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Changes in physical activity and heart rate variability in chronic neck–shoulder pain: monitoring during work and leisure time
Objectives Neck–shoulder pain (NSP) is a common work-related musculoskeletal disorder with unclear mechanisms. Changes in physical activity and autonomic nervous system regulation may be involved in the pathogenesis of chronic NSP. The aim of the current study was to investigate autonomic regulation...
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| Published in: | International archives of occupational and environmental health 2014-10, Vol.87 (7), p.735-744 |
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| container_title | International archives of occupational and environmental health |
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| creator | Hallman, David M. Ekman, Annika Hed Lyskov, Eugene |
| description | Objectives
Neck–shoulder pain (NSP) is a common work-related musculoskeletal disorder with unclear mechanisms. Changes in physical activity and autonomic nervous system regulation may be involved in the pathogenesis of chronic NSP. The aim of the current study was to investigate autonomic regulation in relation to physical activity and perceived symptoms during work and leisure time among workers with chronic NSP (
n
= 29) as compared to a healthy control group (CON,
n
= 27).
Methods
Physical activity was objectively monitored for 7 days using accelerometry. Beat-to-beat heart rate was collected continuously for 72 h, with simultaneous momentary ratings of pain, stress, and fatigue. Duration of sitting/lying, standing and walking, number of steps, and energy expenditure were used as measures of physical activity. Heart rate variability (HRV) indices were extracted in time and frequency domains as reflecting autonomic regulation. Data were divided into work hours, leisure time, and sleep.
Results
The NSP group rated higher levels of stress and fatigue at work and leisure, and reduced sleep quality as compared to CON. Elevated heart rate and reduced HRV were found in NSP compared with CON, especially during sleep. The NSP group demonstrated a different pattern of physical activity than CON, with a lower activity level in leisure time. Higher physical activity was associated with increased HRV in both groups.
Conclusion
Changes in HRV reflected an autonomic imbalance in workers with chronic musculoskeletal pain. This can be explained by reduced physical activity in leisure time. Intervention studies aimed at increasing physical activity may shed further light on the association between autonomic regulation and physical activity in work-related NSP. |
| doi_str_mv | 10.1007/s00420-013-0917-2 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_swepu</sourceid><recordid>TN_cdi_swepub_primary_oai_DiVA_org_hig_13414</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1561970460</sourcerecordid><originalsourceid>FETCH-LOGICAL-c571t-358a206de34c42231493ef697782c5338cedc76966d641a3e971e724e9b20313</originalsourceid><addsrcrecordid>eNqNkctu1DAUQC0EosPAB7BBlhASCwJ-xU7YVUMLSJXYVGwtj3Nn4jaxg520ml3_gT_kS3BmhoKQkFjdxT33eRB6TslbSoh6lwgRjBSE8oLUVBXsAVpQwVlBmZAP0YJwsc_SE_QkpStCqJKKP0YnTFDJSFUt0N2qNX4LCTuPh3aXnDUdNnZ0N27cYeMb3IKJI45mBHxjojNr182pzNs2Bu8s9mCvf9x9T22YugYiHozz73Gfc2OIzm9xM-3DbYjX-5YduDRFwKPr4Sl6tDFdgmfHuESX52eXq0_FxZePn1enF4UtFR0LXlaGEdkAF1YwxqmoOWxkrVTFbMl5ZaGxStZSNlJQw6FWFBQTUK8Z4ZQv0ZtD23QLw7TWQ3S9iTsdjNMf3NdTHeJWt26rKRf5hUv0-oAPMXybII26d8lC1xkPYUqallJWnLHqv1BaKyIkyejLv9CrMEWfz95TgimmVKbogbIxpBRhc78sJXr2rg_edTarZ--a5ZoXx87TuofmvuKX6Ay8OgImZcWbaLx16TdXqaouy_kadvzTMDuD-MeK_5z-EwpmxXI</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1561427277</pqid></control><display><type>article</type><title>Changes in physical activity and heart rate variability in chronic neck–shoulder pain: monitoring during work and leisure time</title><source>Springer Nature</source><creator>Hallman, David M. ; Ekman, Annika Hed ; Lyskov, Eugene</creator><creatorcontrib>Hallman, David M. ; Ekman, Annika Hed ; Lyskov, Eugene</creatorcontrib><description>Objectives
Neck–shoulder pain (NSP) is a common work-related musculoskeletal disorder with unclear mechanisms. Changes in physical activity and autonomic nervous system regulation may be involved in the pathogenesis of chronic NSP. The aim of the current study was to investigate autonomic regulation in relation to physical activity and perceived symptoms during work and leisure time among workers with chronic NSP (
n
= 29) as compared to a healthy control group (CON,
n
= 27).
