People are advised not to begin an exercise program without first consulting a physician or other expert. This is especially true of people suffering from pain, as it is crucial to design a program that helps relieve a patient’s pain and is safe enough to prevent additional injury.

A physician may want to review the medical history, perform a physical examination and possibly conduct blood tests, an exercise stress test or other diagnostic tests before clearing a patient for exercise.

In addition, people with certain conditions may need precautionary exercise routines that take into account their condition, such as:

• High blood pressure (greater than 160/100 mm Hg)
  
  
• Diabetes or disease of the heart, lung or kidneys

• Family history of cardiovascular problems before the age of 55
  
  
• Previous exercise symptoms that include chest pain, shortness of breath or dizziness
  

Exercise routines often include a flexibility component, a cardiovascular component and a strength-training component. Flexibility exercises typically involve various stretching techniques. Cardiovascular exercise includes activities such as running, aerobics, biking, swimming or sports activities that allow the patient to strengthen the heart and lungs. Strength-training exercises allow patients to improve muscle strength and tone and to increase flexibility. They usually involve use of free weights or resistance machines.

Aside from a physician, other experts who can help design an appropriate exercise program include:

• Physical therapist (PT). These experts are trained and licensed in ways to use exercise and other treatments to achieve physical health. Physical therapists can help choose the most appropriate exercises to address a patient’s particular type of pain. They often have certain specialties, such as pediatrics, orthopedics, sports medicine or rehabilitation.
  
  
• Occupational therapist. These therapists help teach patients to perform daily tasks in ways that will not aggravate injuries or place extra stress on the joints.

PTs and OTs hold college degrees, have completed internships and have received certification from their national organization. In physical therapy and occupational therapy, exercise or other physical activity often follows use of modalities (physical agents) such as thermotherapy, ultrasound therapy, hydrotherapy or electrical therapy. These modalities help maximize the joints’ range of motion and function.

• Exercise therapist. Most commonly known as a personal trainer, these are experts trained in helping people to exercise safely and effectively. Most health clubs have trainers available to help club members design and execute an exercise program.
  
  

  There is a wide range of exercise therapists, such as certified personal trainer, certified exercise therapist, certified athletic trainer or exercise physiologist. Depending on the designation, qualifications can range from a home study course to an advanced university degree. Certifications are available through a range of organizations, such as American College of Sports Medicine, National Athletic Trainers Association, American Council on Exercise, National Exercise Therapy Association or National Federation of Personal Trainers. Patients are advised to ask about an exercise therapist’s qualifications and experience.

Exercise may also be part of complementary and alternative pain management such as chiropractic or other manipulation therapy.