The Pain Exchange

EXERCISE and Relaxation and Breathing 

Welcome to PEX exercise blog – we want to stay in contact and help keep you fit and well in every way.

We would love your thoughts and any resources you are already using and finding helpful.

Why not try a daily exercise routine.  Gentle exercises performed in a comfortable range, will help to maintain body health and flexibility


!.Start with a  breathing exercise.

Breathe in deeply but slowly through the nose and out through the mouth, imagine breathing into the bottom of the lungs, the back of the lungs and the top of your lungs.  1 breath into each area.

2. Get the heart and lungs ready.

March on the spot for 1 min

3. Practice Balance

Standing on 1 leg for 1 minute

 – try at least 10 secs  at one time and see how quickly it takes you to manage 30 secs x2.  Holding on to start with is fine as we want you to be safe.  You could challenge a friend to do it with you and see you gets to manage it first.  

If you can already do it try with your eyes closed 

4. Warm up the spinal joints 

Roll downs 

– starting with head to chest and then rolling down to touch your toes.  Try to keep weight across the middle of the foot and bend your knees when you need to.  Once down breathe in and out x2 and then slowly roll back up, keep range of motion comfortable and do not exercise through pain. keep movement slow and controlled.

Follow this with arm elevation with or without standing on tiptoes to give yourself a good stretch.

Do these x2-3

Side flexion

 – best done in front of a mirror so you can make sure you keep your pelvis straight and not twist.  Elevate arm and bend to the opposite side so you feel a stretch.  Breathe in and out x2 and repeat on the other side.  


Remember with strength exercises; stop repetitions when you sense that the muscles are tired, aching, trembling or movement no longer feels smooth and easy.

1. Heel raises approx  x10 -20 holding on to a wall or chair/work surface. 

2. Sit to stand approx x5 to 10 from a dining or kitchen chair


sit on the chair and rotate slowly side to side remembering to breathe in and out as you do so x2 each way.


Wall  press ups approx x10.

 Press heels into the ground as this will help pull in your tummy and stop your hips falling forward.  Your body should stay straight.

Floor exercises for lower limb and trunk strength

Lie on your back Knees bent up Bridge / Roll ups

 – tilt your pelvis gently into the floor and lift bottom and then roll up lower back to upper back,segment by segment of the spine.  When you reach your shoulders breathe in and out and then slowly roll back down again. Approx 8-10 repetitions

Knee rolling side to side.  Moving from the waist x5 each way slowly breathing in and out as you do it. keep your movement slow and controlled.


Relaxation techniques are a useful way to help reduce stress and anxiety.  To allow your body to rest and be in the moment.  May be take time to reflect on your day being grateful, being sad, remembering something funny.  It is good for all of us to put time aside at least once a day for this type of reflection.  

There are various apps you can use and you might wish to explore some of these like calm or headspace.  Reviews are mixed which suggests that they work for some but not all.

You could try the relaxation below as a starting point

Lie on the floor comfortably on in bed or even just sitting.  

Start by breathing slowly in and out. 

 People suggest you should breathe out for longer than you breathe in.  Say breathe in for 5 sec and out for 7secs.  

Do this for a minute or two just listening to your breath and feeling your chest rise and fall.  If you start to wonder bring yourself back to your breathing.

Then do a body scan.

  Is there any tension? Any pain? Allow yourself to think about that area for a moment of two.  Accept it is there.

Then start at the bottom and work your way up your body.  Tensing each muscles group as you go for 5 secs as hard as you can and then let go until you feel the tension release and the limb feels loose.  

Start with the feet

 – pull up foot and toes towards you and then point away.  Let the feet relax

Tense the thigh muscles and feel the tension and then the relaxation as you  let go.

Tighten your bottom muscles and then let go

Pull your shoulder blades back towards the floor and then let go

Pull your shoulders up towards your ears and let go

Push your head gently into the pillow and then relax.

Now do another body scan

 – is your body relaxed.  Has your pain changed? Are you feeling rested against the floor or back of the chair?

Breathe in and out again slowly – Can you breathe in for longer and out for longer 

And then take a walk or get in to your car and travel to a place you like and has happy memories for you. 

- Think about the things you see and people you pass.  What do you hear.  

If my father cant sleep he does the journey to Pembrokeshire starting at getting into the car and going through each part of the journey – he very rarely gets there!

