Prospective associations between 24-h device-measured occupational and leisure-time physical activity and register-based musculoskeletal-related primary healthcare utilization among Danish workers

Musculoskeletal pain is a leading cause of seeking care and imposes an immense economic burden to the healthcare systems. The guidelines recommend physical activity for managing musculoskeletal pain but do not differentiate between occupational and leisure-time physical activity. Research indicates that occupational physical activity may not have similar health benefits as leisure-time physical activity. Thus, we investigated the association between occupational and leisure-time physical activity and musculoskeletal-related primary healthcare utilization. At baseline, physical activity data (sitting, standing, light physical activity, moderate-to-vigorous physical activity and time in bed) were collected from 824 blue-collar workers using a thigh-worn accelerometer during work and leisure for up to five days. Musculoskeletal-related primary healthcare utilization (i.e., contacts with general practitioners, physiotherapists and specialists) was retrieved from the Danish National Health Services Registry during a 4-year follow-up from baseline. The association between occupational and leisure-time physical activity and musculoskeletal-related primary healthcare utilization was analyzed using a generalized linear model adjusted for potential confounders. During follow-up, 62%, 42% and 10% of the workers had at least one musculoskeletal-related contact to the general practitioner, physiotherapist and specialist, respectively. Leisure-time moderate-to-vigorous physical activity was associated with a decreased risk of a general practitioner contact (RR = 0.78; p value = 0.02), a tendency for a decreased risk of a physiotherapist contact (RR = 0.83; p value = 0.23), but with a tendency for increased risk of a specialist contact (RR = 1.49; p value = 0.20). On the contrary, occupational moderate-to-vigorous physical activity was not associated with a decreased risk of a general practitioner contact (RR = 1.04; p value = 0.75), physiotherapist contact (RR = 1.00; p value = 0.99) or a specialist contact (RR = 1.80; p value = 0.05). Our findings indicate that the domain of physical activity is of importance for musculoskeletal-related primary healthcare utilization. While leisure-time physical activity was associated with a decreased risk of a general practitioner and physiotherapist contact, occupational physical activity was not associated with such benefits.