Abstract
Background and aims
There is high level evidence for physical activity (PA) improving outcomes in persistent pain disorders and one of the mechanisms proposed is the effect of exercise on central nociceptive modulation. Although laboratory studies and small field intervention studies suggest associations between physical activity and pain sensitivity, the association of objectively measured, habitual PA and sedentary behaviour (SB) with pain sensitivity requires further investigation. Current evidence suggests PA typically lowers pain sensitivity in people without pain or with single-site pain, whereas PA is frequently associated with an increase in pain sensitivity for those with multisite pain. The aim of this study was to explore the relationships of PA and SB with pain sensitivity measured by pressure pain thresholds and cold pain thresholds, considering the presence of single-site and multisite pain and controlling for potential confounders.
Methods
Participants from the Western Australian Pregnancy Cohort (Raine) Study (n = 714) provided data at age 22-years. PA and SB were measured via accelerometry over a 7-day period. Pain sensitivity was measured using pressure pain threshold (4 sites) and cold pain threshold (wrist). Participants were grouped by number of pain areas into “No pain areas” (n = 438), “Single-site pain” (n = 113) and “Multisite pain” (n = 163) groups. The association of PA and SB variables with pain sensitivity was tested separately within each pain group by multivariable regression, adjusting for potential confounders.
Results
For those with “Single-site pain”, higher levels (>13 min/day) of moderate-vigorous PA in ≥10 min bouts was associated with more pressure pain sensitivity (p = 0.035). Those with “Multisite pain” displayed increased cold pain sensitivity with greater amounts of vigorous PA (p = 0.011). Those with “No pain areas” displayed increased cold pain sensitivity with decreasing breaks from sedentary time (p = 0.046).
Conclusions
This study was a comprehensive investigation of a community-based sample of young adults with “No pain areas”, “Single-site pain” and “Multisite pain” and suggests some associations of measures of PA and SB with pain sensitivity.
Implications
The findings suggest that the pattern of accumulation of PA and SB may be important to inform improved clinical management of musculoskeletal pain disorders. This study provides a baseline for follow-up studies using the Raine Study cohort. Future research should consider temporal influences of PA and SB on pain sensitivity, pain experience and consider using a broader range of pain sensitivity measures.
Acknowledgements
The authors would like to acknowledge the Raine Study Participants and their families for their ongoing contribution to the study and the Raine Study staff for cohort coordination and data collection. The Raine Study has been supported by the National Health and Medical Research Council, with additional funding provided by the University of Western Australia, Raine Medical Research Foundation, Telethon Kids Institute, Curtin University, Edith Cowan University, Women and Infants Research Foundation, Murdoch University and The University of Notre Dame Australia.
Authors’ statements
Research funding: The Raine Study has been funded by National Health and Medical Research Council (NHMRC) project grants 1027449, 1044840 and 1021858. Funding was also generously provided by, SafeWork Australia, University of Western Australia, Raine Medical Research Foundation, Telethon Kids Institute, Curtin University, Edith Cowan University, Women and Infants Research Foundation, Murdoch University and The University of Notre Dame Australia.
Conflicts of interest: There are no actual or potential conflicts of interest for any of the authors.
Informed consent: Informed consent has been obtained from all individuals included in this study
Ethical approval: The research related to human use complies with all the relevant national regulations, institutional policies and was performed in accordance with the tenets of the Helsinki Declaration, Ethics approval for the Raine Study Cohort 22-year follow up was obtained from the University of Western Australia (UWA) (RA/4/1/5202).