I try and walk the cliff path or sit on St Davids head looking out to sea and visualising the birds and the waves and the sounds I here around me.

Just a couple of ideas to try and allow your body and mind to switch off from things that may be worrying you and concentrate the mind on one particularly thing.

Breathing exercises


Helen Alsop 

Covid 19 is a virus that is affecting the respiratory system.  Mild symptoms include a dry cough and temperature.  More serious symptoms affect the lungs and cause shortness of breath and fatigue. 

If you are well it is important to keep as active as possible during this time of isolation.  Joining the exercise class weekly is one way and making sure you get out for a walk or other form of exercise is another way to remain active.

If you become unwell with mild symptoms you may well not be able to exercise as much as you would wish, and if you have a temperature you should be resting. Some people find the fatigue puts them out of action for some time.  

There has been some information on social media recommending the use of deep breathing exercises for people with covid-19. As we do not know enough about the virus at this point in time, we can only advise on what we already know.  Deep breathing exercises may well be helpful because they can encourage air into the depths of the lungs, if the depths of the lungs are not used they can close and become at risk of infection. Deep breaths can also increase the amount of oxygen getting into the lungs and the amount of carbon dioxide leaving it.

It is important to seek medical help and assistance if you are short of breath or struggling to breathe. Hospital treatment aims to ensure that air is getting to all areas of your lungs so it seems logical to expect that doing breathing exercises, or exercises which increase air into your lungs, would be helpful. If you have to stay in bed for longer than a few days it is important to try and sit out for short lengths of time to allow air further down into the lungs.  When lying in bed the best position is alternating lying on each side.

Whether sitting, standing or lying in bed trying to do some deep breathing exercises will be helpful in getting air to the bottom of your lungs.  Try these exercises 

Start by placing your hand on your chest and breathing in through your nose for 5 secs hold the breath and then slowly breathe out.  Repeat this twice. Breathing in through the nose warms and moistens the air that you take in, breathing in dry air through the mouth may irritate the dry cough and not help you.

Next place your hands around your rib cage and breathe in through the nose again gently pushing your hands outwards hold your breath for a few seconds and then breathe out slowly – again repeat twice.

Lastly place your hands around the bottom of your shoulder blades and breathe in gently pushing your hands outwards.  You should feel your chest expand fully.  Slowly breathe out.  On the second repetition try a little sniff to take in that extra bit of air.

Once you have gone through this cycle of deep breathing relax and let your diaphragm rise and fall gently for a couple of minutes.  The following link gives a good explanation of this breathing technique and will be helpful for all the reasons it talks about.

These exercises may make you cough as you increase the air into your lungs.  This is not a bad thing but may mean you have to rest in between each section.

Try and do these exercises hourly 

Once you start to feel better walking around and sitting up will be as affective but it is worth continuing with the breathing exercises until you are able to take a normal walk outside again.



Ageing Exercise and Immunity



By Sharon Morgans 

References for facts and figures in this blog are taken from an article written by Helen Thomson in the New Scientist dated April 18th   2020, and from a lecture for The Academy of Medical Sciences given by Professor Janet Lord who is a professor in Immune cell biology at the University of Birmingham


As individuals we all vary greatly in our love of exercise. Some of us do not like exercise in any shape or form and at the other end of the spectrum, some of us are rather fanatical about it.

There are many reasons why we might not be keen on exercise. Pain experience is one of the factors that can reduce our enjoyment of exercise and result in a more sedentary lifestyle. This blog seeks to help those who fall into this category.


Over the last 150 years average life span has been increasing but this has not been mirrored by average life health. Some data indicate that, on average women experience poor health over the last 19 years of their life, whilst men experience poor health over the last 16 years of their life. 

Questions that we are exploring in this blog are: -

1. What happens to our musculoskeletal system as we age?

2. What happens to our immune system as we age?

3. Is ageing affected by exercise?

4. What exercises can we do if we suffer from persistent pain and long-term conditions?


There is evidence to show that we start to lose 5% of our muscle mass every decade from our 30s and this process seems to speed up once we hit our 70s. During ageing our muscle fibres change, the muscle fibres that help us bear loads for short periods are replaced by muscle fibres that are more efficient over longer periods. In addition as we age our muscles become less efficient at repair with injury and recovery post activity. 

