Physical activity characteristics, sleep health, and chronic pain in older adults with arthritis
Date
2025
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
University of Delaware
Abstract
Arthritis affects nearly 50% of older adults and leads to chronic pain, stiffness, and impaired mobility. Biobehavioral factors, such as sleep and physical activity (PA), play a key role in pain modulation. PA is recommended for arthritis management. However, the associations between daily PA and chronic pain remain unclear, particularly in individuals with poor sleep. Additionally, social determinants of health (SDOH), such as race and poverty, influence both sleep and pain. However, there is limited evidence on complex relationships among SDOH, sleep disturbance and pain. It was thus the aim of present study to 1) systematically review the literature on the associations of daily PA characteristics and sleep patterns with pain outcomes (i.e. intensity, interference, sensitivity) as well as the effect of PA and sleep interventions on pain in older adults with OA, 2) empirically investigate the association between PA characteristics and pain severity in older adults over time and the moderating role of sleep disturbance on this association, and 3) test how SDOH modifies the association between sleep disturbance and pain severity/interference in older adults with arthritis over time and explore whether sleep mediated the SDOH and pain relationship. ☐ Study one (Chapter 2) systematically reviewed the existing studies (n=25) on the relationship between PA, sleep health, and pain outcomes in older adults with arthritis, thereby providing the background and generating hypotheses for the empirical sub-studies. Using data sets from 3 waves of the Health and Retirement Study, mixed-effect multinominal logistic regression models were performed to test the association between PA and pain severity with sleep disturbance as a moderator (n=5,304) (chapter 3). Additionally, moderation and mediation analyses were conducted (n=5,024) to examine the associations among sleep, SDOH and pain over time (Chapter 4). The study findings of these studies suggested that sleep disturbances significantly amplified the association between reduced frequency in moderate PA and higher moderate pain (Chapter 3). In addition, the results showed that sleep disturbance was linked to greater pain severity and interference, while fewer social disadvantages reduced pain severity. Educational attainment, poverty, and food insecurity moderated the sleep-pain severity and interference associations. Sleep disturbances also partially mediated the relationships between SDOH and pain outcomes (Chapter 4). ☐ Findings from this dissertation provide preliminary evidence for understanding the multifaceted and interrelated association between PA, sleep health, and pain among older adults with arthritis, which may be useful for developing interventions to optimize pain management in this population. Future research is needed to develop integrated biobehavioral interventions to improve pain outcomes.
Description
Keywords
Behavioral interventions, Older adults, Physical activity, Sleep health, Arthritis