Reallocating time spent in sleep, sedentary behavior and physical activity and its association with pain: a pilot sleep study from the Osteoarthritis Initiative

Associations between life's essential 8 and arthritis among adults in United States: a national-wide longitudinal study

BACKGROUND

Arthritis, a common condition in the U.S., is caused by autoimmune reactions, osteoarticular injuries, and uric acid deposition. It affects around 25% of adults and is strongly linked to cardiovascular disease. The American Heart Association's Life's Essential 8 (LE8) composite, which considers cardiovascular health factors, has been studied for its predictive capacity in assessing arthritis risk. The study aims to provide tailored prevention recommendations and monitor factors associated with arthritis within the LE8 framework specifically for arthritic individuals.

METHODS

This population-based study used data from the U.S. NHANES (2017-2020) for adults aged 20 + . Multivariate logistic and restricted cubic spline modeling explored the relationship between LE8 and arthritis, revealing significant nonlinearity (P < 0.001). Gradient Boosting Decision Trees were employed to conduct a predictive model of Arthritis risk.

RESULTS

Through study, we found that idealer LE8 scores correlated with poorer arthritis risk. Subgroup analyses ideallighted poorer scores for smoking (P < 0.002, poor_socre and intermediate_score) and physical activity(P = 0.001, poor_score) as significant risk factors. Gradient Boosting Decision Trees predicted disease risk, with age, HDL cholesterol, and blood pressure identified as the three most significant predictive factors.

CONCLUSION

The LE8 score in U.S. adults shows a negative association with arthritis outcomes, with arthritis prevalence decreasing as the score increases. poorer Smoke and Physical Exercise Time components and intermediate Blood Glucose scores may be arthritis risk factors. The LE8 may help identify arthritis risk early and reduce its burden.

Moderate-To-Vigorous Physical Activity Independent of Stationary Time Is Associated With Better Functional Outcomes Over Four-Years in Individuals With or at Risk of Knee Osteoarthritis

INTRODUCTION

Osteoarthritis is a progressive joint disease that causes pain and disability, impairing physical function. Moderate-to-vigorous physical activity (MVPA) is recommended for knee osteoarthritis, while stationary time, independent of activity, may negatively impact health outcomes. We hypothesised that individuals with the highest MVPA and lowest stationary time would have better long-term function compared to those with the lowest MVPA and highest stationary time, as well as those with high levels of both MVPA and stationary time.

METHODS

Data included 442 participants, with an average age of 66-years and 190-females from the Osteoarthritis Initiative who wore accelerometers to assess MVPA and stationary time. Participants were grouped into tertiles of MVPA and stationary time normalised to total accelerometer wear time. The three groups were: highest activity, lowest stationary (HALS), highest activity, highest stationary (HAHS), and lowest activity, highest stationary (LAHS). Gait speed, the 400 m walk test, and five-time repeated chair stand were assessed at baseline and four-year follow-up.

RESULTS

Compared to the LAHS group, the HALS and HAHS groups had better performance in gait speed p < 0.001, d = 0.96-1.06, 400m walk time p < 0.001, d = 1.21-1.36, and five-time repeated chair stand p < 0.001, d = 0.54-0.81 at baseline and four-year follow-up. No differences were found between the HALS and HAHS groups at either timepoint.

CONCLUSION

Higher levels of MVPA were associated with better lower-limb functional outcomes in individuals with or at risk of knee osteoarthritis. Higher levels of stationary time do not negatively influence functional performance as long as higher numbers of MVPA levels (∼30 min/day) are achieved.

Social determinants of health and youth chronic pain

OBJECTIVES

To identify the relationships between social determinants of health (SDOH) and chronic pain among U.S. youth (referring to children and adolescents).

METHODS

Data including a national sample of U.S. youth were retrieved from the 2022 National Survey of Children's Health. Twenty indicators within five SDOH-related domains (e.i., economic stability, social and community context, neighborhood and built environment, health care access and quality, and education access and quality) were included. The presence of chronic pain was assessed using a self-reported question, answered by the main caregiver. Associations of SDOH-related indicators and youth chronic pain were estimated using multi-variable logistic regression models, while adjusting for covariates (e.g., age, sex, ethnicity, weight status, and movement behaviors).