Methods
Physical activity was objectively monitored for 7 days using accelerometry. Beat-to-beat heart rate was collected continuously for 72 h, with simultaneous momentary ratings of pain, stress, and fatigue. Duration of sitting/lying, standing and walking, number of steps, and energy expenditure were used as measures of physical activity. Heart rate variability (HRV) indices were extracted in time and frequency domains as reflecting autonomic regulation. Data were divided into work hours, leisure time, and sleep.
Results
The NSP group rated higher levels of stress and fatigue at work and leisure, and reduced sleep quality as compared to CON. Elevated heart rate and reduced HRV were found in NSP compared with CON, especially during sleep. The NSP group demonstrated a different pattern of physical activity than CON, with a lower activity level in leisure time. Higher physical activity was associated with increased HRV in both groups.
Conclusion
Changes in HRV reflected an autonomic imbalance in workers with chronic musculoskeletal pain. This can be explained by reduced physical activity in leisure time. Intervention studies aimed at increasing physical activity may shed further light on the association between autonomic regulation and physical activity in work-related NSP.</description><identifier>ISSN: 0340-0131</identifier><identifier>ISSN: 1432-1246</identifier><identifier>EISSN: 1432-1246</identifier><identifier>DOI: 10.1007/s00420-013-0917-2</identifier><identifier>PMID: 24162088</identifier><identifier>CODEN: IAEHDW</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Accelerometry ; Adult ; Autonomic Nervous System - physiopathology ; Biological and medical sciences ; Cardiac dysrhythmias ; Cardiology. Vascular system ; Chronic Pain - epidemiology ; Chronic Pain - physiopathology ; Chronic Pain - psychology ; Daily physical activity ; Diseases of striated muscles. Neuromuscular diseases ; Diseases of the osteoarticular system ; Earth and Environmental Science ; Environment ; Environmental Health ; Exercise ; Exercise - physiology ; Fatigue ; Female ; Health Status ; Heart ; Heart rate ; Heart Rate - physiology ; Heart rate variability ; Humans ; Leisure Activities ; Male ; Medical sciences ; Mental Health ; Middle Aged ; Miscellaneous. Osteoarticular involvement in other diseases ; Monitoring, Ambulatory ; Musculoskeletal diseases ; Neck Pain - epidemiology ; Neck Pain - physiopathology ; Neck Pain - psychology ; Neurology ; Occupational health ; Occupational Medicine/Industrial Medicine ; Original Article ; Pain ; Perceived stress ; Rehabilitation ; Shoulder Pain - epidemiology ; Shoulder Pain - physiopathology ; Shoulder Pain - psychology ; Sleep ; Stress, Psychological - epidemiology ; Stress, Psychological - psychology ; Sympathetic ; Trapezius myalgia ; Work</subject><ispartof>International archives of occupational and environmental health, 2014-10, Vol.87 (7), p.735-744</ispartof><rights>Springer-Verlag Berlin Heidelberg 2013</rights><rights>2015 INIST-CNRS</rights><rights>Springer-Verlag Berlin Heidelberg 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c571t-358a206de34c42231493ef697782c5338cedc76966d641a3e971e724e9b20313</citedby><cites>FETCH-LOGICAL-c571t-358a206de34c42231493ef697782c5338cedc76966d641a3e971e724e9b20313</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28789554$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24162088$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-13414$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Hallman, David M.</creatorcontrib><creatorcontrib>Ekman, Annika Hed</creatorcontrib><creatorcontrib>Lyskov, Eugene</creatorcontrib><title>Changes in physical activity and heart rate variability in chronic neck–shoulder pain: monitoring during work and leisure time</title><title>International archives of occupational and environmental health</title><addtitle>Int Arch Occup Environ Health</addtitle><addtitle>Int Arch Occup Environ Health</addtitle><description>Objectives
Neck–shoulder pain (NSP) is a common work-related musculoskeletal disorder with unclear mechanisms. Changes in physical activity and autonomic nervous system regulation may be involved in the pathogenesis of chronic NSP. The aim of the current study was to investigate autonomic regulation in relation to physical activity and perceived symptoms during work and leisure time among workers with chronic NSP (
n
= 29) as compared to a healthy control group (CON,
n
= 27).
