Abstract

Background and Purpose Physical activity (PA) is a key recommendation for musculoskeletal pain, but social determinants of health (SDH) may limit older adults' participation. The purpose of this study was to assess the association of SDH with PA in a large representative sample of older Europeans with musculoskeletal pain.Methods A cross-sectional study was conducted based on data from the 9th wave of the SHARE (2021-2022), a representative survey of people aged 50 years and older in 27 European countries and Israel. People with back, hip, knee, or other joint pain were included. The SDH (exposures) examined were education, household income, current job status, and loneliness. Self-reported vigorous or moderate PA were the outcomes. Survey-weighted ordinal logistic regression models were applied, adjusting for age, sex, country, comorbidities, sleep problems, smoking, sadness, and pain characteristics.Results 21,679 individuals (mean age: 70 years, 64% female) were included. Low educational level was consistently associated with reduced participation in moderate (OR: 0.79; 95% CI: 0.65-0.97) and vigorous PA (OR: 0.68; 95% CI: 0.57-0.82). Loneliness was consistently associated with reduced participation in moderate (OR: 0.78; 95% CI: 0.65-0.93) and vigorous PA (OR: 0.76; 95% CI: 0.67-0.87). Active employment was associated with a lower likelihood of engaging in vigorous PA (OR: 0.69; 95% CI: 0.60-0.79) but not moderate PA. No significant association was observed with income.Discussion Our findings highlight the need for educational interventions and targeted strategies addressing social support to promote physical activity in older adults with musculoskeletal pain.