RESULTS

Data from 30,287 U S. youth aged 6-17 years (median [SD] age, 11.59 [3.30] years; 14,582 girls [48.97 %]) were collected. In 7.5 % of the final sample size, caregivers reported that they had chronic pain. Youth grow up in conditions with diverse SDOH profiles, including food insufficiency (OR = 1.46, 95 % CI: 1.01 to 2.10) and parental unemployment (OR = 1.56, 95 % CI: 1.15 to 2.12); low school engagement (OR = 1.48, 95 % CI: 1.14 to 1.92) and low school safety (OR = 1.65, 95 % CI: 1.14 to 2.39); limited access to quality health care (OR = 2.56, 95 % CI: 2.12 to 3.09), a high frequency of hospital visits (OR = 4.76, 95 % CI: 1.82 to 12.44), and alternative health care (OR = 2.57, 95 % CI: 2.07 to 3.20); bullying victimization (OR = 1.37, 95 % CI: 1.11 to 1.68) and community-based adverse childhood experiences (OR = 1.64, 95 % CI: 1.32 to 2.05); and disadvantageous amenity characteristics (OR = 1.38, 95 % CI: 1.05 to 1.79); resulted in higher odds of presenting chronic pain.

CONCLUSIONS

Different indicators included in the SDOH domains were associated with a higher probability of presenting chronic pain in U.S youth. These findings have implied relationships between the SDOH and chronic pain in youth, requiring a comprehensive approach to addressing health equity to prevent and reduce the presence of youth chronic pain.

Pain catastrophizing in rheumatic diseases: prevalence, origin, and implications

Pain is a crucial factor in rheumatic disorders, and reducing it is a primary goal of successful treatment. Adaptive pain-coping strategies can enhance this improvement, but maladaptive approaches such as pain catastrophizing may worsen overall patient well-being. This narrative review aims to provide a concise overview of the existing knowledge on pain catastrophizing in the most prevalent specific rheumatic disorders. The objective of this study was to improve understanding of this phenomenon and its implications, as well as to pinpoint potential directions for future research. We conducted searches in the MEDLINE/PubMed, SCOPUS, and DOAJ bibliography databases to identify articles related to pain catastrophizing in rheumatoid arthritis, psoriatic arthritis, axial spondylarthritis, systemic sclerosis, systemic lupus erythematosus, Sjögren's syndrome, juvenile idiopathic arthritis, and osteoarthritis (non-surgical treatment). Data extraction was performed on November 1, 2023. The investigators screened the identified articles to determine their relevance and whether they met the inclusion criteria. Following a bibliography search, which was further expanded by screening of citations and references, we included 156 records in the current review. The full-text analysis centred on pain catastrophizing, encompassing its prevalence, pathogenesis, and impact. The review established the role of catastrophizing in amplifying pain and diminishing various aspects of general well-being. Also, potential treatment approaches were discussed and summarised across the examined disorders. Pain catastrophizing is as a significant factor in rheumatic disorders. Its impact warrants further exploration through prospective controlled trials to enhance global patient outcomes.

Has the COVID 19 Pandemic Impacted the Management of Chronic Musculoskeletal Pain?

PURPOSE OF REVIEW

The COVID-19 pandemic has affected the management of chronic musculoskeletal pain; however, the extent of its impact has not been established. We conducted a comprehensive review of the pandemic's impact on clinical outcomes and healthcare accessibility for osteoarthritis (OA), rheumatoid arthritis (RA), fibromyalgia (FM), lower back pain (LBP), and other musculoskeletal disorders and chronic pain syndromes to better inform clinical decision-making.

