Yes |
| Pain up, slept badly | Reduced volume or load; or mobility only | Yes |
| Flare | Gentle range-of-movement work, or a walk — as agreed with your clinician or physiotherapist | Yes |
| New or sharp pain | Stop, and ask | Rest is the right call |
Recording training beside pain
The point of tracking here is not the workout log itself but the comparison it allows. Record what you actually did — type, rough duration, and whether you scaled it — on the same timeline as pain, stiffness and sleep. After several weeks you can ask:
- What did the day or two after a heavier session look like, compared with an ordinary day?
- What did the weeks where you kept some movement going look like, compared with the weeks you stopped entirely?
- Are there types of session that are more often followed by worse days in your record?
These produce associations, not verdicts. Both overload and total rest can sit beside worse days, and the direction is never given by the record alone. Take what you find to your physiotherapist or clinician. See how to track pain patterns.
If you have an inflammatory condition
For ankylosing spondylitis and axial spondyloarthritis specifically, NICE recommends referral to a specialist physiotherapist for a structured programme, and NASS publishes practical guidance on exercising safely and on adapting during a flare (NICE NG65; NASS). See exercise during an AS flare and training with ankylosing spondylitis.