Application Of Positive Reinforcement To Increase Exercise To Reduce Chronic Pain
Abstract
A self-control program was developed to increase my weekly exercise schedule from 0 to 5 times a week for 50 minutes daily. I am a 26-year-old female with a medical condition where I am required to keep my strength and muscles built with a low weight to reduce pain and further complications for my ability to walk. The frequency of my weekly workout was measured for two weeks without any interference in order to achieve my goals. A hypothesis was made that by executing positive reinforcement the goals set would enable me to be pain free and gain more strength which I had lost since I have not been doing exercises regularly. Results indicated that positive reinforcement was successful in increasing my weekly exercises in order to diminish my pain and increase my strength while maintaining my weight.
Introduction
There are various people around the globe who suffer from chronic pain. Some of these are due to medical conditions and would require a lot of support in managing pain so individuals will be able to stay fit and pain free. Some of these pains are dealt with medications while others are through exercises and keeping fit. An important goal in rehabilitation of patients with chronic pain is for the individual to have an increased level of physical activity and normalisation of activities of the daily living. It has been seen that for years, the choice of treatment for chronic pain had been rest and inactivity. However, exercising the body has specific and great benefits in the reduction of chronic pain. It also has other general benefits for improved physical and mental health, and physical functioning. Physical activities and exercise programs are highly promoted activities offered in various healthcare systems and for a variety of chronic pain conditions. Building a programme for exercise is not difficult but implementing this in the daily life takes effort. The short-term consequences of exercises are negative for example it takes up your time, shower is required afterwards and you feel sore once you start the programme
One of the ways to achieve this is through methods of positive reinforcement, first described by Skinner (1953) it is the addition of a pleasant or desirable stimulus to increase a specified behaviour. Skinner (1953) argues that such a program needs to employ positive reinforcers presented as closely as possible following the required behaviour. Exercise done was recorded for a period of two week without any intervention in order to determine a more realistic and achievable goal for the self-controlled programme. Positive reinforcement was established once the daily goal had been reached. The reinforces which we used was a cheat meal at the end of the week with my favourite dessert and a shopping spree if I continue to upheld my exercise programme. Also I included a reward daily as well which was to have a carbohydrate food in my meal if I performed my exercise for a full 50 minutes. As mentioned by Skinner (1953) the reinforcers chosen should be effective in modifying the behaviour, therefore my chosen reinforces were rewarding for me. The aim of this programme is to follow my daily schedule to go to gym in order to gain strength and have a reduction in my chronic pain and maintain my weight so my ability to walk will not be affected. It was hypothesised that by using positive reinforcement, my goals was to performe my exercise for 50 minutes in order to reduce chronic pain level which will decrease significantly with the continuation of my programme.
Method
I was the subject of the self-control program, a 26-year-old Indo-Fijian female university student who had a car accident five years back with fractures to the spine. After five years , I still suffer from chronic pain in the lower back. Therefore exercises and strengthening of muscles keeps my pain level down. Since I had stopped working out I decided this would be an opportunity for me to get me back into something which was beneficial to me. Therefore, with the use of positive reinforcement I decided to put a programme for myself. I decided to firstly arrange my weekly schedule and write up reminders of my daily activity using my smart phone device. It was an easy and inexpensive method for me to utilise. I wrote a week’s plan on my smart phone using the APP called ‘note’ with my daily activities and the days I would be heading off to the gym to do my strengthening workouts. My first week’s programme was recorded from Monday. As soon as I completed my first day I would tick and check the progression of the activity I did. The entire activity was then repeated again for the following week and noted on my smart phone device for two consecutive weeks. For my exercise programme I began the baseline condition on a Monday doing a 30 minute of strengthening exercise contain 15 minutes of cardio and 15 minutes of weights for my lower body. Second day I would start with the 15minute cardio and then my upper body, but I would exercise for 40-minute and slowly by the end of week one I built up my tendency to work out for at least 50 minutes. The following week I did manage to exercise five times for 50 minutes.
When the baseline had been in operation for a week, I implemented my program. During the program whenever I went out for my training, I would put on my music with high beats so it will keep me motivated and going. I would only listen to songs which are fast playing only when I am training but not in my car. I also started to eat healthier and since I completed my base week as I had mentioned I rewarded myself with a cheat meal and I planned to do this cheat meals every time I reach my goal. I also allowed myself the day I do my exercise for 50 minutes I would eat at least one carbohydrate for my meal as rest of days the food I consume would be high in protein and fruits and vegetables. Therefore, positive reinforcement was received each day of the program week with one meal with a carbohydrate diet, and a cheat meal at the end of the week and a reward to go on a shopping spree after two weeks once I achieved my target and have my rythm in place.
Results
The graph below shows my daily exercise time in minutes. I used my smart phone to tract how long I did my exercises for. The left-hand panel of graph shows the steps recorded during the baseline week. During the initial days of the baseline, I started with a 30 minute workout programme and then it gradually increased to my desired amount of time I require to do my exercise. The right-hand panel graph shows the amount of time in minutes taken to perform my task.
Discussion
Examining the baseline period, my physical activity for physical pain relieve and strengthening gradually improved in time as well as my workout time from 30 minute to 50 minutes. I had a slow start where on my first day back doing exercise, It lasted for only 30 minutes but I gradually improved. Moving onwards the days which I have lower minutes then fifty is because I had been tired from my work so I did not keep up with my time. I already have a job as a nurse which kept me on my feet so theses day where I did not try to keep up was when I was exhausted with work load. The use of my over ear head phones to listening to fast beat songs would always motivate me to keep going and it felt like I had great energy throughout these period. Furthermore, Costas, I. Karageorghis & Priest, D, L., (2012) claim that in accordance to the available evidence, music captures attention, raises spirits, triggers a range of emotions, alters or regulates mood, evokes memories, increases work output, heightens arousal, induces states of higher functioning, reduces inhibitions and encourages rhythmic movement.
However the amount of exercise was only greater than during the baseline period on some days and not on others. Thus, the daily rewarding in positive reinforcement strategy and the absence of any punishing consequences increased my daily activity of deliberate exercise as predicted by Skinner (1953). However, the amount of deliberate exercise I engaged in greatly depended on the other activities competing for my time. It all came back to positive reinforcement which enabled me to remember to carry out my daily goal and be content and focussed. Within the amount of time of my activity I became pain free and gained strength and started to function more better and felt good. Hence t is a clear indication that the results of the study supports my original hypotheses.
To conclude positive reinforcement methods are provided to be highly successful in increasing behaviour as mentioned by Skinnier, (1953) to give vital importance to the reinforcers used that individuals find desirable. Therefore, cheat meal with all the sugars and a shopping spree for clothing and a meal with carbohydrates will not be suitable for all individuals.
References
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