RECENT FINDINGS

We examined 30 studies (n = 18,810) from 36 countries investigating the impact of the COVID-19 pandemic on chronic musculoskeletal pain outcomes. The available evidence suggests that the pandemic significantly impacted pain levels, mental health, quality of life and healthcare accessibility in patients with chronic musculoskeletal pain. Of 30 studies, 25 (83%) reported symptom worsening, and 20 (67%) reported reduced healthcare accessibility. Patients were unable to access necessary care services during the pandemic, including orthopedic surgeries, medications, and complementary therapies, leading to worsened pain, psychological health, and quality of life. Across conditions, vulnerable patients reported high pain catastrophizing, psychological stress, and low physical activity related to social isolation. Notably, positive coping strategies, regular physical activity, and social support were associated with positive health outcomes. Most patients with chronic musculoskeletal pain had greatly affected pain severity, physical function, and quality of life during the COVID-19 pandemic. Moreover, the pandemic significantly impacted treatment accessibility, preventing necessary therapies. These findings support further prioritization of chronic musculoskeletal pain patient care.

Osteoarthritis is positively associated with self-reported sleep trouble in older adults

BACKGROUND

Osteoarthritis (OA) is a leading cause of disability in older adults. Most research has focused on minimizing pain and maximizing physical function so as to maintain patient mobility preceding joint arthroplasty. However, few studies have formally studied the relationship between OA and sleep trouble, although it is clinically recognized that OA may affect sleep.

METHODS

The study was based on the National Health and Nutrition Examination Survey (NHANES) database from 2011-2018. Participants were defined as adults aged 60 years or older with diagnoses of OA and self-reported sleep trouble. Multivariable regression analyses were applied to assess the association between OA and sleep trouble, adjusting for age, sex, body mass index, race/ethnicity, education level, marital status, income, depression level, etc. RESULTS: This study included 4154 participants, consisting of the control group (n = 2966) and the OA group (n = 1188). OA individuals were 2.11 (95% CI 1.79-2.47, p < 0.001) times more likely to have sleep trouble compared with those without OA. On subgroup analyses, there was lower odds ratio value of sleep trouble in men compared with women, and in the highest income group compared with the other income groups.

CONCLUSIONS

OA was positively associated with sleep trouble in older adults, with different odds ratio values among different subgroups. Our results suggest that older adults with OA should be aggressively screened for sleep problems.

Reallocating Time Spent in Physical Activity, Sedentary Behavior and Its Association with Fear of Falling: Isotemporal Substitution Model

The aim of the current study was to provide new evidence for the associations between physical activity (PA), sedentary behavior (SB), and fear of falling (FOF) by investigating the impact of replacing 30 min SB with both light-intensity PA (LPA) and moderate-to-vigorous PA (MVPA) on FOF in older Chinese women. Cross-sectional data from a Physical Activity and Health in Older Women Study (PAHIOWS) were analyzed for 1114 Chinese community-dwelling older women. Variables of focus were demographics, FOF, objectively measured PA and SB. Three different logistic models were used to examine the associations between PA, SB, and FOF (a single parameter model, a partition model and an isotemporal substitution). The results showed that reallocating 30 min/day of MVPA by SB was significantly associated with higher FOF (OR = 1.37; 95%CI: 1.04−1.79; p = 0.024), reallocating 30 min/day of SB by MVPA was significantly associated with a reduction of FOF (OR = 0.73; 95%CI: 0.56−0.96; p = 0.024). No significant associations were found between FOF with reallocating other activities by LPA and vice versa (p > 0.05). Subgroup analysis showed the isotemporal-substituted effects of MVPA and SB on FOF were stronger in older women with fall experience. In conclusion, the current findings showed that the increase of MVPA engagement and reduction of SB engagement may be most beneficial for FOF management and should be involved in public health guidelines, especially for older women with fall experience.

Accelerometer-Based Physical Activity Patterns and Associations With Outcomes Among Individuals With Osteoarthritis

BACKGROUND

This study examined patterns of physical activity and associations with pain, function, fatigue, and sleep disturbance among individuals with knee or hip osteoarthritis.

METHODS

Participants (n = 54) were enrolled in a telephone-based physical activity coaching intervention trial; all data were collected at baseline. Self-reported measures of pain and function (WOMAC [Western Ontario and McMaster Universities Osteoarthritis Index] subscales), fatigue (10-point numeric rating scale), and PROMIS (Patient-Reported Outcomes Information System) Sleep Disturbance were collected via telephone. Accelerometers were mailed to participants and were worn for at least 3 days. Proportion of time participants spent in sedentary behavior during the morning (from wake until 12:00 pm), afternoon (12:00 pm until 5:59 pm) and evening (6:00 pm until sleep) each day was averaged across all days of wear. Pearson correlations assessed associations between activity and self-reported measures.

