@article {Whibleye036219,
	title = {Sleep disturbance as a moderator of the association between physical activity and later pain onset among American adults aged 50 and over: evidence from the Health and Retirement Study},
	journal = {BMJ Open},
	volume = {10},
	year = {2020},
	pages = {e036219},
	abstract = {Objective To examine whether sleep disturbance modifies the association between physical activity and incident pain.Design Prospective population-based study.Setting Health and Retirement Study.Participants American adults aged >=50 years who reported no troublesome pain in 2014 were re-assessed for pain in 2016. Of 9828 eligible baseline respondents, 8036 (82\%) had complete follow-up data for adjusted analyses (weighted analysis population N=42 407 222).Exposures Physical activity was assessed via interview with questions about time spent in moderate and vigorous physical activity. Sleep disturbance, assessed using a modified form of the Jenkins Sleep Scale, was examined as a potential moderator.Main outcome measure Troublesome pain.Results In weighted analyses, 37.9\% of the 2014 baseline pain-free sample participated in moderate or vigorous physical activity once a week or less, with an overall mean Physical Activity Index Score of 9.0 (SE=0.12). 18.6\% went on to report troublesome pain in 2016. Each one-point higher on the Physical Activity Index Score was associated with a reduced odds ratio (OR) of incident pain for those who endorsed sleep disturbance never/rarely (OR=0.97, 95\% CI 0.94 to 0.99), but not for those who endorsed sleep disturbance sometimes (OR=0.99, 95\% CI 0.97 to 1.01) or most of the time (OR=1.01, 95\% CI 0.99 to 1.03). The analysis of possible interaction demonstrated that frequency of sleep disturbance moderated the physical activity and incident pain association (Wald test: p=0.02).Conclusions The beneficial association of physical activity on reduced likelihood of later pain was only observed in persons who endorsed low levels of sleep disturbance.},
	keywords = {pain, Physical activity, sleep disorders},
	issn = {2044-6055},
	doi = {10.1136/bmjopen-2019-036219},
	author = {Whibley, Daniel and Heidi M Guyer and Swanson, Leslie M and Braley, Tiffany J and Kratz, Anna L and Galit L Dunietz}
}