Appendix
Multivariable regression models for PPT (kPa) measures with at least 3 valid weekdays and 1 valid weekend day.
| Variable | No pain areas (n=281) | Single-site pain (n=69) | Multisite pain (n=110) | |||
|---|---|---|---|---|---|---|
| Regression coefficient (95% CI)d | p-Value | Regression coefficient (95% CI)d | p-Value | Regression coefficient (95% CI)d | p-Value | |
| Moderate PA (min/day)a,b | ||||||
| Linear term | 4.0 (−36.6, 28.7) | 0.721e | 37.6 (−16.6, 91.9) | 0.091e | −12.2 (−49.2, 4.7) | 0.441e |
| Quadratic term | 0.0 (−3.4, 3.4) | −5.1 (−10.7, 0.5) | 2.1 (−2.2, 6.5) | |||
| Vigorous PA (min/day)a,b | ||||||
| Zero | Ref. | 0.582e | Ref. | 0.527e | Ref. | 0.544e |
| <1.75 min/day | −30.1 (−87.3, 27.1) | 0.302 | −55.3 (−43.1, 153.6) | 0.271 | 38.1 (−30.0, 106.3) | 0.273 |
| ≥1.75 min/day | −21.5 (−80.5, 37.6) | 0.541 | −19.6 (−83.2, 122.4) | 0.709 | 20.7 (−53.7, 95.1) | 0.586 |
| MVPA (min/day)a,b | ||||||
| Linear term | −10.2 (−42.9, 22.5) | 0.560e | 52.5 (−0.5, 105.5) | 0.038e | −7.2 (−44.5, 30.2) | 0.170e |
| Quadratic term | 0.6 (−2.7, 3.9) | −6.5 (−12.0, −1.0) | 1.3 (−3.1, 5.7) | |||
| MVPA in ≥10 min bouts (min/day)a,b | ||||||
| Zero | Ref. | 0.630e | Ref. | 0.084e | Ref. | 0.897e |
| ≤13 min/day | −0.9 (−70.7, 69.1) | 0.980 | 83.1 (−28.4, 194.7) | 0.144 | −12.8 (−60.8, 86.3) | 0.734 |
| >13 min/day | −22.8 (−93.5, 47.9) | 0.527 | −9.7 (−118.3, 98.6) | 0.858 | 19.3 (−62.6, 101.2) | 0.644 |
| Sedentary time per day (min)a,b | −0.6f (−3.4, 2.3) | 0.702 | −1.1f (−4.2, 6.3) | 0.694 | −0.5f (−4.2, 3.1) | 0.770 |
| Sedentary time as percentage of non-MVPA timea,b | −7.7g (−34.0, 18.6) | 0.568 | −2.2g (−43.9, 48.3) | 0.926 | −1.1g (−35.2, 33.1) | 0.951 |
| Sedentary time ≥20 min (min/day)a,b | −1.2f (−4.1, 1.8) | 0.432 | −0.2f (−5.0, 5.5) | 0.928 | −0.9f (−4.9, 3.2) | 0.677 |
| Sedentary time ≥30 min (min/day)a,b | −1.8f (−5.4, 1.7) | 0.315 | 0.4f (−5.4, 6.1) | 0.892 | −1.4f (−6.5, 3.6) | 0.574 |
| Proportion of sedentary time ≥20 min (percent)b | −12.8h (−34.0, 8.4) | 0.237 | 4.3h (−34.2, 42.7) | 0.828 | −9.9h (−39.4, 19.5) | 0.508 |
| Number of breaks from sedentary time/daya,b,c | 2.4i (−14.3, 19.1) | 0.779 | −7.7i (−40.3, 25.0) | 0.645 | −1.8i (−25.1, 21.5) | 0.878 |
aAdjusted for awake wear time; badjusted for number of days of valid wear time; cadjusted for sedentary time per day; dAdjusted for sex, site, waist-hip ratio, SF12-mental component summary; eOverall p-value; fDifference estimate represents the expected change for a 10 min change in sedentary or sitting time; gDifference estimate represents the expected change for a 10% change in sedentary time as % of non-MVPA time; hDifference estimate represents the expected change for a 10% change in proportion of sedentary time ≥20 min; iDifference estimate represents the expected change for 10 breaks in sedentary time; CI=confidence interval; PA=physical activity; MVPA=moderate vigorous physical activity.