RESULTS

Participants spent a large proportion of time in sedentary behavior: 65.6% of mornings, 70.0% of afternoons, and 76.6% of evenings. Associations between proportion of time spent in sedentary behavior and reported outcomes were generally strongest in the afternoon, strongest for WOMAC function, and lowest for PROMIS Sleep Disturbance. In the evening hours, sedentary time was most strongly associated with fatigue.

CONCLUSIONS

Overall, findings stress the importance of reducing sedentary behavior among adults with osteoarthritis and suggest behavioral interventions may be strengthened by considering patients' within-day variation in symptoms and activity.

The profile of musculoskeletal pain and its associations with sleep quality and depression during the COVID-19 in Turkey

Background

The current pandemic has affected people’s health multidimensionally. This study aims to investigate musculoskeletal pain, sleep quality, depression levels, and their relationships in individuals belonging to different age groups during COVID-19 in Turkey.

Methods

A web-based self-administered survey that consisted of demographic questions, The Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI), and scores of musculoskeletal pain was sent to participants. Pearson correlation analysis was used for determining the statistical relationship between variables.

Results

The study includes 1,778 participants. The highest percentage for mild, moderate, and severe pain was in the head (49.8%), back (15.5%), and head (11.5%), respectively. The PSQI-total had shown a weak correlation with pain levels in all body parts. The highest correlation for sleep quality and pain levels was between the PSQI-5 and lower back pain. There was a weak correlation between PSQI-2 and the BDI score, and a moderate correlation between the PSQI-1, PSQI-5, PSQI-7, PSQI-total, and BDI score. Pain in all body parts showed a weak correlation with depression level.

Conclusions

This study showed that musculoskeletal pain was varied in body parts with different intensities according to age groups in Turkey during the pandemic. The most common pain was in the head, back, and lower back. Headache was found correlated with the parameters of sleep quality. Pain of the head, neck, back, lower back, and shoulder were correlated with sleep latency. Sleep quality was associated with depression and musculoskeletal pain, while musculoskeletal pain was correlated with depression.

Linking physical activity with clinical, functional, and structural outcomes: an evidence map using the Osteoarthritis Initiative

Physical activity is consistently recommended across clinical practice guidelines for managing knee osteoarthritis, yet prescription rates are low. Evidence mapping uses a systematic approach to visually illustrate and summarize published evidence, highlight gaps in the literature, and formulate research questions. The purpose of this study was to review and summarize evidence published from the Osteoarthritis Initiative (OAI) linking physical activity with clinical, functional, and structural knee osteoarthritis outcomes. Electronic databases were searched until June 2021. Studies from the OAI reporting subjective (Physical Activity Scale for the Elderly, PASE) or objective (accelerometry) physical activity data were included. Scatter plots were created to represent each outcome group (clinical, functional, structural) and physical activity measure (PASE, accelerometry) to map the evidence by the directional effect (positive, interaction, negative, or no effect) associated with physical activity. Forty-two articles were included in this review. Physical activity was quantified using PASE (n = 21), accelerometry (n = 20), or both (n = 1). Studies reported consistently positive physical activity effects on clinical (n = 22) and functional (n = 20) outcomes, with few exceptions. Structural (n = 15) outcomes were largely reported as interaction effects by physical activity intensity or sex, or as no significant effect. A network of interconnected outcomes emerged, with clinical and functional outcomes often reported together, and structural outcomes reported individually. This study provides an overview of current evidence linking physical activity to multiple interrelated knee osteoarthritis outcomes using an OAI-driven model. These evidence maps can be used as a framework to guide future investigations of the effects of physical activity on knee osteoarthritis.

Daily Walking and the Risk of Knee Replacement Over 5 Years Among Adults With Advanced Knee Osteoarthritis in the United States

OBJECTIVE

To examine the association of the volume and intensity of daily walking at baseline with the risk of knee replacement (KR) over 5 years in adults with advanced structural knee osteoarthritis.

