Active therapies

PDF download is not available for Arabic and Urdu languages at this time. Please use the browser print function instead

teen tying running shoes

Active therapies are treatments that require effort from you. They may increase your overall function and assist in managing your pain. Active therapies include activities such as aerobic training, muscle strengthening or conditioning, exercise to improve your balance or flexibility, functional exercises (those that help with everyday movements such as bending or lifting), sports and active hydrotherapy.

What is the evidence for active physical therapies?

In general, there is very strong evidence that regular use of active therapies will lead to long-term improvements in chronic pain.

Are active therapies right for me?

Active physical therapies are an important part of the 3P approach to managing chronic pain. Anyone can benefit from starting an active physical therapy program that is tailored to their needs, once it is developed with their healthcare team.

General tips for staying active

  • Find physical activities that you enjoy, and consider doing them with a friend or family member.
  • Modify your activity schedule, or the activity itself, so that it is safe and manageable for your life.
  • Start slow, and gradually increase your activity. Graded activity is key!
  • Try using a timer or reminder on your phone to get up and move, even for a short walk, if you are sitting for a long time.
  • Plan to have several pain coping strategies​ ready to use during exercise in case your pain increases during an activity.


group of women stretching

Regular exercise is one of the best ways to help relieve most persistent pain problems. Exercise in general is an important part of our lives, as it helps keep us healthy by maintaining the strength of our heart, lungs, bones and muscles. When the body does not move, it can experience more pain from the stiffness of unused joints and muscles.

Having pain can make exercising or being active very difficult. This is especially true when starting a new exercise program. However, we know that taking part in a regular aerobic exercise routine (exercises that increase your heart rate) can reduce pain and improve physical functioning.

The benefits of exercise on pain and function may take some time to see. Often, people who live with persistent pain see improvements in fitness, strength and function before they see changes in pain.

An exercise program can include aerobic training, muscle strengthening or conditioning, balance, stretching or movements to increase flexibility, functional exercises or sports. When considering what type of exercise program to follow, make sure to discuss your options with a physiotherapist first. They can recommend exercises that are tailored to your individual needs. You may need to change your usual physical activities, but the physiotherapist can help you engage safely in activities that you enjoy.

It is important to start a new exercise program slowly and build up gradually over time. This is called graded activity, which you can learn about in the session on physical activty​. The ultimate goal is to make physical activity part of your lifestyle, every day.

What is the evidence?

There is strong evidence that regular exercise has many long-term benefits for people with persistent pain, such as better sleep, improved mood, increased energy, better endurance, reduced muscle tension and less pain.

strong evidence icon

Active hydrotherapy

teen doing hydrotherapy

Active hydrotherapy is a specific form of active therapy in a heated pool. The exercise involves using the water to support your body weight while you exercise. This takes the pressure off your joints while still providing cardio and resistance training.

Exercising in the water can make you more physically comfortable and increase your range of motion. Water also acts as resistance to help strengthen your muscles and improve stability.

What is the evidence?

Hydrotherapy is thought to help relieve pain by increasing blood circulation and reducing muscle spasm. Active hydrotherapy has been shown by current evidence to help reduce pain and improve function, joint mobility, strength and balance.

strong evidence icon


Ayling-Campos, A. (2009). Exercise and physiotherapy for pain management. [Accessed August 25, 2018]

Tyrrell, J. (2009). Chronic pain. [Accessed August 25, 2018]

Last updated: May 2nd 2016