Multivariable Tobit regression models for CPT (°C) measures (min 3 valid weekdays, 1 valid weekend day).
| Variable | No pain areas (n=277) | Single-site pain (n=68) | Multisite pain (n=109) | |||
|---|---|---|---|---|---|---|
| Regression coefficient (95% CI)d | p-Value | Regression coefficient (95% CI)d | p-Value | Regression coefficient (95% CI)d | p-Value | |
| Moderate PA (min/day)a,b | ||||||
| Linear term | 0.4 (−0.1, 1.0) | 0.112 | −0.3 (−1.3, 0.7) | 0.548 | −0.1 (−1.0, 0.7) | 0.800 |
| Vigorous PA (min/day)a,b | ||||||
| Zero | Ref. | 0.405e | Ref. | 0.819e | Ref.f | 0.004e |
| <1.75 min/day | 2.4 (−1.1, 5.8) | 0.180 | −0.7 (−7.0, 5.5) | 0.819 | −2.9 (−8.0, 2.2) | 0.267 |
| ≥1.75 min/day | 1.6 (−2.0, 5.1) | 0.394 | −2.0 (−8.5, 4.7) | 0.534 | 6.5 (1.0, 11.9) | 0.020 |
| MVPA (min/day)a,b | ||||||
| Linear term | 0.5 (−0.1, 1.0) | 0.085 | −0.4 (−1.3, 0.6) | 0.451 | 0.0 (−0.8, 0.9) | 0.954 |
| MVPA in ≥10 min bouts (min/day)a,b | ||||||
| Zero | Ref. | 0.364e | Ref. | 0.725e | Ref. | 0.438e |
| ≤13 min/day | 1.5 (−2.9, 5.8) | 0.500 | 1.7 (−5.7, 9.1) | 0.651 | 0.1 (−5.5, 5.7) | 0.962 |
| >13 min/day | 2.9 (−1.5, 7.3) | 0.190 | −0.6 (−7.6, 6.5) | 0.873 | 3.2 (−3.0, 9.3) | 0.306 |
| Sedentary time per day (min)a,b | 0.0g (−0.1, 0.2) | 0.506 | 0.1g (−0.3, 0.4) | 0.764 | 0.0g (−0.3, 0.3) | 0.951 |
| Sedentary time as percentage of non-MVPA timea,b | 0.9h (−0.7, 2.6) | 0.261 | 0.8h (−2.9, 3.0) | 0.956 | −0.1h (−2.6, 2.5) | 0.991 |
| Sedentary time ≥20 min (min/day)a,b | 0.1g (−0.1, 0.3) | 0.176 | 0.0g (−0.2, 0.4) | 0.622 | −0.1g (−0.4, 0.2) | 0.591 |
| Sedentary time ≥30 min (min/day)a,b | 0.2g (−0.1, 0.4) | 0.143 | 0.1g (−0.3, 0.5) | 0.604 | −0.2g (−0.5, 0.2) | 0.427 |
| Proportion of sedentary time ≥20 min (percent)b | 1.0i (−0.3, 2.3) | 0.119 | 1.1i (−1.5, 3.6) | 0.402 | −0.8i (−3.0, 1.5) | 0.494 |
| Number of breaks from sedentary time/daya,b,c | −1.1j (−2.1, −0.1) | 0.032 | −0.3j (−2.4, 1.8) | 0.798 | 0.8j (−0.9, 2.5) | 0.355 |
aAdjusted for awake wear time; badjusted for number of days of valid wear time; cadjusted for sedentary time per day; dadjusted for sex, smoking, SF12-mental component summary; eOverall p-value; fContrast of group 2 vs. 1: 9.3 (3.8, 14.9), p=0.001: gDifference estimate represents the expected change for a 10 min change in sedentary or sitting time; hDifference estimate represents the expected change for a 10% change in sedentary time as % of non-MVPA time; iDifference estimate represents the expected change for a 10% change in proportion of sedentary time ≥20 min; jDifference estimate represents the expected change for an additional 10 breaks in sedentary time; CI=confidence interval; PA=physical activity; MVPA=moderate vigorous physical activity.
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