Greater psychosocial well-being predicts higher physical activity in older adults with musculoskeletal pain: evidence from observational and simulation models

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Background Musculoskeletal pain and psychosocial well-being both influence leisure-time physical activity (LTPA) in older adults, but their combined impact remains poorly understood. This study examines the impact of musculoskeletal pain and psychosocial well-being on LTPA trajectories in older adults and estimates the potential impact of improved energy levels on LTPA using simulation modeling. Methods In a community-based cohort of 2,209 older adults, we investigated whether baseline musculoskeletal and psychosocial well-being (perceived energy and social engagement) predicted 9-year LTPA trajectories. Two LTPA trajectory groups were identified: lower (45%, median[range]: 11[0–86] minutes walking/week) and higher (55%, median[range]: 111[10–1610] minutes walking/week). Logistic regression models examined associations of musculoskeletal pain, energy, and social engagement with LTPA trajectory group adjusting for demographics, health behaviors, and comorbidities. An interaction of psychosocial well-being by musculoskeletal pain was tested. A simulation analysis estimated how increasing energy among older adults with musculoskeletal pain could influence predicted LTPA group membership, and the number needed to treat (NNT) was calculated. Results Baseline perceived energy, but not social engagement or musculoskeletal pain, consistently ranked among the top three predictors of LTPA across models. In adjusted logistic regression models, musculoskeletal pain was associated with a 40% lower likelihood of being in the higher LTPA trajectory; high energy corresponded with a 73% higher likelihood of being in the higher LTPA trajectory. Social engagement was associated with 33% higher LTPA, but only among men. The interaction between musculoskeletal pain and energy was not significant. After reassigning higher energy levels to older adults with low energy and musculoskeletal pain, the predicted probability of being in the higher LTPA trajectory increased from 41% to 50%, yielding an NNT of 11. Conclusions Perceived energy is a strong, independent predictor of LTPA, even in the presence of musculoskeletal pain. Simulated increase in energy among 11 older adults with pain corresponded with one additional person in the higher LTPA trajectory, an effect comparable to current behavioral interventions. Supporting psychosocial wellbeing may offer a valuable approach to promoting LTPA in older adults alongside pain management.