Methods
Physical activity was objectively monitored for 7 days using accelerometry. Beat-to-beat heart rate was collected continuously for 72 h, with simultaneous momentary ratings of pain, stress, and fatigue. Duration of sitting/lying, standing and walking, number of steps, and energy expenditure were used as measures of physical activity. Heart rate variability (HRV) indices were extracted in time and frequency domains as reflecting autonomic regulation. Data were divided into work hours, leisure time, and sleep.
Results
The NSP group rated higher levels of stress and fatigue at work and leisure, and reduced sleep quality as compared to CON. Elevated heart rate and reduced HRV were found in NSP compared with CON, especially during sleep. The NSP group demonstrated a different pattern of physical activity than CON, with a lower activity level in leisure time. Higher physical activity was associated with increased HRV in both groups.
Conclusion
Changes in HRV reflected an autonomic imbalance in workers with chronic musculoskeletal pain. This can be explained by reduced physical activity in leisure time. Intervention studies aimed at increasing physical activity may shed further light on the association between autonomic regulation and physical activity in work-related NSP.</description><subject>Accelerometry</subject><subject>Adult</subject><subject>Autonomic Nervous System - physiopathology</subject><subject>Biological and medical sciences</subject><subject>Cardiac dysrhythmias</subject><subject>Cardiology. Vascular system</subject><subject>Chronic Pain - epidemiology</subject><subject>Chronic Pain - physiopathology</subject><subject>Chronic Pain - psychology</subject><subject>Daily physical activity</subject><subject>Diseases of striated muscles. Neuromuscular diseases</subject><subject>Diseases of the osteoarticular system</subject><subject>Earth and Environmental Science</subject><subject>Environment</subject><subject>Environmental Health</subject><subject>Exercise</subject><subject>Exercise - physiology</subject><subject>Fatigue</subject><subject>Female</subject><subject>Health Status</subject><subject>Heart</subject><subject>Heart rate</subject><subject>Heart Rate - physiology</subject><subject>Heart rate variability</subject><subject>Humans</subject><subject>Leisure Activities</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Mental Health</subject><subject>Middle Aged</subject><subject>Miscellaneous. Osteoarticular involvement in other diseases</subject><subject>Monitoring, Ambulatory</subject><subject>Musculoskeletal diseases</subject><subject>Neck Pain - epidemiology</subject><subject>Neck Pain - physiopathology</subject><subject>Neck Pain - psychology</subject><subject>Neurology</subject><subject>Occupational health</subject><subject>Occupational Medicine/Industrial Medicine</subject><subject>Original Article</subject><subject>Pain</subject><subject>Perceived stress</subject><subject>Rehabilitation</subject><subject>Shoulder Pain - epidemiology</subject><subject>Shoulder Pain - physiopathology</subject><subject>Shoulder Pain - psychology</subject><subject>Sleep</subject><subject>Stress, Psychological - epidemiology</subject><subject>Stress, Psychological - psychology</subject><subject>Sympathetic</subject><subject>Trapezius myalgia</subject><subject>Work</subject><issn>0340-0131</issn><issn>1432-1246</issn><issn>1432-1246</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><recordid>eNqNkctu1DAUQC0EosPAB7BBlhASCwJ-xU7YVUMLSJXYVGwtj3Nn4jaxg520ml3_gT_kS3BmhoKQkFjdxT33eRB6TslbSoh6lwgRjBSE8oLUVBXsAVpQwVlBmZAP0YJwsc_SE_QkpStCqJKKP0YnTFDJSFUt0N2qNX4LCTuPh3aXnDUdNnZ0N27cYeMb3IKJI45mBHxjojNr182pzNs2Bu8s9mCvf9x9T22YugYiHozz73Gfc2OIzm9xM-3DbYjX-5YduDRFwKPr4Sl6tDFdgmfHuESX52eXq0_FxZePn1enF4UtFR0LXlaGEdkAF1YwxqmoOWxkrVTFbMl5ZaGxStZSNlJQw6FWFBQTUK8Z4ZQv0ZtD23QLw7TWQ3S9iTsdjNMf3NdTHeJWt26rKRf5hUv0-oAPMXybII26d8lC1xkPYUqallJWnLHqv1BaKyIkyejLv9CrMEWfz95TgimmVKbogbIxpBRhc78sJXr2rg_edTarZ--a5ZoXx87TuofmvuKX6Ay8OgImZcWbaLx16TdXqaouy_kadvzTMDuD-MeK_5z-EwpmxXI</recordid><startdate>20141001</startdate><enddate>20141001</enddate><creator>Hallman, David M.