Social barriers associated with not engaging in physical activity in older adults with musculoskeletal pain.

To assess the association of social barriers with physical inactivity in a large representative sample of older adults with musculoskeletal pain.

A cross-sectional study was conducted based on data from the 9th wave of the Survey of Health, Ageing and Retirement in Europe (SHARE), a representative survey of people aged 50 years and older in 27 European countries and Israel. People with back, hip and/or knee pain were included. Cases with cancer, neurological diseases (Stroke, Alzheimer's disease, Parkinson's disease) and hip fracture were excluded. Social barriers examined were education, current job status, household income and loneliness (exposures). Self-reported vigorous or moderate physical activity (outcome) was categorized as high or low according to whether it was performed at least once a week or not, respectively. A multivariate logistic regression analysis, mutually adjusted for social barriers and controlling for age, sex, country, smoking habit, number of comorbidities, sleep problems, self-reported sadness, pain level and number of sites with pain.

A total of 11,276 participants (mean [SD] age = 73.5 [20.7] years, 69% female) were included. Twenty-three percent of cases did not engage in moderate activity at least once a week, while 61% did not engage in vigorous activity at least once a week. Low educational level (odds ratio [OR] = 1.70; 95% confidence interval [CI] = 1.54 to 1.87, p0.001) and loneliness (OR = 1.72; 95% CI = 1.49 to 1.99, p0.001)  were the main social barriers associated with not engaging in moderate physical activity. Likewise, low educational level (OR = 1.39; 95% CI = 1.27 to 1.32, p0.001) and loneliness (OR = 1.47; 95% CI = 1.27 to 1.71, p0.001)  were the main social barriers associated with not engaging in vigorous physical activity. The results were also consistent when analyzing subgroups by pain location (back, hips or knees).

Low education and loneliness were the main barriers to physical activity. These findings highlight the need for interventions to reduce these barriers by promoting education about the benefits of physical activity for pain management and social support to improve participation in physical activity and, therefore, quality of life for older adults with musculoskeletal pain.

Physical therapy interventions should go beyond physical care by including education about the benefits of physical activity and promoting social support to increase engagement in healthy activities. At the administrative, educational, and public policy levels, it is recommended that programs be designed to promote physical activity, reduce social inequalities, and improve the quality of life of this population.