Chronic musculoskeletal pain constitutes a large socioeconomic challenge, and preventive measures with documented effects are warranted. The authors' aim in this study was to prospectively investigate the association between physical exercise, body mass index (BMI), and risk of chronic pain in the low back and neck/shoulders. The study comprised data on approximately 30,000 women and men in the Nord-Trøndelag Health Study (Norway) who reported no pain or physical impairment at baseline in 1984-1986. Occurrence of chronic musculoskeletal pain was assessed at follow-up in 1995-1997. A generalized linear model was used to calculate adjusted risk ratios. For both females and males, hours of physical exercise per week were linearly and inversely associated with risk of chronic pain in the low back (women: P-trend = 0.02; men: P-trend < 0.001) and neck/shoulders (women: P-trend = 0.002; men: P-trend < 0.001). Obese women and men had an approximately 20% increased risk of chronic pain in both the low back and the neck/shoulders. Exercising for 1 or more hours per week compensated, to some extent, for the adverse effect of high BMI on risk of chronic pain. The authors conclude that physical inactivity and high BMI are associated with an increased risk of chronic pain in the low back and neck/shoulders in the general adult population.

BackgroundLow back pain (LBP) is a common cause of disability and is ranked as the most burdensome health condition globally. Self-management, including components on increased knowledge, monitoring of symptoms, and physical activity, are consistently recommended in clinical guidelines as cost-effective strategies for LBP management and there is increasing interest in the potential role of digital health.ObjectiveThe study aimed to synthesize and critically appraise published evidence concerning the use of interactive digital interventions to support self-management of LBP. The following specific questions were examined: (1) What are the key components of digital self-management interventions for LBP, including theoretical underpinnings? (2) What outcome measures have been used in randomized trials of digital self-management interventions in LBP and what effect, if any, did the intervention have on these? and (3) What specific characteristics or components, if any, of interventions appear to be associated with beneficial outcomes?MethodsBibliographic databases searched from 2000 to March 2016 included Medline, Embase, CINAHL, PsycINFO, Cochrane Library, DoPHER and TRoPHI, Social Science Citation Index, and Science Citation Index. Reference and citation searching was also undertaken. Search strategy combined the following concepts: (1) back pain, (2) digital intervention, and (3) self-management. Only randomized controlled trial (RCT) protocols or completed RCTs involving adults with LBP published in peer-reviewed journals were included. Two reviewers independently screened titles and abstracts, full-text articles, extracted data, and assessed risk of bias using Cochrane risk of bias tool. An independent third reviewer adjudicated on disagreements. Data were synthesized narratively.ResultsOf the total 7014 references identified, 11 were included, describing 9 studies: 6 completed RCTs and 3 protocols for future RCTs. The completed RCTs included a total of 2706 participants (range of 114-1343 participants per study) and varied considerably in the nature and delivery of the interventions, the duration/definition of LBP, the outcomes measured, and the effectiveness of the interventions. Participants were generally white, middle aged, and in 5 of 6 RCT reports, the majority were female and most reported educational level as time at college or higher. Only one study reported between-group differences in favor of the digital intervention. There was considerable variation in the extent of reporting the characteristics, components, and theories underpinning each intervention. None of the studies showed evidence of harm.ConclusionsThe literature is extremely heterogeneous, making it difficult to understand what might work best, for whom, and in what circumstances. Participants were predominantly female, white, well educated, and middle aged, and thus the wider applicability of digital self-management interventions remains uncertain. No information on cost-effectiveness was reported. The evidence base for interactive digita...