</creator><creator>Ekman, Annika Hed</creator><creator>Lyskov, Eugene</creator><general>Springer Berlin Heidelberg</general><general>Springer</general><general>Springer Nature B.V</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7T2</scope><scope>7T5</scope><scope>7TM</scope><scope>7U7</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>PATMY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PYCSY</scope><scope>Q9U</scope><scope>7X8</scope><scope>7TS</scope><scope>7U2</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8W</scope></search><sort><creationdate>20141001</creationdate><title>Changes in physical activity and heart rate variability in chronic neck–shoulder pain: monitoring during work and leisure time</title><author>Hallman, David M. ; Ekman, Annika Hed ; Lyskov, Eugene</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c571t-358a206de34c42231493ef697782c5338cedc76966d641a3e971e724e9b20313</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Accelerometry</topic><topic>Adult</topic><topic>Autonomic Nervous System - physiopathology</topic><topic>Biological and medical sciences</topic><topic>Cardiac dysrhythmias</topic><topic>Cardiology. Vascular system</topic><topic>Chronic Pain - epidemiology</topic><topic>Chronic Pain - physiopathology</topic><topic>Chronic Pain - psychology</topic><topic>Daily physical activity</topic><topic>Diseases of striated muscles. Neuromuscular diseases</topic><topic>Diseases of the osteoarticular system</topic><topic>Earth and Environmental Science</topic><topic>Environment</topic><topic>Environmental Health</topic><topic>Exercise</topic><topic>Exercise - physiology</topic><topic>Fatigue</topic><topic>Female</topic><topic>Health Status</topic><topic>Heart</topic><topic>Heart rate</topic><topic>Heart Rate - physiology</topic><topic>Heart rate variability</topic><topic>Humans</topic><topic>Leisure Activities</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Mental Health</topic><topic>Middle Aged</topic><topic>Miscellaneous. Osteoarticular involvement in other diseases</topic><topic>Monitoring, Ambulatory</topic><topic>Musculoskeletal diseases</topic><topic>Neck Pain - epidemiology</topic><topic>Neck Pain - physiopathology</topic><topic>Neck Pain - psychology</topic><topic>Neurology</topic><topic>Occupational health</topic><topic>Occupational Medicine/Industrial Medicine</topic><topic>Original Article</topic><topic>Pain</topic><topic>Perceived stress</topic><topic>Rehabilitation</topic><topic>Shoulder Pain - epidemiology</topic><topic>Shoulder Pain - physiopathology</topic><topic>Shoulder Pain - psychology</topic><topic>Sleep</topic><topic>Stress, Psychological - epidemiology</topic><topic>Stress, Psychological - psychology</topic><topic>Sympathetic</topic><topic>Trapezius myalgia</topic><topic>Work</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hallman, David M.</creatorcontrib><creatorcontrib>Ekman, Annika Hed</creatorcontrib><creatorcontrib>Lyskov, Eugene</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Toxicology Abstracts</collection><collection>ProQuest Health and Medical</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection (Proquest) (PQ_SDU_P3)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>ProQuest Science Journals</collection><collection>Environmental Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>Environmental Science Collection</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>Physical Education Index</collection><collection>Safety Science and Risk</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Högskolan i Gävle</collection><jtitle>International archives of occupational and environmental health</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hallman, David M.</au><au>Ekman, Annika Hed</au><au>Lyskov, Eugene</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Changes in physical activity and heart rate variability in chronic neck–shoulder pain: monitoring during work and leisure time</atitle><jtitle>International archives of occupational and environmental health</jtitle><stitle>Int Arch Occup Environ Health</stitle><addtitle>Int Arch Occup Environ Health</addtitle><date>2014-10-01</date><risdate>2014</risdate><volume>87</volume><issue>7</issue><spage>735</spage><epage>744</epage><pages>735-744</pages><issn>0340-0131</issn><issn>1432-1246</issn><eissn>1432-1246</eissn><coden>IAEHDW</coden><abstract>Objectives
