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Epidemiology and Population Health

Physical activity mediates the relationship between weight status and pain impacting daily activities

International Journal of Obesity volume 49, pages 1882–1890 (2025)Cite this article

Subjects

Abstract

Background

Individuals who have chronic pain experience reductions in physical activity (PA), quality of life, and physical capabilities, creating a debilitating cycle where decreased PA and increased weight exacerbate pain. This study aimed to examine associations between weight status, PA, and time spent in pain using a nationally representative sample, accounting for demographic factors.

Methods

Using data from the 2011–2012 NHANES cycle, a comparison of pain groups with weight status and PA (total and type) and a mediation analysis using PA (total and type) as a mediator between weight status and time spent in pain were conducted.

Results

Total PA groups differed in pain levels with those engaging in vigorous activity having the lowest prevalence in the "pain always" category (5.4%), and those with obesity had a higher prevalence of “pain always” (49.6%) compared to those with normal weight (19.5%) and those with overweight (30.9%). Total PA mediated the relationship between people with obesity and the amount of time spent in pain (effect:1.141; CI:0.456–1.837), that is, compared to those who have normal weight, those who have obesity were less likely to meet the total PA guideline, and subsequently likely to spend more days in pain. Breaking down PA by types, travel PA (effect:0.071; CI:0.024–0.152), moderate recreational PA (effect:0.041; CI:0.018–0.079), and vigorous recreational PA (effect:0.135; CI:0.035–0.279) significantly mediated the relationships between people with obesity and days spent in pain.

Conclusion

Findings suggest that vigorous PA is linked to lower pain prevalence. Additionally, PA significantly mediates the relationship between people with obesity and days spent in pain. While people with overweight alone was not associated with the number of days spent in pain, engaging in vigorous recreational activities was linked to reductions in days spent in pain for individuals with overweight, highlighting the importance of staying active to manage pain.

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Fig. 1
Fig. 2: Final mediation models of weight status, physical activity and days spent in pain.

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Data availability

The datasets generated during and/or analyzed during the current study were extracted from the National Health and Nutrition Examination Study (NHANES) 2011-2012 repository, https://wwwn.cdc.gov/nchs/nhanes/search/datapage.aspx?Component=Demographics&Cycle=2011-2012. The specified extracted data and their applicable datasets, generated during and/or analyzed during the current study, are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Department of Health and Exercise Science, University of Oklahoma, Norman, OK, USA

    Jessica A. Peterson, Ashley Venturini, Daniel J. Larson, Yu Lu, Rebecca D. Larson & Christopher D. Black

  2. Department of Kinesiology, New Mexico State University, Las Cruces, NM, USA

    Jessica A. Peterson

  3. North Florida Foundation for Research and Education, Malcom Randall Veterans Medical Center, Gainesville, FL, USA

    Jessica A. Peterson

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Contributions

JP drafted the manuscript, performed data analysis, created tables and figures, and made revisions. AV contributed to the conceptualization of the study, assisted with drafting the manuscript, and participated in data collection. DL and YL served as primary data analysts and statisticians for the project. RL assisted in the study design and reviewed and approved the initial and subsequent manuscript drafts. CB designed the study, contributed to conceptualization, participated in data extraction, and provided overall project oversight and management. All authors made edits, reviewed, and approved the manuscript at various points of submission.

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Correspondence to Christopher D. Black.

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Peterson, J.A., Venturini, A., Larson, D.J. et al. Physical activity mediates the relationship between weight status and pain impacting daily activities. Int J Obes 49, 1882–1890 (2025). https://doi.org/10.1038/s41366-025-01838-x

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