The leisure time and occupational physical activity paradox in persistent musculoskeletal pain

Leisure time and occupational physical activity (LTPA, OPA) seem to have opposite associations with some health outcomes. Few studies have investigated this for musculoskeletal pain. We investigated the association between (1) LTPA and OPA, and (2) combinations thereof, and persistent pain and number of pain sites, respectively, among adults. We used cross-sectional data from the Copenhagen City Heart Study. LTPA and OPA was measured using the Saltin-Grimby Physical Activity Level Scale. The outcomes were persistent pain and number of pain sites (past six months). Using hurdle models, the association between physical activity and the outcomes was expressed as odds ratios (OR) and incidence rate ratios. We included 2787 individuals. High LTPA was associated with decreased odds of persistent pain and lower number of pain sites, whereas high OPA was associated with increased odds of persistent pain and higher number of pain sites (e.g., high LTPA vs. inactive, OR: 0.38, 95% confidence interval [CI]: 0.26, 0.57; high OPA vs. sedentary work, OR: 2.94, 95% CI 1.66, 5.20). All LTPA-OPA-combinations indicated higher odds for persistent pain and higher number of pain sites when compared to moderate-to-high LTPA and sedentary work. This study highlights that not all physical activity may be beneficial.