Resilience Factors and Physical Activity Engagement in Adolescents with Chronic Musculoskeletal Pain: A Cross-Sectional Study

<b>Background/Objectives</b>: Chronic musculoskeletal pain (CMSKP) affects up to 40% of adolescents and leads to substantial disability, reduced quality of life, and long-term health risks. Physical activity is central to treatment, but adherence to moderate-to-vigorous physical activity (MVPA) is inconsistent. We evaluated higher-resilience constructs-self-efficacy, pain acceptance, motivational stage, and affect-and hypothesized that higher resilience would be associated with greater objectively measured physical activity, better daily functioning, and higher quality of life in adolescents with CMSKP. <b>Methods</b>: Forty-three adolescents (13-18 years) with CMSKP completed measures of physical activity-specific self-efficacy, acceptance (AFQ-Y), motivational stage (PSOCQ-A), and affect (PANAS-C). Participants wore activPAL monitors to assess MVPA, light activity, and sedentary time. Physical function endurance was measured by the six-minute walk test (6MWT) and the Functional Disability Inventory (FDI); quality of life by the Pediatric Quality of Life Inventory (PedsQL). Spearman's correlations assessed associations among resilience variables, physical activity metrics, 6MWT distance, FDI, and PedsQL. <b>Results</b>: MVPA was correlated positively with 6MWT distance (<i>ρ</i> = 0.48, <i>p</i> = 0.002) and negatively with FDI scores (<i>ρ</i> = -0.56, <i>p</i> < 0.001). Self-efficacy related to higher MVPA (<i>ρ</i> = 0.41, <i>p</i> = 0.009), better endurance (<i>ρ</i> = 0.36, <i>p</i> = 0.017), and lower disability (<i>ρ</i> = -0.38, <i>p</i> = 0.013). Acceptance was correlated with PedsQL total (<i>ρ</i> = 0.45, <i>p</i> = 0.004); motivation (specifically maintenance) scores were correlated with higher quality of life (<i>ρ</i> = 0.33, <i>p</i> = 0.027). Light activity and sedentary time were not significantly linked to functional or psychosocial outcomes. In a step-wise regression, only physical activity self-efficacy for ambulation at school predicted MVPA, <i>B =</i> 1.56, <i>p</i> = 0.008. <b>Conclusions</b>: Resilience constructs-including self-efficacy, acceptance, and readiness to change-were meaningfully associated with MVPA, daily functioning, and quality of life, and may have implications for treatment development.