Do Physical Activity and Sleep Health Predict Chronic Pain in Middle Childhood? An Examination of Direct and Moderated Effects of Health Behaviors

Chronic pain is common during childhood and has negative immediate and long-term implications for physical and mental health. Prior research points to physical activity and sleep as protective health-promoting behaviors predicting lower chronic pain intensity and disability during adulthood. No study has yet examined the interaction of physical activity and sleep parameters in prediction of chronic pain in a community sample of children. Guided by the biopsychosocial model of pediatric chronic pain, this study explored objectively assessed physical activity and sleep patterns at age 8 as predictors of childhood chronic pain at age 9 in a racially/ethnically and socioeconomically diverse sample of 896 twins participating in the longitudinal Arizona Twin Project. It was hypothesized that parameters of physical activity levels and sleep health would independently predict chronic pain one year later, and that sleep parameters would moderate the association between physical activity and chronic pain. Monthly chronic pain was common, with 57.1% of participants reporting at least one pain location. Headaches, stomachaches, and backaches were the most frequent chronic pain presentations. Participants exceeded physical activity guidelines but did not meet sleep recommendations for their age group. Multilevel modeling analyses revealed that physical activity and sleep parameters at age 8 did not predict chronic pain one year later, and that sleep parameters did not moderate the associations between physical activity and chronic pain. The present study provides evidence that the associations between objectively assessed physical activity and sleep and chronic pain are not yet evident during middle childhood in this community sample compared to patient samples who have existing pain, suggesting that these health behaviors may play distinct roles in pain development versus pain management. They also point to the need to pinpoint the time frame during which these health behaviors become relevant and potentially interact to predict chronic pain development and maintenance. Longitudinal research tracking these health behaviors and pain using both subjective and objective methods as children transition into and through adolescence can help to identify optimal developmental stages at which to target prevention and intervention efforts to promote long term health.