The effect of physical activity in leisure time on neck and upper limb symptoms
Introduction
In general, the assumption that a physically active lifestyle has a favorable effect on health is widely accepted [1]. Studies have shown the relationship between physical activity and several health outcomes such as mortality [1], [2], cardiovascular diseases [1], [3], [4], and cancer [1], [4], [5], [6]. Whether physical activity prevents musculoskeletal disorders, and especially neck and upper limb complaints, is not yet clear. Sports and exercises can cause musculoskeletal injuries. However, these injuries mainly concern the lower extremities [1]. In their review, Hildebrandt et al. found associations between physical activity in leisure time and musculoskeletal symptoms, although the results of the studies were somewhat inconsistent [7]. In another review, Hoogendoorn et al. found no evidence for an effect of physical activity during leisure time on low back pain [8]. However, the review of Vuori concluded that physical activity could be effective in preventing low back pain [9]. Studies on the association between physical activity and musculoskeletal complaints mostly concern low back pain, whereas studies on neck and upper limb complaints are rare. Ariëns et al. concluded in their review that there was inconclusive evidence for a relationship between sports and exercise and neck pain [10], but hardly any high-quality studies were found. Miranda et al. evaluated the effects of physical activity and sports on shoulder pain among forestry workers and concluded that physical exercise had more protective than impairing effects on the shoulders [11].
Besides observational studies, the effectiveness of leisure time physical activity on the prevention of neck and upper limb disorders can be deduced from randomized controlled trials evaluating physical activity programs. In a recent review, Proper et al. concluded that there was strong evidence for a positive effect of worksite physical activity programs on musculoskeletal disorders. However, most studies concerned low back pain [12]. In a randomized controlled trial, Proper et al. studied the effects of an individual counseling intervention at the workplace on musculoskeletal symptoms [13], but found no significant effect regarding the upper extremities.
Summarizing, it may be said that there are indications that physical activity could have a favorable effect on neck and upper limb symptoms, but high-quality studies on this subject are scarce. The present study can enlighten this subject with longitudinal data on physical activity as well as neck and upper limb symptoms. The objective of this study was to examine the effects of physical activity on neck and upper limb symptoms in a working population, as well as sickness absence due to these symptoms. As employees who perform physically demanding work are likely to derive less benefit from further physical activity than employees whose work is primarily sedentary, special attention was given to employees with sedentary jobs.
Section snippets
Study population
In 1994, the Study on Musculoskeletal disorders, Absenteeism, Stress and Health (SMASH), a prospective cohort study with a follow-up period of 3 years, was initiated among a working population in The Netherlands. The main purpose of this study was to determine risk factors for musculoskeletal disorders, with a focus on low back, neck, and shoulder disorders. The 34 participating companies were asked to select workers who had been employed in their current job for at least 1 year and who were
Prevalence of symptoms and sickness absence
Of the 1312 subjects with complete data, 17% reported neck or shoulder symptoms in the previous year at one follow-up, 11% at two follow-up, and 12% at all three follow-up measurements. With regard to elbows, wrists, or hands, 13% reported symptoms in the previous year at one follow-up, 6% at two follow-up, and 4% at all three follow-up measurements. For 687 respondents, complete data were available on sickness absence. Of these respondents, 10% were on sick leave due to the symptoms mentioned
Sporting activities throughout the year and mean intensity per week
Particularly notable is the effect of sporting activities on sickness absence. Employees not practicing sports are at an almost threefold risk of long-term sickness absence due to neck or upper limbs symptoms compared to employees practicing sports at least 10 months a year. A statistically significant effect of physically active commuting on neck and upper limb symptoms could not be demonstrated, although there seems to be a tendency towards a favorable effect.
Two measures of sporting
Conclusion
Practicing sports for at least 10 months a year had a favorable effect on neck/shoulder symptoms and on sickness absence due to neck and upper limb symptoms. Therefore, it should be recommended to remain active the whole year round, instead of practicing sports incidentally during a limited number of months. Probably, physically active commuting could contribute to this more active lifestyle.
Acknowledgments
The study was funded by the Dutch Ministry of Health, Welfare and Sport and the Ministry for Social Affairs and Employment. We thank Hendriek Boshuizen for her methodological advice.
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