International archives of occupational and environmental health · 2026
Fatigue, physical activity, and musculoskeletal burden in adults surveyed during the COVID-19 pandemic: a cross-sectional indirect-association analysis.
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Аннотация
OBJECTIVE: To examine the independent cross-sectional associations of fatigue and total physical activity with musculoskeletal burden and to estimate indirect associations through fatigue for prior COVID-19 infection, sex, and educational attainment.
METHODS: Questionnaire data were obtained from 400 community-dwelling adults aged ≥ 60 years surveyed in Antalya, Türkiye, in 2021. Physical activity, musculoskeletal discomfort, and fatigue were assessed using the Physical Activity Scale for the Elderly (PASE), the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ), and the Multidimensional Assessment of Fatigue. The Global Fatigue Index (GFI) was calculated for all participants. Regression models used heteroskedasticity-consistent (HC3) standard errors; robustness was examined with outcome transformation, winsorization, and influential-observation analysis. Indirect associations were estimated with 5,000 bootstrap samples.
RESULTS: The regression sample comprised 388 participants; 54.1% had a CMDQ score of zero. Higher GFI was associated with greater CMDQ burden (B = 3.114, SE = 0.566, p < 0.001), and this association remained positive across sensitivity analyses. PASE total was not associated with CMDQ in the primary model (B = - 0.053, p = 0.245), but its coefficient became significant after exclusion of influential observations (B = - 0.044, p = 0.027). Bootstrap 95% CIs for indirect estimates through GFI excluded zero for prior infection (15.55; 6.02-26.89), female sex (8.66; 1.49-17.55), and ordinal education (- 4.61; -9.68 to - 0.65).
CONCLUSIONS: Fatigue showed a consistent concurrent association with musculoskeletal burden, whereas the association with total physical activity was less stable. The indirect estimates are cross-sectional and do not establish temporal or causal mediation.
METHODS: Questionnaire data were obtained from 400 community-dwelling adults aged ≥ 60 years surveyed in Antalya, Türkiye, in 2021. Physical activity, musculoskeletal discomfort, and fatigue were assessed using the Physical Activity Scale for the Elderly (PASE), the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ), and the Multidimensional Assessment of Fatigue. The Global Fatigue Index (GFI) was calculated for all participants. Regression models used heteroskedasticity-consistent (HC3) standard errors; robustness was examined with outcome transformation, winsorization, and influential-observation analysis. Indirect associations were estimated with 5,000 bootstrap samples.
RESULTS: The regression sample comprised 388 participants; 54.1% had a CMDQ score of zero. Higher GFI was associated with greater CMDQ burden (B = 3.114, SE = 0.566, p < 0.001), and this association remained positive across sensitivity analyses. PASE total was not associated with CMDQ in the primary model (B = - 0.053, p = 0.245), but its coefficient became significant after exclusion of influential observations (B = - 0.044, p = 0.027). Bootstrap 95% CIs for indirect estimates through GFI excluded zero for prior infection (15.55; 6.02-26.89), female sex (8.66; 1.49-17.55), and ordinal education (- 4.61; -9.68 to - 0.65).
CONCLUSIONS: Fatigue showed a consistent concurrent association with musculoskeletal burden, whereas the association with total physical activity was less stable. The indirect estimates are cross-sectional and do not establish temporal or causal mediation.