DESIGN

Prospective, longitudinal, and multicenter observational study.

SETTING

Osteoarthritis Initiative study with follow-up from 2008-2015.

PARTICIPANTS

Community-dwelling adults with or at risk of knee osteoarthritis were recruited from 4 sites in the United States (N=516; mean age, 67.7±8.6y; body mass index, 29.3±4.7 kg/m2; 52% female). We included participants with advanced structural disease, without KR and had valid daily walking data (quantified using Actigraph GT1M), at baseline.

INTERVENTIONS

Not applicable.

MAIN OUTCOMES

KR. Walking volume was measured as steps/day and intensity as minutes/day spent not walking (0 steps/min) and walking at very light (1-49 steps/min), light (50-100 steps/min), or moderate (>100 steps/min) intensities. To examine the relationship of walking volume and intensity with the risk of KR, we calculated hazard ratios (HRs) and 95% confidence intervals (CIs) adjusting for covariates.

RESULTS

Of 516 adults with advanced structural disease, 88 received a KR over 5 years (17%). Walking an additional 1000 steps/d was not associated with the risk of KR (adjusted HR=0.95; 95% CI, 0.84-1.04). Statistically, replacing 10 min/d of very light and light walking with 10 min/d of moderate walking reduced the risk of KR incidence by 35% and 37%, respectively (adjusted HR=0.65, 95% CI, 0.45-0.94, for very light and adjusted HR=0.63; 95% CI, 0.40-1.00, for light).

CONCLUSIONS

Daily walking volume and intensity did not increase KR risk over 5 years and may be protective in some cases in adults with advanced structural knee osteoarthritis.

Joint Association of Moderate-to-vigorous Intensity Physical Activity and Sedentary Behavior With Incident Functional Limitation: Data From the Osteoarthritis Initiative

OBJECTIVE

To examine the joint association of moderate-to-vigorous intensity physical activity (MVPA) and sedentary behavior with the risk of developing functional limitation 4 years later in adults with knee osteoarthritis (OA).

METHODS

Using 48-month (baseline) accelerometry data from the Osteoarthritis Initiative, we classified participants as Active-Low Sedentary (≥ 1 10-min bout/week of MVPA, lowest tertile for standardized sedentary time), Active-High Sedentary (≥ 1 10-min bout/week of MVPA, top 2 tertiles for standardized sedentary time), Inactive-Low Sedentary (zero 10-min bouts/week of MVPA, lowest tertile for standardized sedentary time), and Inactive-High Sedentary (zero 10-minute bouts/week of MVPA, top 2 tertiles for standardized sedentary time) groups. Functional limitation was defined as > 12 seconds for the 5-repetition sit-to-stand test (5XSST) and < 1.22 m/s gait speed during the 20-meter walk test. To investigate the association of exposure groups with risk of developing functional limitation 4 years later, we calculated adjusted risk ratios (aRR; adjusted for potential confounders).

RESULTS

Of 1091 and 1133 participants without baseline functional limitation, based on the 5XSST and 20-meter walk test, respectively, 15% and 21% developed functional limitation 4 years later. The Inactive-Low Sedentary and Inactive-High Sedentary groups had increased risk of developing functional limitations compared to the Active-Low Sedentary and Active-High Sedentary groups. The Inactive-Low Sedentary group had 72% (aRR 1.72, 95% CI 1.00-2.94) and 52% (aRR 1.52, 95% CI 1.03-2.25) more risk of developing functional limitation based on the 5XSST and 20-meter walk test, respectively, compared to the Active-Low Sedentary group.

CONCLUSION

Regardless of sedentary category, being inactive (zero 10-min bouts/week in MVPA) may increase the risk of developing functional limitation in adults with knee OA.

The relationship between restless sleep and symptoms of the knee: data from the Osteoarthritis Initiative

OBJECTIVE

To examine the associations between restless sleep and knee symptoms among individuals with radiographically confirmed KOA.

