Hi, this is James Fricton again. And this is the next part of the module entitled The Body. And this part is entitled Exercise. And we probably already realize this, but exercise is the original protector. its, the studies have demonstrated that exercise will probably prevent chronic pain more than anything else that we can do. And, I'll show you a few of the exercises, as well as some of the studies that demonstrate this. It's important to realize that there are five types of exercise. One is the goal we're achieving range of motion, so this is like stretching, or yoga helps us improve range of motion. The second one is improving strength, and here weights and resistance exercises can accomplish that. Third is endurance, and here conditioning and aerobic exercises are helpful for that. And then balance, maintaining a balanced posture. There are several exercises that can help us do that. And then, reducing repetitive strain is also important, and this is where relaxation exercises can be very helpful. Even taking a slow and deep breath. So, let's go through each one of these a little bit more in detail. Range of motion is something that we all need, we all achieve. We all try to maintain it whether anywhere in the animal kingdom, as you can show, shown by these animals doing their stretch, their daily stretching exercises. We also need, need to do our daily stretching exercises. So, probably the most common the stretching exercises is yoga. It's very popular right now, with yoga studios popping up all over most of the cities. And yoga is a dynamic stretching, so it's not a static stretching, where you're just stretching one particular joint, but it's a movement where you incorporate stretching as part of a movement exercise. Now, there is many different studies. The systematic review by Diaz demonstrated that for pain, yoga has been very, very effective in reducing pain, improving quality of life. Decrease in disability, improving stress, depression, and even medication use among patients with pain problems. And so, it's been very effective with regard to preventing chronic pain. Now, what are the principles of stretching? Well. Here are a few that you could use. For one, do it slowly, gently and frequently. It's good to do it several times a day just like the animals do it. We need to stretch to the point of pain, but not necessarily beyond the point of pain. You need to feel each muscle being stretched so that we do not over stretch it or over exert it and injure it in any way. But we need to just push it just a little bit to the point of pain and to the point of tightness. So, ultimately, we want to push it to the full joint range of motion. So, when you feel the full joint range of motion, you want to hold it and then count to 20. Now, while you're doing yoga or your stretching exercise, it's important to breathe slowly, and deeply as you stretch, and this way you can relax the muscles as you stretch. And try to avoid hurrying, and do not bounce with the stretch. It's just, it's a steady stretch that you do. And you don't push and bounce against the end range of motion. Hold it steady. So, these are some of the characteristics of stretching that you can incorporate into your daily routine. I typically add about 10 to 15 minutes of yoga every morning, and it makes me feel good the rest of the day. Later on, if I develop tightness from sitting too long writing, whatever. I will do some stretching later on in the afternoon and sometimes I'll do it ev, even before I go to bed. It doesn't take long to do it, five minutes or so. Now, the next type of exercise is strengthening. You've heard the phrase, use it or lose it. And this is so true about strengthening exercises. You really need to build up your muscles so they maintain strength over time. Now, strengthening studies have been very effective in preventing chronic back pain. Studies have shown that it's more effective than no exercise in those patients who have acute or sub-acute pain, and increasing intensity of the exercise and motivation does increase results. So, if you do it for a couple of minutes, it's going to be helpful, but if you do it for a sustained period of time, day after day, it's going to work even more. So, strengthening is equal to conditioning and stretching exercises. So, each one does different things. But they're all effective. And one of the things that's probably most important is try to incorporate all of them into your routine. So, what about conditioning? The conditioning studies that have been done, particularly for preventing chronic pain, have shown that running, walking, swimming, any type of conditioning exercise significantly will improve pain, function, quality of life, reduce disability and improve psycho-social status such as depression and anxiety. They did 9 systematic reviews comprising a total of 224 clinical trials, and 24,059 patients with a variety of different pain conditions. It doesn't seem to matter what musculoskeletal pain condition you have, it all seems to work. And there are different types of conditioning. One that has been recently advocated a lot, is this high intensity interval training. And this is something that you know, as this commercial states. The leanest, fastest, most powerful creatures on earth don't do aerobics where there's a steady exercise over time. It uses a first of all, a sprint or intense exercise. And then take a rest, where you do a, you know, just exercising gently like walking, and then you repeat the sprint, so you go back and forth between the repetitions of, of intensive exercise, and then resting, and then intense exercise. And in this way, you have the potential of improving. Many more characteristics in a shorter period of time than if you were to just run or swim continuously. So, thank you for your attention.