Regular exercise, including any type of physical activity, is a crucial part of staying healthy as we age. In one study, 5,314 male veterans age 65 to 92 were assessed for their exercise capacity and were followed for 22 years. The researchers looked at the connection between fitness levels and mortality rates of the participants.

Not surprisingly, the most fit men fared the best; their death rates were 61 percent lower overall. Moderately fit men were 38 percent better off. Men who were out of shape but then started an exercise program lowered their mortality by 35 percent during the study.

The researchers concluded that “survival improved significantly when unfit individuals became fit.”

But it isn’t always that simple for my older patients. Many of them would love to exercise or be more active, but they are limited by pain, often joint and muscle pain. And while medications can give short-term relief, they are not a good option for chronic pain. Anti-inflammatory drugs such as aspirin, Motrin, Celebrex and others have serious side effects, including stomach ulcers, internal bleeding and kidney damage. The stronger painkillers are addictive and lose their effectiveness after a few months. More aggressive treatments such as cortisone shots also are usually temporary and can damage the tissues, especially with repeated treatments.

There are natural alternatives for exercise-related pain. The most important is joint manipulation. This is so important because most exercise pain originates in the joints. However, this also is the area where I have to do the most education for my patients. They are very familiar with tight muscles, and causes of pain such as arthritis, but the idea that joints can be a problem is new, even foreign, to most.

There is often a lot of resistance to the idea at first; patients keep trying to tell me about the disc problems on the MRI or the arthritis on the X-rays or the torn tendons in the rotator cuff. While all these may cause pain, joints being out of alignment and not moving properly make them all much worse. I always advise a patient that we cannot really say the arthritis is the actual cause of the pain until the joints are corrected.

If the pain persists, it is likely the arthritis is the problem; but often the pain responds to the manipulation. I have seen patients respond to joint treatment even after several cortisone shots, months of exercise and medication, even surgery have been tried. If the underlying problem is joint alignment, these treatments are not likely to be very successful.

Another great treatment for activity-related pain is acupuncture. The mechanics of how acupuncture works is a topic for a later column; suffice to say, it works and works well. Much chronic pain is because of a stalled healing process. When healing is jump-started with acupuncture, chronic inflammation resolves, pain eases and the patient can start to get up and do more. It has the added benefit of being very safe — similar to manipulation.

These natural treatments are very different from the usual treatments of drugs and cortisone shots for pain relief. The biggest difference is that they actually address the cause of the problem; manipulation realigns problem joints, and acupuncture restores the healing process. The best drugs can do is ease the symptoms.

Also, these natural treatments tend to improve your overall health. I recently had a patient who is getting acupuncture for foot pain tell me it also is improving her chronic heartburn. It is not unusual for manipulation patients to notice better digestion or breathing or sleep as a side benefit of the treatment. Unfortunately, the standard treatments have numerous side effects, and the longer they are used the more serious the side effects become.

The goal of all these treatments is the same: to allow the patient to resume an active, pain-free lifestyle. But the more aggressive treatments should be saved for cases that prove resistant to wellness care. Once a patient can be more active, their health can improve with time instead of worsen with inactivity.

Dr. Michael Noonan practices chiropractic, chiropractic acupuncture and other wellness therapies in Old Town. He can be reached at