Global disparities in association between leisure-time physical activity and chronic musculoskeletal pain: A systematic review and meta-analysis

Glob Health Res Policy. 2026 May 20;11(1):74-83. doi: 10.1016/j.ghrp.2026.05.002. eCollection 2026 Dec.

ABSTRACT

BACKGROUND: Previous studies have extensively investigated the association between leisure-time physical activity (LTPA) and chronic musculoskeletal pain (CMSP). However, the results have been inconsistent. It is not known whether the differences in the association between LTPA and CMSP are due to underlying factors such as demographic patterns, geographical characteristics, and location(s) of pain.

METHODS: The systematic review and meta-analysis was conducted to assess global disparities in association between LTPA and CMSP. PubMed, EMBASE, MEDLINE, and Web of Science were searched for observational studies examining LTPA and the prevalence or incidence of CMSP in the general population. The systematic review with quality assessment using the JBI checklist and the Newcastle-Ottawa Scale was followed by a random-effects meta-analysis, including subgroup analysis using the following variables: sex, age group, geographical regions and location(s) of pain. Clinical significance of the pooled odds ratio (OR) was assessed using Cohen's d and risk of publication bias was assessed using Egger's test, funnel plot and trim-and-fill analysis.

RESULTS: Across 119 studies, the overall OR for the association between LTPA and CMSP averaged 0.78 (95% CI: 0.70-0.87, I2 = 99.5%) with no clinical significance (d = -0.137). Differences between genders were insignificant. Among age subgroups, adults and middle-aged/older adults showed a negative association between LTPA and CMSP (OR = 0.62, 95% CI: 0.47-0.82). Pain locations with reduced odds included unspecified pain locations (OR = 0.73, 95% CI: 0.62-0.86) and lower back (OR = 0.82, 95% CI: 0.69-0.98). Geographic subgroups with negative LTPA-CMSP associations included high-income countries (OR = 0.78, 95% CI: 0.70-0.88), the continents of North and South America and Europe, and the regions of Northern and Western Europe. The differences between continents and between subcontinental regions were both significant (p = 0.0211 and p = 0.0260, respectively), suggesting an influence of sociocultural factors in addition to income level.

CONCLUSIONS: LTPA was inversely associated with CMSP, especially in selected populations and pain locations. This association could be due to underlying factors, such as local factors that characterize LTPA in different countries. These findings suggest that the benefits of LTPA cannot be considered universally applicable. Locally and regionally tailored interventions should be developed, taking into account place-specific structural, economic and social characteristics.

PMID:42318168 | PMC:PMC13273654 | DOI:10.1016/j.ghrp.2026.05.002