Device-measured sitting time and musculoskeletal pain in adults with normal glucose metabolism, prediabetes and type 2 diabetes–The Maastricht Study

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Thank you to Dr. Francis Q.S. Dzakpasu for sharing a summary of their study titled “Device-measured sitting time and musculoskeletal pain in adults with normal glucose metabolism, prediabetes and type 2 diabetes–The Maastricht Study” recently published in PLOS ONE. The full publication can be found here (open access). The summary of the paper and citation details are posted below.

An analysis of a large population-based epidemiological cross-sectional data examined the linear and non-linear relationships of device-measured sitting time with musculoskeletal pain outcomes in community-dwelling middle-aged and older adults – separately in those with type 2 diabetes, prediabetes, and normal glucose metabolism. The findings indicate the statistically significant association observed between the volume of daily sitting time and knee pain may be in a linear function and potentially driven by the presence of type 2 diabetes. In that, the significant association observed was only seen in the subgroup with type 2 diabetes but not in those with prediabetes nor normal glucose metabolism. Furthermore, though no statistically significant associations were observed with neck, shoulder, and low back pain of daily sitting time, the relationships appear to be curvilinear. This study provides some initial insight into the potential detrimental association of sedentary behaviour with musculoskeletal pain-related outcomes (knee pain) in type 2 diabetes which could be relevant for future studies exploring the role of sedentary behaviour in the pathogenesis of musculoskeletal pain, specifically knee pain in type 2 diabetes.



Detrimental associations of sedentary behaviour (time spent sitting) with musculoskeletal pain (MSP) conditions have been observed. However, findings on those with, or at risk of, type 2 diabetes(T2D) have not been reported. We examined the linear and non-linear associations of device-measured daily sitting time with MSP outcomes according to glucose metabolism status (GMS).


Cross-sectional data from 2827 participants aged 40–75 years in the Maastricht Study (1728 with normal glucose metabolism (NGM); 441 with prediabetes; 658 with T2D), for whom valid data were available on activPAL-derived daily sitting time, MSP [neck, shoulder, low back, and knee pain], and GMS. Associations were examined by logistic regression analyses, adjusted serially for relevant confounders, including moderate-to-vigorous intensity physical activity (MVPA) and body mass index (BMI). Restricted cubic splines were used to further examine non-linear relationships.


The fully adjusted model (including BMI, MVPA, and history of cardiovascular disease) showed daily sitting time to be significantly associated with knee pain in the overall sample (OR = 1.07, 95%CI: 1.01–1.12) and in those with T2D (OR = 1.11, 95%CI: 1.00–1.22); this was not statistically significant in those with prediabetes (OR = 1.04, 95%CI: 0.91–1.18) or NGM (OR = 1.05, 95%CI: 0.98–1.13). There were no statistically significant associations between daily sitting time and neck, shoulder, or low back pain in any of the models. Furthermore, the non-linear relationships were statistically non-significant.


Among middle-aged and older adults with T2D, daily sitting time was significantly associated with higher odds of knee pain, but not with neck, shoulder, or low back pain. No significant association was observed in those without T2D for neck, shoulder, low back, or knee pain. Future studies, preferably those utilising prospective designs, could examine additional attributes of daily sitting (e.g., sitting bouts and domain-specific sitting time) and the potential relationships of knee pain with mobility limitations.


Dzakpasu FQS, Koster A, Owen N, Galan BEd, Carver A, Brakenridge CJ, et al. (2023) Device-measured sitting time and musculoskeletal pain in adults with normal glucose metabolism, prediabetes and type 2 diabetes–The Maastricht Study. PLoS ONE 18(5): e0285276.

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