Objective. To examine the association between leisure time physical exercise, body mass index (BMI), and risk of fibromyalgia (FM). Methods. A longitudinal study with baseline assessment of physical exercise (frequency, duration, and intensity) and BMI was used to explore the risk of having FM at 11-year followup in a large, unselected female population (n ‫؍‬ 15,990) without FM or physical impairments at baseline. Results. At followup, 380 cases of incident FM were reported. A weak dose-response association was found between level of physical exercise and risk of FM (for trend, P ‫؍‬ 0.13) where women who reported the highest exercise level had a relative risk (RR) of 0.77 (95% confidence interval [95% CI] 0.55-1.07). BMI was an independent risk factor for FM (for trend, P < 0.001), and overweight or obese women (BMI >25.0 kg/m 2 ) had a 60 -70% higher risk compared with women with normal weight (BMI 18.5-24.9 kg/m 2 ). Overweight or obese women who exercised >1 hour per week had an RR of 1.72 (95% CI 1.07-2.76) compared with normal-weight women with a similar activity level, whereas the risk was >2-fold higher for overweight or obese women who were either inactive (RR 2.09, 95% CI 1.36 -3.21) or exercised <1 hour per week (RR 2.19, 95% CI 1.39 -3.46). Conclusion. Being overweight or obese was associated with an increased risk of FM, especially among women who also reported low levels of physical exercise. Community-based measures aimed at reducing the incidence of FM should emphasize the importance of regular exercise and the maintenance of normal body weight.

Objective. Sleep problems are common among patients with fibromyalgia (FM). However, it is not known whether poor sleep is a contributing factor in FM or a consequence of the illness. The aim of the current study was to prospectively investigate the association between self-reported sleep problems and risk of FM among adult women.Methods. We longitudinally studied 12,350 women who did not have FM, musculoskeletal pain, or physical impairments at baseline (1984)(1985)(1986) Conclusion. These prospective data indicate a strong dose-dependent association between sleep problems and risk of FM. The association is somewhat, although not significantly, stronger in middle-aged and older women than in younger women.Fibromyalgia (FM) is a chronic musculoskeletal pain syndrome with a complex etiology. The prevalence of FM in the general adult population is ϳ3-5%, with a predominance among women (1). Disturbed sleep (e.g., insomnia and nocturnal awakening) and undue fatigue due to nonrestorative sleep are common comorbid symptoms in patients with FM (2,3). Self-reported sleep problems in patients with FM have been substantiated by polysomnographic recordings, showing alterations in sleep architecture and electroencephalographic sleep pattern, in some but not all studies (4). Whether poor sleep is a contributing factor in the development of FM or, rather, develops as a consequence of the illness is currently not known. We prospectively studied a large and unselected population of women who did not have FM, musculoskeletal pain, or physical impairment at baseline, to investigate whether sleep problems increase the risk of FM development. PATIENTS AND METHODSStudy population. The (Helseundersøkelsen i NordTrøndelag [Nord-Trøndelag Health Study] [HUNT study]) is a collaborative effort of the HUNT Research Centre at the Norwegian University of Science and Technology, the NordTrøndelag (Norway) County Council, and the Norwegian Institute of Public Health. All residents of Nord-Trøndelag County age Ն20 years were invited to participate in 2 separate phases of the HUNT study: first in 1984-1986 (HUNT 1) and then in 1995-1997 (HUNT 2). Among 42,568 women who were eligible, 38,274 (89.9%) accepted the invitation to participate in the HUNT 1 and completed a questionnaire that was sent with the invitation. A clinical examination was conducted, at which body mass and height were measured and the women were given a second questionnaire to complete at home and return in a prestamped envelope. For the HUNT 2, 46,709 women were invited to participate, and 34,518 (73.9%) accepted the invitation. The procedures were similar to those described for the HUNT 1, although both the questionnaires and the clinical examination were more comprehensive.There were 24,357 women who participated in both the HUNT 1 and the HUNT 2, and these women were selected for the present study. Of these 24,357 women, we excluded 6,093

Sleep problems are associated with an increased risk of chronic pain in the low back and neck/shoulders. Regular exercise and maintenance of normal body weight may reduce the adverse effect of mild sleep problems on risk of chronic pain.