METHODS

Cross-sectional and longitudinal associations were examined using Osteoarthritis Initiative (OAI) data. Participants with radiographic KOA (n = 2517) were asked how often sleep was restless in the past week over the 4 years, and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) was used to measure knee symptoms. Adjusted β coefficients (aβ) and 95% confidence intervals (CI) were derived from generalized estimating equations (GEEs) models stratified by sex.

RESULTS

One in 7 participants reported ≥ 3 nights with restless sleep. Cross-sectional analyses indicated that restless sleep 5-7 nights was associated with worse symptoms (Women: pain: aβ 1.93, 95% CI 1.12-2.74, stiffness: aβ 0.57, 95% CI 0.19-0.94, physical function: aβ 5.68, 95% CI 3.09-8.27; Men: pain: aβ = 1.85, 95% CI 0.85-2.86; stiffness: aβ 0.63, 95% CI 0.15-1.12; physical function: aβ 5.89, 95% CI 2.68-9.09) compared with < 1 night. Longitudinal analyses confirmed that more nights with restless sleep were associated with worse pain (P trend = 0.01) and function (P trend = 0.04) in women and physical function in men (P trend = 0.04), although estimates did not meet thresholds for minimal clinically meaningful differences.

CONCLUSION

While the analysis of cross-sectional data supported the association between restless sleep and KOA symptoms, such relationships were not confirmed in more robust longitudinal analysis. Further research examining whether sleep quality, duration, or disorders is associated with worsening symptoms in persons with KOA is warranted. Key Points • The prevalence of frequent restless sleep among persons with knee OA is not uncommon. • There were linear trends between frequency of restless sleep and self-reported symptoms of the knee in cross-sectional analyses. • In the more robust longitudinal analysis, despite the statistically significant linear trends observed between frequency of restless sleep and symptoms (women: pain and physical function; men: function), none appeared to reach the a priori selected ranges for minimally clinically relevant differences.

Musculoskeletal Pain and Teleworking in Times of the COVID-19: Analysis of the Impact on the Workers at Two Spanish Universities

The special situation brought about by the coronavirus pandemic and the confinement imposed by the Government, has given rise to numerous changes in working habits. The workers at the universities have had to start a period of teleworking that could give rise to consequences for the musculoskeletal system. The objective of this article is to analyze the impact of the confinement on the musculoskeletal health of the staff of two Spanish universities. A cross-sectional, observational study was carried out on the workers. Data was taken in April-May 2020 and included: The Standardized Kuorinka Modified Nordic Questionnaire, the Perceived Stress Scale and another one on sociodemographic data. This study comprised 472 people. The areas of pain noted during the confinement period concluded that it was less in all cases (p < 0.001). The frequency of physical activity carried out increased significantly during the period of confinement (p < 0.04), especially in women. The type of physical activity done was also seen to modify during this period (p < 0.001), with a preference for strength training and stretching exercises. In conclusion, the confinement gave rise to changes in the lifestyle and in the musculoskeletal pain of the workers at the universities. All of this must be taken into account by health institutions and those responsible for the Prevention of Occupational Risks at Spanish universities.

Musculoskeletal Pain and Non-Classroom Teaching in Times of the COVID-19 Pandemic: Analysis of the Impact on Students from Two Spanish Universities

The lockdown, due to the coronavirus, has led to a change in lifestyle and physical activity in Spanish university students. The objective of this study was to analyze the prevalence of musculoskeletal pain and changes in physical activity and self-perceived stress in the student bodies of two Spanish Universities during the lockdown. A cross-sectional study was carried out in a sample of 1198 students (70.6% women). The main instruments used for measuring were the Standardized Kuorinka Modified Nordic Questionnaire and the Perceived stress scale (the questionnaire regarding the practice of physical activity). A reduction in the prevalence of musculoskeletal pain (p < 0.001) was identified in the sample of men and women, an increase (12.5%) in the frequency of carrying out physical activity from moderate to frequent, and the preference for strength training (15.1%), especially among women, was identified. All of this may be taken into account by health institutions when implementing measures to encourage physical activity in both suitable amounts and types, which improves the quality of life of the students.

Impact of Sedentary Behavior on Bodily Pain While Staying at Home in COVID-19 Pandemic and Potential Preventive Strategies

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