721: Correlation between step count, physical activity level, and sedentary behavior in chronic neck pain

Topic: Experimental (Non-clinical) Human Studies
Subtopic: Pain Category (ICD-11), Chronic primary musculoskeletal pain, Physiotherapy, Digital Health Technologies

Background and Aims: Accurate assessment of physical activity (PA) is essential for health monitoring in patients with musculoskeletal disorders. In individuals with chronic neck pain, objective measures from accelerometry and subjective data from questionnaires often capture different dimensions of movement. Therefore, understanding how these metrics relate is crucial for developing more precise clinical interventions that target both physical inactivity and sedentary behavior (SB) in this population. This study aims to investigate the correlation between objective step count, physical activity levels, and sedentary behavior specifically within a chronic neck pain population.

Methods: This cross-sectional study included 100 participants (71% female; mean age 36.3 ± 14.2 years) diagnosed with chronic neck pain. PA levels were subjectively measured using the Baecke Physical Activity Questionnaire (BPAQ). Objective step count and SB were collected using an accelerometer worn on the right thigh for 7 consecutive days. SB was quantified based on time spent in low-intensity activities. Data analysis was restricted to participants with at least 5 valid days of recording (>10 hours of wear time per day). Statistical analysis was performed using Pearson and Spearman correlation coefficients (p < 0.05).

Results: A significant moderate positive correlation was found between the 7-day average step count and the BPAQ scores (r = 0.513, p < 0.001), indicating that higher objective movement levels align with higher self-reported activity in this population. Regarding SB, no significant correlation was observed between the accelerometer step count (r = -0.111, p = 0.309). However, a significant weak negative correlation was found between the BPAQ scores and SB (Spearman’s ρ = -0.269, p = 0.012), suggesting that participants who report higher levels of physical activity tend to spend less time in sedentary activities.

Conclusions: Step count recorded by thigh-worn accelerometry is a valid reflection of physical activity levels as reported by the BPAQ in chronic neck pain patients. Conversely, step count and SB appear to be independent variables, suggesting that high ambulatory activity does not necessarily equate to low sedentary time. These findings emphasize that clinical strategies for chronic neck pain should independently target the promotion of active behavior and the reduction of sedentary patterns, as one does not automatically mitigate the other.

References: Giné-Garriga M, Sansano-Nadal O, Tully MA, Caserotti P, Coll-Planas L, Rothenbacher D, Dallmeier D, Denkinger M, Wilson JJ, Martin-Borràs C, Skjødt M, Ferri K, Farche AC, McIntosh E, Blackburn NE, Salvà A, Roqué-I-Figuls M. Accelerometer-Measured Sedentary and Physical Activity Time and Their Correlates in European Older Adults: The SITLESS Study. J Gerontol A Biol Sci Med Sci. 2020 Sep 16;75(9):1754-1762. doi: 10.1093/gerona/glaa016. PMID: 31943000; PMCID: PMC7494025.
Hamer M, Stamatakis E, Chastin S, Pearson N, Brown M, Gilbert E, Sullivan A. Feasibility of Measuring Sedentary Time Using Data From a Thigh-Worn Accelerometer. Am J Epidemiol. 2020 Sep 1;189(9):963-971. doi: 10.1093/aje/kwaa047. PMID: 32219368; PMCID: PMC7443760.
Meng Y, Xue Y, Yang S, Wu F, Dong Y. The associations between sedentary behavior and neck pain: a systematic review and meta-analysis. BMC Public Health. 2025 Feb 4;25(1):453. doi: 10.1186/s12889-025-21685-9. PMID: 39905389; PMCID: PMC11796249.
Prince SA, Cardilli L, Reed JL, Saunders TJ, Kite C, Douillette K, Fournier K, Buckley JP. A comparison of self-reported and device measured sedentary behaviour in adults: a systematic review and meta-analysis. Int J Behav Nutr Phys Act. 2020 Mar 4;17(1):31. doi: 10.1186/s12966-020-00938-3. PMID: 32131845; PMCID: PMC7055033.
Sitthipornvorakul E, Janwantanakul P, Lohsoonthorn V. The effect of daily walking steps on preventing neck and low back pain in sedentary workers: a 1-year prospective cohort study. Eur Spine J. 2015 Mar;24(3):417-24. doi: 10.1007/s00586-014-3577-3. Epub 2014 Sep 11. PMID: 25208502.
Tebar WR, Ritti-Dias RM, Fernandes RA, Damato TMM, Barros MVG, Mota J, Andersen LB, Christofaro DGD. Validity and reliability of the Baecke questionnaire against accelerometer-measured physical activity in community dwelling adults according to educational level. PLoS One. 2022 Aug 15;17(8):e0270265. doi: 10.1371/journal.pone.0270265. PMID: 35969609; PMCID: PMC9377570.
Theochari G, Hall J, Pandyan A, Lewis J. The association between the physical activity of patients with idiopathic chronic neck pain and their psychological state: A cross-sectional study. Musculoskelet Sci Pract. 2024;69:102874.

Presenting Author: Maria Ramela Schalch Vivaldini
Submitting Author: Maria Vivaldini

Senior Author: Luiz Fernando Approbato Selistre

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Giovanna Laura Neves Antonio Gaban: PhD student - Federal University of São Carlos
• Rebecca Bianca Ramalho: PhD student - Federal University of São Carlos
• Luiz Fernando Approbato Selistre: PhD - Federal University of São Carlos