Associations of Physical Activity and Sedentary Behavior with Internalizing Problems among Youth with Chronic Pain

Abstract

Background: Taking actions to maintain a healthy lifestyle, including regular engagement in physical activity (PA) and reducing sedentary behavior (SB), may protect against the development of internalizing problems among healthy youth. However, it remains unclear whether such associations exist among youth with chronic pain who often report symptoms of depression and anxiety. To this end, we aimed to investigate the associations between independent and combined PA and/or SB patterns with indicators of internalizing problems in this vulnerable population. Methods: Data used in this cross-sectional study were retrieved from the U.S. National Survey of Children’s Health for the years 2021–2022. Specifically, caregiver proxy reports on sociodemgraphic factors and lifestyle behaviors of 4735 U.S. children and adolescents (referring to youth) aged 6–17 years were collected. We examined independent and combined patterns of PA and SB as exposures, with internalizing problems serving as outcomes of interest. Logistic regressions were used to examine the independent and combined associations of PA and/or SB patterns with anxiety and depression symptoms among youth with chronic pain while adjusting for covariates including age, sex, ethnicity, primary caregivers’ education level, overweight status, and household federal poverty level. Results: Overall, our results indicated that PA was negatively associated with anxiety and depressive symptoms. Specifically, youth with chronic pain who engaged in at least 60–minute PA for 1–3 days, 4–6 days, or every day reported significantly lower likelihood of experiencing symptoms of anxiety (OR = 0.71, 95% CI: 0.60–0.84; OR = 0.44, 95% CI: 0.36–0.53; OR = 0.50, 95% CI: 0.40–0.63, respectively; all p-value < 0.001) and depression (OR = 0.63, 95% CI: 0.53–0.75; OR = 0.38, 95% CI: 0.31–0.47; OR = 0.46, 95% CI: 0.36–0.59, respectively; all p-value < 0.001) symptoms compared to those with 0 days. Conversely, SB (operationalized via the proxy screen time) was positively associated with anxiety and depression symptoms. Youth with chronic pain who reported 4 or more hours of daily screen time had significantly higher odds of experiencing symptoms of anxiety (OR = 2.17, 95% CI: 1.52–3.09, p < 0.001) and depression (OR = 2.30, 95% CI: 1.48–3.59, p < 0.001). Furthermore, youth with chronic pain who engaged in higher PA levels and reported lower SB levels had a lower likelihood of experiencing symptoms of anxiety (OR = 0.68, 95% CI: 0.52–0.87, p = 0.003) and depression (OR = 0.49, 95% CI: 0.34–0.70, p < 0.001) symptoms compared to those with lower PA levels and higher SB levels. Conclusions: Higher PA levels and lower SB levels were associated with a reduced likelihood of developing anxiety and depression symptoms, which are indicative of internalizing problems, among youth with chronic pain. Future public health actions in this vulnerable population should prioritize intervention programs that promote PA engagement to reduce SB levels