The Association Between 24-h Physical Behavior Compositions and Persistent Musculoskeletal Pain

Individuals with musculoskeletal pain are generally advised to "be active", "reduce sedentary behavior", and "sleep enough", but such broad recommendations can be challenging to implement in daily life. We identified 24-h physical behavior compositions associated with musculoskeletal pain, using cross-sectional data from 817 participants in the Copenhagen City Heart Study. Daily durations of sedentary behavior, standing, light intensity, and moderate-to-vigorous physical activity during leisure and work, and time in bed were measured using thigh- and hip-worn accelerometers (24 h/day for 7 days) and were used as exposure. The outcome was persistent musculoskeletal pain (past 6 months, pain intensity or activity limitation: ≥ 3 on a 0-10 scale). We used logistic regression models to predict 24-h physical behavior compositions with the 15% lowest and highest probabilities of pain. Persistent musculoskeletal pain was reported by 40%. Individuals with a low and high probability of persistent musculoskeletal pain had distinct 24-h physical behavior compositions compared to the mean 24-h composition of the study population. Individuals with a low probability of pain had less leisure time sedentary behavior and time in bed but more sedentary behavior during work ("sweet spot" composition). Those with a high probability of pain had more leisure time sedentary behavior and time in bed but were less sedentary and more active during work ("sour spot" composition). In conclusion, these results can inform the development of actionable domain-specific 24-h physical behavior guidelines for individuals with musculoskeletal pain and aid in developing targeted interventions to improve musculoskeletal health, but we acknowledge the risk of reversed causality.