Association of musculoskeletal symptoms with physical activity, sedentary behavior and sleep: A secondary analysis of the 2016 to 2017 Chilean National Health Survey

Introduction: Musculoskeletal symptoms are a public health concern because of their association with disability and increased economic burden. In other countries, people with these symptoms report lower physical activity levels, less sleep and more sedentary behavior. Evidence in Chile remains limited. Objective: To analyze the association between musculoskeletal symptoms and physical activity, sedentary behavior, and sleep in the Chilean adult population. Methods: A secondary analysis of the 2016 to 2017 Chilean National Health Survey (5472 adults), accounting for its complex sampling design. Musculoskeletal symptoms experienced during the previous seven days were assessed using the Community-Oriented Programme for the Control of Rheumatic Disease Core Questionnaire. Physical activity and sedentary behavior were assessed using the Global Physical Activity Questionnaire, while sleep duration was measured as the self-reported average number of hours per day. Differences in minutes per day were estimated with linear regression, while adherence to recommendations (World Health Organization physical activity guidelines, sedentary time of less than four hours per day, and sleep duration of seven to nine hours per day) was assessed using univariable and adjusted logistic regression models. Results: Musculoskeletal symptoms were present in 38% (95% confidence interval 35 to 41) of adults. Compared to adults without symptoms, those with symptoms had mean differences of 16 minutes per day (95% confidence interval -8 to 40) in total physical activity, 16 minutes per day (95% confidence interval -1 to 33) in sedentary behavior, -16 minutes per day (95% confidence interval -25 to -7) in sleep, 28 minutes per day (95% confidence interval 8 to 49) in work physical activity and -12 minutes per day (95% confidence interval -22 to -3) in travel physical activity. Among adults with symptoms, 36%, 35%, and 48% did not meet the physical activity, sedentary, and sleep recommendations, respectively. No statistically significant associations were found between musculoskeletal symptoms and adherence to any of these recommendations. Conclusions: Adults with musculoskeletal symptoms reported similar levels of total physical activity and sedentary behavior, about 16 fewer minutes of sleep per day, and more work-related physical activity than adults without symptoms. Failure to meet the recommendations was frequent in both groups. Given the cross-sectional study design, prospective studies are needed to clarify the direction of these associations.