Neck–shoulder pain (NSP) is a common work-related musculoskeletal disorder with unclear mechanisms. Changes in physical activity and autonomic nervous system regulation may be involved in the pathogenesis of chronic NSP. The aim of the current study was to investigate autonomic regulation in relation to physical activity and perceived symptoms during work and leisure time among workers with chronic NSP (
n
= 29) as compared to a healthy control group (CON,
n
= 27).
Methods
Physical activity was objectively monitored for 7 days using accelerometry. Beat-to-beat heart rate was collected continuously for 72 h, with simultaneous momentary ratings of pain, stress, and fatigue. Duration of sitting/lying, standing and walking, number of steps, and energy expenditure were used as measures of physical activity. Heart rate variability (HRV) indices were extracted in time and frequency domains as reflecting autonomic regulation. Data were divided into work hours, leisure time, and sleep.
Results
The NSP group rated higher levels of stress and fatigue at work and leisure, and reduced sleep quality as compared to CON. Elevated heart rate and reduced HRV were found in NSP compared with CON, especially during sleep. The NSP group demonstrated a different pattern of physical activity than CON, with a lower activity level in leisure time. Higher physical activity was associated with increased HRV in both groups.
Conclusion
Changes in HRV reflected an autonomic imbalance in workers with chronic musculoskeletal pain. This can be explained by reduced physical activity in leisure time. Intervention studies aimed at increasing physical activity may shed further light on the association between autonomic regulation and physical activity in work-related NSP.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>24162088</pmid><doi>10.1007/s00420-013-0917-2</doi><tpages>10</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0340-0131 |
| ispartof | International archives of occupational and environmental health, 2014-10, Vol.87 (7), p.735-744 |
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| language | eng |
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| source | Springer Nature |
| subjects | Accelerometry Adult Autonomic Nervous System - physiopathology Biological and medical sciences Cardiac dysrhythmias Cardiology. Vascular system Chronic Pain - epidemiology Chronic Pain - physiopathology Chronic Pain - psychology Daily physical activity Diseases of striated muscles. Neuromuscular diseases Diseases of the osteoarticular system Earth and Environmental Science Environment Environmental Health Exercise Exercise - physiology Fatigue Female Health Status Heart Heart rate Heart Rate - physiology Heart rate variability Humans Leisure Activities Male Medical sciences Mental Health Middle Aged Miscellaneous. Osteoarticular involvement in other diseases Monitoring, Ambulatory Musculoskeletal diseases Neck Pain - epidemiology Neck Pain - physiopathology Neck Pain - psychology Neurology Occupational health Occupational Medicine/Industrial Medicine Original Article Pain Perceived stress Rehabilitation Shoulder Pain - epidemiology Shoulder Pain - physiopathology Shoulder Pain - psychology Sleep Stress, Psychological - epidemiology Stress, Psychological - psychology Sympathetic Trapezius myalgia Work |
| title | Changes in physical activity and heart rate variability in chronic neck–shoulder pain: monitoring during work and leisure time |
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