An Exploratory Study on the Physical Activity Health Paradox—Musculoskeletal Pain and Cardiovascular Load during Work and Leisure in Construction and Healthcare Workers

Suzanne Lerato Merkus*, Pieter Coenen, Mikael Forsman, Stein Knardahl, Kaj Bo Veiersted, Svend Erik Mathiassen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Using a novel approach, this exploratory study investigated whether the physical activity (PA) paradox extends to cardiovascular load and musculoskeletal pain. At baseline, 1–2 days of 24 h heart rate was assessed in 72 workers from construction and healthcare. Workers then reported pain intensity in 9 body regions (scale 0–3) every 6 months for two years. Using a novel ilr structure in compositional data analysis, time spent during work and leisure above three thresholds of percentage heart rate reserve (%HRR), i.e., ≥20 %HRR, ≥30 %HRR, and ≥40 %HRR, were regressed on to the 2-year average of musculoskeletal pain (sum of 9 pain scores; scale 0–27). Analyses were stratified for several important variables. Workers spending more time in physical activity at work had higher pain, while workers with more time in physical activity during leisure had less pain (i.e., the PA paradox), but none of the associations were statistically significant. Higher aerobic capacity and lower body mass index lowered the pain score among those with higher physical activity at work. This exploratory study suggests that the PA paradox may apply to musculoskeletal pain and future studies with larger sample sizes and additional exposure analyses are needed to explain why this occurs.
Original languageEnglish
Article number2751
JournalInternational Journal of Environmental Research and Public Health
Issue number5
Publication statusPublished - 1 Mar 2022

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