Facing obesity in pain rehabilitation clinics: Profiles of physical activity in patients with chronic pain and obesity-A study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)

Background: Due to the obesity epidemic, pain rehabilitation clinics have had to reconsider how to best serve their patients. To date, little is known about baseline level of physical activity (PA) in patients referred to pain rehabilitation clinics.Objectives: To investigate the PA levels of patients referred to pain rehabilitation clinics and to evaluate the effect of excess weight on PA level.Methods: Data were obtained from the Swedish Quality Registry for Pain Rehabilitation (SQRP) between 2016 and 2017. These data included PA time, Body Mass Index (BMI), sociodemographic factors, chronic pain and psychological aspects (e.g., pain intensity, depressive and anxiety symptoms and insomnia problems). The SQRP collects data on PA using a questionnaire that asks patients to indicate how much time they spend on everyday PA and physical exercise (PE) per week. Insufficient PA was defined as less than 150 minutes per week. We performed logistic regressions as well as orthogonal partial least square regression to estimate the effects of excess weight on PA.Results: Over one-fourth of the patients were classified as obese (BMI ≥30 kg/m 2 , 871/3110, 25.3%) and nearly one-third of these patients were classified as severely obese (BMI ≥35 kg/m 2 , 242/871, 27.8%). Time estimations for PE varied among the BMI groups, but patients in the higher BMI category were more likely to spend less time on everyday PA. After controlling for sociodemographic factors, pain, and psychological aspects, mild obesity (OR 0.65, 95% CI 0.53-0.81) and severe obesity (OR 0.56, 95% CI 0.42-0.74) were associated with less PA. Compared to normal weight peers, mild obese patients had an elevated risk of 65% and severe obese patients had an elevated risk of 96% for insufficient PA. For obese patients, increased pain intensity was positively related to insufficient PA (OR 1.17, 95% CI 1.06-1.29).Conclusion: Having low PA is very common for patients referred to pain rehabilitation clinics, especially for those with comorbid obesity. As a first step to increase PA, obese patients need to be encouraged to increase the intensity and amount of less painful daily PA.