Q. My doctor tells me that I should exercise to improve the symptoms of fibromyalgia and rheumatoid arthritis. But I’m afraid to because it hurts. So I don’t know what to do.

A. Some illnesses, especially those that involve joint pain or overall fatigue, such as arthritis and fibromyalgia, present a chicken-egg scenario: You know you should exercise because it can strengthen your body—and if you don’t your body will weaken and the effects of the condition may make the pain and fatigue worse. On the other hand, exercising to improve the health and strength of your body is so painful or tiring it’s easier not to do it.

Humans are hardwired to avoid pain. So it’s not surprising that many people with these types of painful conditions opt out of pushing through the pain to stay active. . While various surveys show that around one-quarter of all adults are inactive, those with a painful joint conditions are, not surprisingly, more so. A 2003 study in the journal Arthritis & Rheumatism found that around 31% of US adults with arthritis were inactive, and more than one-third of women, adults over 45 years old and those whose were obese were inactive.

Avoid Avoiding Pain

But bodies are also meant to move. And when a body moves less, physical systems weaken: The heart doesn’t pump as efficiently, lung capacity and the ability to use oxygen you breathe declines, muscles weaken which allows more stress load on joints, and fat- and weight- gain are likely to occur. Plus, it is common for people with conditions like arthritis and fibromyalgia to have other illness such as heart disease, diabetes or hypertension—which do benefit from regular exercise. So, generally, the medical consensus on most medical conditions is that it is important to stay physically active. If you are afraid to move because you’re afraid to or don’t want to hurt yourself, you may need to address the psychological aspects of your fear of discomfort.

Push Through Pain?

But that doesn’t mean that you should force yourself to move through searing pain. In contrast to the “pain-avoiders” there are some people known as “pain-persisters”. They stick to activities that may be too stressful and that may exacerbate chronic pain. There is a fine line between giving yourself a manageable dose of exercise stress in order to improve physiological systems, but not so much that the body is overloaded and the physical activity is more than the body can handle.

How Much Effort Is The Appropriate Amount?

The level of effort that someone with chronic pain or fatigue can handle will vary from person to person, and probably even from moment to moment. In some cases, even a very small amount of effort may be enough to do some good: More research is showing, not only the benefits of bonafide “exercise”, but the benefits of simply being less inactive. Being less inactive means sitting less during the day and evening, regardless of how much “exercise” is performed. I wrote about this in a recent column: Excessive sitting can worsen cholesterol levels and lead to unhealthy fats accumulating around the internal organs. Simply standing move and doing easy tasks around the home and office can prevent some of the atrophy that occurs with an overly-sedentary lifestyle.

What this means is that no matter how much pain you are in at any given time—and with many of these conditions the pain and fatigue waxes and wanes—there is likely something that you can do to stay at least minimally active. So even if you skip a workout on some days, you can still benefit from just sitting less. It is absolutely true that for good health some movement, no matter how easy, is always better than none.

If your problem is not staying active, but avoiding overdoing it, it can be helpful for you to realize that you can take it easier and still reap the benefits of movement.

A 2010 randomized clinical trial published in the journal Arthritis Care & Research tailored a two-month treatment plan for fibromyalgia sufferers according to whether they tended to avoid the pain of exercise, or whether they persisted through perhaps excessive activity. The individually-tailored plans focused on both short-term and long-term physical and psychological aspects of being active and the patients showed improvements in physical functioning even six months after the intervention ended. Although the participants in this study were monitored and counseled by trained psychotherapists and physical therapists, there are take-home messages for you who exercise on your own (or are thinking about it).