• Nicole E Andrews, Jenny Strong, Pamela J Meredith, and Rachel G D'Arrigo.
• N.E. Andrews, OT, BOccThy(Hons), Department of Occupational Therapy and Professor Tess Cramond Multidisciplinary Pain Centre, The Royal Brisbane and Women's Hospital, Herston, Queensland, Australia, and Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia. Mailing address: Occupational Therapy Department, The Royal Brisbane and Women's Hospital, Butterfield Street, Level 2, James Mayne Building, Herston, Queensland, Australia, 4029.
• Phys Ther. 2014 Apr 1;94(4):499-510.

BackgroundIndividuals with chronic pain consider improved sleep to be one of the most important outcomes of treatment. Physical activity has been shown to have beneficial effects on sleep in the general population. Despite these findings, the physical activity-sleep relationship has not been directly examined in a sample of people with chronic pain.ObjectiveThis study aimed to examine the association between objective daytime physical activity and subsequent objective sleep for individuals with chronic pain while controlling for pain and psychosocial variables.DesignAn observational, prospective, within-person study design was used.MethodsA clinical sample of 50 adults with chronic pain was recruited. Participation involved completing a demographic questionnaire followed by 5 days of data collection. Over this period, participants wore a triaxial accelerometer to monitor their daytime activity and sleep. Participants also carried a handheld computer that administered a questionnaire measuring pain, mood, catastrophizing, and stress 6 times throughout the day.ResultsThe results demonstrated that higher fluctuations in daytime activity significantly predicted shorter sleep duration. Furthermore, higher mean daytime activity levels and a greater number of pain sites contributed significantly to the prediction of longer periods of wakefulness at night.LimitationsThe small sample size used in this study limits the generalizability of the findings. Missing data may have led to overestimations or underestimations of effect sizes, and additional factors that may be associated with sleep (eg, medication usage, environmental factors) were not measured.ConclusionsThe results of this study suggest that engagement in high-intensity activity and high fluctuations in activity are associated with poorer sleep at night; hence, activity modulation may be a key treatment strategy to address sleep complaints in individuals with chronic pain.

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