Why high-intensity exercise can help ease midlife pain

Examples of vigorous activity include swimming, jogging and digging with a spade, while moderate exercise included dancing, stretching, fast walking or gardening. Photo / Dallas Morgan, Unsplash

At the age of 58, cycling convert Marco Baggioli is relishing the high-intensity thrills of time-trial racing – a challenging sport that sees him cycle at speeds of 40-50kmh. His vigorous workouts certainly hurt during the sessions themselves, but they seem to be protecting him against the everyday aches and pains which haunt many of his friends and colleagues of the same age.

"I don't remember feeling healthier than this, even when I was younger," insists Baggioli, who started cycling in his late 40s. "I feel like I am getting better and better. My 10-mile record is down from 22 minutes in 2018 to about 20 minutes today. But even when I feel tired, it is 'healthy tired', not muscle aches or pain."

Baggioli is one of a growing number of 50-somethings who have learnt that challenging exercise can keep you feeling young, supple and pain-free. For years many people have assumed that hard exercise causes – rather than prevents – joint and muscle pain in older age. But there is growing evidence that it can have a protective effect.

A recent study of people aged 50 and above, by the University of Portsmouth, found that people who perform vigorous or moderate exercise suffer less bone, joint and muscle pain in later life. Examples of vigorous activity recorded in the study include swimming, jogging and digging with a spade, while moderate exercise included dancing, stretching, fast walking or gardening.

"The findings are not entirely novel, as we knew that physical activity can be beneficial in the context of pain, but what's really novel is that the activity needs to be of sufficient intensity and frequency," explains Dr Nils Niederstrasser, a lecturer at the University of Portsmouth.

"About 50 per cent of those aged between 55 and 75 tend to report pain complaints, and that can go as high as 62 per cent for those aged 75 and older. But it still means that there are a good number of people who don't report pain at that age, so pain is not an inevitability."

Although all exercise was found to protect against pain, only high physical activity (defined as vigorous activity at least once a week) was associated with a lower risk of musculoskeletal pain 10 years later. It seems that people who enjoy challenging bike rides, tennis matches or gym workouts in their senior years are onto something. "It's important to stay physically active," concludes Dr Niederstrasser. "And if you can be active, try to make it of sufficient frequency and intensity."

A recent study of people aged 50 and above found that people who perform vigorous or moderate exercise suffer less bone, joint and muscle pain in later life. Photo / krakenimages, Unsplash

Experts believe this may be because challenging exercise improves muscle function, cartilage health and bone mass better than mild exercise, thereby reducing your risk of joint and muscle pain. It also helps to control body weight, which prevents muscular degradation and lower back, knee and hip pain that often comes from being overweight.

Baggioli is certainly not surprised at the findings. "As you age, you lose a lot of muscle power, so it is important to do high-intensity stuff to keep that muscle power," he explains.

Chronic pain is a major societal health issue, which can lead to physical disability, reduced quality of life, depression, sleep disturbances and spiralling healthcare costs. But evidence of the protective value of challenging exercise is now mounting up.

A 2005 study in the journal Arthritis Research & Therapy found that over-60s who engage in vigorous aerobic exercise, like running, suffer 25 per cent less joint and muscle pain than their more sedentary peers. A 2014 study in the Journal of Pain found that doing more moderate-to-vigorous exercise helped to protect people from chronic pain, whereas lighter activities did not. And a 2021 study by the University of Limerick found that people aged 50 and above who do not perform enough moderate-intensity exercise are at higher risk of pain in later life.

Kid glove approach misguided

Dr Kieran O'Sullivan, a senior lecturer in physiotherapy at the University of Limerick. explains: "The data suggests there is something particularly useful, not just about pottering around and being active, but if you can include harder exercise – like some form of basic weight training, or more vigorous activity. In the past, we had a habit of wrapping older people in cotton wool and saying: 'The young guys can go to the gym but we'll give you a nice gentle little hydrotherapy session.'"

He agrees that medical practitioners, physios and fitness coaches have often been too quick to tell older people not to push themselves. "When a younger person who goes hiking gets a sore knee they just get told: well, you've done a lot of hiking, it'll be fine in a day or two. Whereas when you get into your 40s, 50s and 60s, you might be told with the best intentions: 'Why don't we get that looked at?'

"What we've seen over the last couple of decades is that this well-intended advice, based on scary stuff in MRI scans, has ended up not necessarily helping bones and cartilage but weakening bones and muscles and leading to more problems."

He insists we should give ourselves permission to slowly develop or maintain a habit of more moderate or vigorous exercise, whether it be digging in the garden, hitting tennis balls around a court, or hiking in the hills.

"Will this make you tired? Yes. Could you be a bit stiff and sore after them? Yes. But that soreness is as much to do with not being used to it, and your muscles getting achy, rather than damaging any part of your body."

That said, nobody would recommend you suddenly throw yourself into vigorous exercise in later life: it is essential to check your health first with your doctor, build up your activity levels gradually over time, follow the usual warm-up protocols and make sure to recover properly.

'My balance is maybe 20:80'

Always set realistic goals based on your own personal health. "Someone who up until five years ago was jogging three times a week will be able to progress more quickly than a person who's been sedentary for 16 years," O'Sullivan says. "Based on where you are now, look at what you want to do: is it a local park run or a round of golf? If you want to cycle from one village to another, build up towards that and shrink the gap a little bit each time. We often put a lot of emphasis on the first week of exercise, but the real gains here are the not-so-sexy long-term changes."

Baggioli admits he has learnt how to carefully manage his body as he nudges closer to his 60th birthday. "My balance between heavy and lighter work is maybe 20:80, so 20 per cent hard stuff and 80 per cent more gentle endurance rides," he explains. "As you age, your recovery gets a bit slower, so good nutrition and good rest is important. At my age, I can still push hard but I also take time to recover."

O'Sullivan says it is best to build "little bouts of vigorous activity" into your routine. Think about what activities you might enjoy. How can you get started? How can you do it consistently? And how can you make it a little bit harder over time, in order to deliver those vital protective benefits? "I wouldn't like to be blaming somebody if they only walked their dog every day," he says. "But if you could intersperse it with something that was vigorous, that would be nice."

Doing activities you enjoy will improve your exercise consistency, but it will also naturally encourage you to progress and push harder.

The new research is delivering a powerful new message: do what you feel capable of, not what others expect of you. "You might think you're getting old, and your children might think they're protecting you by telling you you're too old to play tennis, but if you love it, do it," O'Sullivan says. "There's no upper limit at which it's no longer appropriate to go into the gym or to run up a hill."