Key Points
- Moderate physical activity of 300–450 minutes per week, following WHO guidelines, is linked to significantly lower odds of musculoskeletal pain in multiple body areas including elbow, forearm, wrist, hand, fingers, and abdomen.
- Excessive physical activity beyond 450 minutes per week may increase the likelihood of musculoskeletal pain especially in lower extremity regions like thighs, knees, and ankles.
- The study highlights that optimal physical activity for reducing musculoskeletal pain differs by body region, with the upper body benefiting more from moderate to high activity levels, while the lower body may be at greater risk with very high activity levels.
- Clinical implication: A physical activity target of 300–450 minutes weekly may best reduce musculoskeletal pain in many areas without causing increased pain for lower limbs, particularly important for populations with growing musculoskeletal concerns.
- Study limitation: The research is observational and cross-sectional, relying on self-reported physical activity and pain, which may include recall bias and cannot establish cause-effect relationships.
Association between Physical Activity and Musculoskeletal Pain: What You Need to Know
Musculoskeletal pain is a common experience affecting many people worldwide and it has a big impact on physical health and daily life. This pain can happen in many areas of the body such as the neck, back, shoulders, arms, and legs. You might wonder how physical activity affects this pain. Can exercising help, or might it make the pain worse? Recent research across 14 countries, including Singapore, gives us some very helpful answers.
This blog explains the findings of a large international study that looked at how different amounts of physical activity influence musculoskeletal pain in adults. The goal is to help you understand how much activity might be best for your body and when too much could possibly lead to more pain.
What Is Musculoskeletal Pain and Why Is It Important?
Musculoskeletal pain (MSK pain) includes discomfort in muscles, bones, joints, ligaments, tendons, and nerves. It is very common and affects a large portion of the population globally. Studies show that between 13.5% and 47% of people experience this pain at various points in life. Women and older adults tend to suffer from it more frequently.
This pain can affect how we move, sleep, and enjoy activities. It may also cause changes in mood and social life. Globally, years of life affected by disability from musculoskeletal conditions have increased significantly in the last decades, partly because populations are aging.
How Much Physical Activity Should You Do?
The World Health Organization (WHO) recommends that adults aim for 150–300 minutes of moderate physical activity or 75–150 minutes of vigorous physical activity per week. Moderate activity might be brisk walking or gardening, while vigorous activity could include running or fast cycling.
This recommendation is important because sufficient physical activity reduces risks for many diseases such as type 2 diabetes, heart disease, some cancers, and even premature death. But how this level of activity relates to musculoskeletal pain is less clear.
What Did The Study Find About Physical Activity and Musculoskeletal Pain?
The study surveyed over 13,700 adults from different countries, including Singapore, using a detailed questionnaire to record physical activity and pain in various body parts.
Participants were grouped based on how much physical activity they did, from inactive (less than 150 minutes a week) to very active (more than 900 minutes a week).
Researchers analysed the relationship between physical activity and pain at 20 different body locations, adjusting for factors like age, gender, work status, and depression.
Moderate Physical Activity Reduces Pain in Several Areas
People who did between 300 and 450 minutes of physical activity weekly experienced significantly lower odds of pain in six body areas:
- Elbow
- Forearm
- Wrist
- Hand
- Fingers
- Abdomen
This means that this amount of physical activity may protect or ease pain in these regions.
Physical Activity Over 450 Minutes Weekly: Benefits and Risks
Higher levels of activity (450 to 900+ minutes per week) were generally linked to reduced pain in the upper body and spine areas—including the neck and lower back. However, this same high level of activity was associated with a rise in pain in parts of the lower body such as:
- Thigh
- Knee
- Ankle and Achilles tendon
Research suggests this might be because the lower limbs are most used in many forms of exercise like walking, running, and cycling, increasing strain on those areas.
Why Could Excessive Physical Activity Increase Pain in Some Areas?
Regular physical activity can influence how the nervous system controls pain. It may reduce pain sensitivity by activating pain regulation pathways in the brain and spinal cord. Exercise also has anti-inflammatory and antioxidant effects that may help reduce chronic pain.
However, very high volume or intensity of physical activity could potentially overload certain muscles and joints, especially in the lower limbs. This might cause or worsen pain in these areas.
Musculoskeletal Pain in the Spine, Neck and Upper Limbs
The study shows that people doing 300–600 minutes of physical activity per week are less likely to experience pain in the neck, thoracic and lumbar spine, elbow, forearm, wrist, hand, and fingers.
Interestingly, the recommended WHO minimum (150–300 minutes) only showed a beneficial effect for pain in the thoracic spine and was not linked to lower pain in these other areas.
Practical Question: How Should I Manage My Physical Activity to Avoid Musculoskeletal Pain?
The results suggest aiming for about 300 to 450 minutes of physical activity per week as a sweet spot. This amount appears to reduce pain in multiple body regions without increasing the risk of pain in lower limbs.
If you enjoy high volumes of activity beyond 450 minutes per week, be mindful of possible pain in your legs or feet and consider balancing with rest or varied exercise types.
What About People Concerned About Lower Limb Pain?
For those experiencing or worried about pain in the knees, thighs, ankles or feet, keeping physical activity in the range of 150 to 450 minutes weekly may be safer.
Very high activity levels (over 600 minutes) were associated with a higher risk of pain in these regions. It’s important to listen to your body and manage any discomfort early.
How Was Physical Activity and Pain Measured?
Physical activity levels were measured using the Nordic Physical Activity Questionnaire – short version. This questionnaire asked participants about the total time spent in moderate and vigorous activities across work and leisure over the past week.
Musculoskeletal pain was checked by asking if participants had pain in 20 specific body parts, answered as yes or no.
What Are The Limitations of The Study?
This study is based on self-reported data, which might be subject to memory errors or exaggeration. It is cross-sectional, meaning it looks at one point in time and cannot prove cause and effect between physical activity and pain.
Moreover, it did not differentiate the types of activities done or the intensity details beyond moderate and vigorous categories. It also did not measure how severe the pain was, only its presence.
Finally, the associations found could vary depending on individual health status, occupation or lifestyle.
Why Is This Research Important?
This study is the first large offer that analyses how general physical activity relates to musculoskeletal pain across multiple body regions internationally.
For Physiotherapists and patients in Singapore, this provides practical guidelines on how much physical activity may reduce pain and improve quality of life.
Conclusion
Research shows physical activity has a complex link to musculoskeletal pain. The key is to aim for the right amount. About 300 to 450 minutes weekly of moderate to vigorous activity lowers pain in many body parts without raising risk in the legs and feet. Singaporeans and others can use these findings to balance their activity for better health and less pain.
References
Rhim, H. C., Tenforde, A., Mohr, L., Hollander, K., Vogt, L., Groneberg, D. A., & Wilke, J. (2022). Association between physical activity and musculoskeletal pain: An analysis of international data from the ASAP survey. BMJ Open, 12(e059525). https://doi.org/10.1136/bmjopen-2021-059525
