Association between the accumulation of unhealthy lifestyle factors and musculoskeletal pain in older adults
Rodrigo Núñez‐Cortés, Carlos Cruz‐Montecinos, Andrea Tur‐Boned, Luis Suso‐Martí, Andrea Fuenzalida‐Palma, Lars Louis Andersen, Joaquín CalatayudAbstract
Background
Although previous studies have examined individual lifestyle behaviors in chronic musculoskeletal pain outcomes, the cumulative impact of unhealthy lifestyle behaviors remains unclear.
Objective
To assess whether the accumulation of unhealthy lifestyle behaviors, as measured by the LIFESTYLE‐4 score, is associated with the intensity and distribution of musculoskeletal pain in older adults.
Methods
A cross‐sectional study was conducted with 100 older adults with chronic pain (83% women; mean age 69 ± 9.8 years). Lifestyle‐related factors were assessed using validated instruments: physical activity (International Physical Activity Questionnaire), diet (Mediterranean diet score), sleep (Pittsburgh Sleep Quality Index), and stress (Perceived Stress Scale‐4). The LIFESTYLE‐4 score was constructed by assigning one point for each unfavorable factor (Pittsburgh Sleep Quality Index score >5, Perceived Stress Scale‐4 score > 8, physical activity <600 metabolic equivalent of task–min/wk, Mediterranean diet score <9). Pain intensity (numerical rating scale, 0–10) and pain distribution (regional vs. widespread) were the main outcomes. The data were analyzed using one‐way analysis of variance, χ 2 tests, and multivariate logistic regression adjusted for sociodemographic and clinical covariates.
Results
Analysis of variance showed significant differences in pain intensity between LIFESTYLE‐4 score categories ( F = 6.40, p = .004; ηp 2 = 0.06). Participants with the highest score reported greater pain compared to the low (mean difference = 1.80, p = .010) and medium (mean difference = 1.49, p = .011) groups. Logistic regression showed higher odds of severe pain in the high‐score group (odds ratio = 10.5, 95% confidence interval 1.08–102.3). A χ 2 test revealed an association between LIFESTYLE‐4 and the number of painful areas ( χ 2 (4) = 12.7, p = .013).
Conclusion
The accumulation of multiple unhealthy lifestyle behaviors was associated with greater intensity and a wider distribution of musculoskeletal pain. These findings underscore the importance of multidomain lifestyle approaches in the prevention and treatment of pain among older adults.