Better quality sleep promotes daytime physical activity in patients with chronic pain? A multilevel analysis of the within-person relationship

Abstract

Background: Promoting physical activity is key to the management of chronic pain, but little is understood about the factors facilitating an individual's engagement in physical activity on a day-to-day basis. This study examined the within-person effect of sleep on next day physical activity in patients with chronic pain and insomnia.

Methods: 119 chronic pain patients monitored their sleep and physical activity for a week in their usual sleeping and living environment. Physical activity was measured using actigraphy to provide a mean activity score each hour. Sleep was estimated with actigraphy and an electronic diary, providing an objective and subjective index of sleep efficiency (A-SE, SE) and a sleep quality rating (SQ). The individual and relative roles of these sleep parameters, as well as morning ratings of pain and mood, in predicting subsequent physical activity were examined in multilevel models that took into account variations in relationships at the 'Day' and 'Participant' levels.

Results: Of the 5 plausible predictors SQ was the only significant within-person predictor of subsequent physical activity, such that nights of higher sleep quality were followed by days of more physical activity, from noon to 11 pm. The temporal association was not explained by potential confounders such as morning pain, mood or effects of the circadian rhythm.

Conclusions: In the absence of interventions, chronic pain patients spontaneously engaged in more physical activity following a better night of sleep. Improving nighttime sleep may well be a novel avenue for promoting daytime physical activity in patients with chronic pain.

Figure 1. Design and analysis plan of the study.

Figure 2. Participant recruitment flowchart.

Figure 3. A comparison of mean physical activity level by hour of the day between days following nights of highest individual sleep quality and those following nights of lowest individual sleep quality.

There was a clear circadian rhythm of physical activity overall, but higher levels of physical activity were seen in participants who had had a night of better quality sleep.