These changes are triggered by several factors including: - alteration in hormone levels such as testosterone and by reorganization of brain cells that control movement.

For a longtime we have known that the strength of our bones diminishes, as we age and you may be familiar with the terms osteopenia and osteoporosis. The strength of our bones is governed by many factors. Osteoporosis is a condition where our bones are weakened and we are more at risk of breaks. Simply put our bones weaken when the rate of bone cell death exceeds the rate of new bone cell formation.


The purpose of the immune system is to

1. Detect and kill infections; viruses, bacteria, fungi and parasites

2. Kill or remove damaged, old or changed cells

3. React better when it encounters infection for a second time (immune memory)

4. Not damage itself (auto immune response)

As we age (over 75) there is evidence that we are more prone to infections and less able to fight them. Our response to vaccination is less marked, our immune memory fades and we are more likely to develop autoimmune conditions.



In a study that looked at keen cyclists aged between 55 and 79, results indicated that compared to a less active similar age group they did not loose muscle mass, their body fat did not increase. They maintained the cells that fight infection and the cells that store a memory of how to fight infection. However aspects of the ageing immune system that did not change in the cyclists was the part of the immune system that make us more likely to develop auto immune disease.


Studies that have looked at the effects strength exercises have shown that strength exercises reduce the risk of osteoporosis by stimulating bone cell growth. A study that investigated the effect of strength exercises performed twice per week over a 14-week period in residents living in a nursing home.  Showed that overall strength increased by 60% .The impact of this was demonstrated by improved independence, one measure was an improved ability to get the bathroom independently.


Age related diseases include, cancer, cardiovascular disease (heart), Alzheimer’s, osteoarthritis, diabetes and blindness.

Is there any evidence to suggest that exercise and in particular strength exercise can reduce the risk of developing these age related diseases?

The answer is yes; there is some evidence that having stronger muscles reduces the risk of cardiovascular disease, type 2 diabetes and the risk of cancer. There is stronger evidence to suggest that strength training can improve memory and prevent cognitive decline. 


The current guidelines in the UK indicate that we should aim for 150 minutes of aerobic exercise per week and 2 sessions of strength exercises per week. 

This I am sure could feel quite daunting and even impossible for those for whom exercise and activity result in an increase in pain experience.

Age and circumstances (including pain experience) influence the amount of aerobic exercise and strength exercise that are possible.

It is my belief that life is about balance and context. I firmly believe that doing some form of physical activity is better than nothing. There are many ways of maintaining physical and mental performance if we are living with long-term conditions and persistent pain.

If you are living with a long term condition and persistent pain remember  

Staying active is good for my body and my brain

And consider 

What does staying active look like in my current situation?

Ways to stay active 

Find something that you enjoy or something that helps maintain independence or gives you a sense of achievement

Staying active can include walking, gardening, shopping, dancing, exercise class, swimming, marching on the spot, sitting and marching.

Or staying active might mean being able to continue with activities of daily living, dressing, bathing, cooking, feeding, getting on/off chair and in/out of bed, climbing stairs.

How much should I do?

An amount of activity, that causes a comfortable increase in rate of breathing. Make a note of how long you can do an activity before your breathing rate increases.

Try to do this every day or aim for 3-4 times per week. 

The activity that you choose should be relevant to your ability. 

Ideas might be marching on the spot in standing for others it might be marching on the spot in sitting or for others it might be walking or jogging or cycling, Choose the level of activity that is achievable for your current level of ability.

Any activity that causes your muscles to feel tired will result in an improvement in strength Studies show that exercise that makes your muscles tired performed 2-3 times per week results in an increase in strength.

The number of repetitions possible to point of fatigue will vary depending on your current level of strength. Explore this for yourself or ask for some guidance from your physiotherapist.

You can expect aching in the muscles that get tired this is a normal response of a muscle to strength training. 

Exercise that takes you into a pain experience that is not related to muscle aching but results in a marked increase in your particular pain experience is not the desired outcome. In this case re think your activity and the amount.

But I can’t do any activity without experiencing pain, what can I do?

There is some evidence to suggest that imagining movement and imagining performing strength exercises can improve muscle strength and in some cases reduce pain experience. Why not try imagining a favourite activity or exercise for a few minutes every day.