An exploratory study on the physical activity health paradox – musculoskeletal pain and cardiovascular load during work and leisure in construction and healthcare workers

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 24h 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, ≥40 %HRR, was related to the 2-year average 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