The effect of physical activity in leisure time on neck and upper limb symptoms S.G. van den Heuvel, M.A. a,b, * , J. Heinrich, M.S. a , M.P. Jans, Ph.D. a , A.J. van der Beek, Ph.D. b,c , P.M. Bongers, Ph.D. a,b a TNO Work and Employment, RSI and Physical Activity, P.O. Box 718, 2130 AS, Hoofddorp, The Netherlands b Body@Work, Research Center Physical Activity, Work and Health TNO VUmc, The Netherlands c Department of Public and Occupational Health, Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands Available online 30 December 2004 Abstract Background. Little is known of the preventive effects of physical activity in leisure time on neck and upper limb symptoms. Methods. A cohort of 1742 employees was selected from a prospective cohort study with a follow-up period of 3 years. Independent variables were sporting activities and physically active commuting. Outcome measures were neck/shoulder symptoms and elbow/wrist/hand symptoms as well as sickness absence due to these symptoms. To analyze the data, the generalized estimating equation (GEE) method was used, with adjustment for individual characteristics, such as age, gender, lifestyle, and the outcome at baseline. Results. Practicing sports for at least 10 months a year decreased the risk of neck/shoulder symptoms (OR: 0.82; CI: 0.67–0.99), sickness absence (OR: 0.48; CI: 0.28–0.84), and long-term sickness absence (OR: 0.37; CI: 0.17–0.84) due to neck or upper limb symptoms. A high mean intensity (z3 h per week) of sporting activities had less effect than the continuation of these activities throughout the year. Conclusion. Sustained sporting activities have a favorable effect on neck/shoulder symptoms and on sickness absence due to neck or upper limb symptoms. An effect of physically active commuting could not be demonstrated, although there was a tendency towards a favorable effect on sickness absence. D 2004 Elsevier Inc. All rights reserved. Keywords: Cohort study; GEE model; Sports; Commuting Introduction In general, the assumption that a physically active lifestyle has a favorable effect on health is widely accepted [1]. Studies have shown the relationship between physical activity and several health outcomes such as mortality [1,2], cardiovascular diseases [1,3,4], and cancer [1,4–6]. Whether physical activity prevents musculoskeletal disorders, and especially neck and upper limb complaints, is not yet clear. Sports and exercises can cause musculoskeletal injuries. However, these injuries mainly concern the lower extrem- ities [1]. In their review, Hildebrandt et al. found associations between physical activity in leisure time and musculoskeletal symptoms, although the results of the studies were somewhat inconsistent [7]. In another review, Hoogendoorn et al. found no evidence for an effect of physical activity during leisure time on low back pain [8]. However, the review of Vuori concluded that physical activity could be effective in preventing low back pain [9]. Studies on the association between physical activity and musculoskeletal complaints mostly concern low back pain, whereas studies on neck and upper limb complaints are rare. AriJns et al. concluded in their review that there was inconclusive evidence for a relationship between sports and exercise and neck pain [10], but hardly any high-quality studies were found. Miranda et al. evaluated the effects of physical activity and sports on shoulder pain among forestry workers and concluded that 0091-7435/$ - see front matter D 2004 Elsevier Inc. All rights reserved. doi:10.1016/j.ypmed.2004.11.006 * Corresponding author. TNO Work and Employment, RSI and Physical Activity, P.O. Box 718, 2130 AS, Hoofddorp, The Netherlands. Fax: +31 235549304. E-mail address: S.vdHeuvel@arbeid.tno.nl (S.G. van den Heuvel). Preventive Medicine 41 (2005) 260 – 267 www.elsevier.com/locate/ypmed