The grade in physical education in adolescence as predictor for musculoskeletal pain diagnoses three decades later

Abstract

We hypothesized that a low grade in physical education (PE) is associated with an increased risk of future musculoskeletal conditions, especially chronic pain. Using a historical cohort study design, we identified all students (mean age 16.0 years), who in 1974-1976 graduated from compulsory school in a Swedish municipality and retrieved their PE grades. We ensured that persons were still alive and resident in the county in 2003-2007 and linked data to the Skåne Health Care Register covering all in- and outpatient care in the county. Diagnoses in focus were soft tissue pain, back pain, and osteoarthritis registered as ICD-10 codes. We used a logistic regression model adjusted for education and occupation to investigate the associations between the PE grade and a future musculoskeletal diagnosis. An average grade served as reference group. Of 2298 graduates born 1957-1962, 1712 (74.5%) were resident in the county at follow-up. Women with a low (bad) PE grade had an increased odds ratio (OR) for a musculoskeletal diagnosis OR=1.5 (95% CI=1.0-2.2) as well as for the subgroup "Other soft tissue disorders, not elsewhere classified" (M79) OR=1.9 (95% CI=1.0-3.3), containing mostly chronic soft tissue pain disorders. In men with a high (good) PE grade, we found a decreased risk for "Soft tissue disorders" (M60-M79) OR=0.54 (95% CI=0.33-0.86) as well as for the subgroup "Other enthesopathies" (M77) OR=0.29 (95% CI=0.11-0.78). This study indicates that adolescent girls with a low PE grade could be an important group to target with early interventions to reduce future musculoskeletal illness.