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Original research
Joint associations of occupational standing and occupational exertion with musculoskeletal symptoms in a US national sample
  1. Ciaran P Friel1,2,
  2. Christian B Pascual3,
  3. Andrea T Duran2,
  4. Jeff Goldsmith3,
  5. Keith M Diaz2
  1. 1 Feinstein Institutes of Medical Research, Northwell Health, Manhasset, New York, USA
  2. 2 Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, New Yok, USA
  3. 3 Department of Biostatistics, Columbia University, New York, New York, USA
  1. Correspondence to Dr Keith M Diaz, Columbia University Medical Center, New York, NY 10032, USA; kd2442{at}


Objective Observational studies have linked occupational standing or walking to musculoskeletal pain. These prior studies, however, are flawed as few accounted for physical exertion; a potential confounder that accompanies many standing-based occupations. The purpose of this study was to examine the individual and joint associations of occupational standing/walking and exertion with musculoskeletal symptoms.

Methods Data for this analysis come from the 2015 National Health Interview Survey, a US nationally representative survey. Occupational standing/walking and exertion were assessed by self-report on a 5-point Likert scale. The presence of musculoskeletal symptoms (pain, aching and stiffness) for upper extremities (neck, shoulders, elbows, wrists and fingers), lower extremities (hips, knees, ankles and toes) and lower back was also assessed.

Results Occupational standing/walking was associated with a greater likelihood of upper extremity, lower extremity and lower back musculoskeletal symptoms; however, associations were attenuated and no longer significant with adjustment for exertion. When stratified by levels of occupational exertion, occupational standing/walking was associated with musculoskeletal symptoms only among the group with high exertion (eg, OR=1.69 (95% CI: 1.48 to 1.94) for lower back symptoms comparing high/high for standing or walking/exertion vs low/low). Among groups with low exertion, occupational standing/walking was not associated with musculoskeletal symptoms (eg, OR=1.00 (95% CI: 0.85 to 1.16) for lower back symptoms comparing high/low for standing or walking/exertion vs low/low).

Conclusion Results from this US representative survey suggest that the association between occupational standing/walking and musculoskeletal symptoms is largely driven by the co-occurrence of occupational exertion and does not provide evidence that standing or walking incurs adverse musculoskeletal symptoms.

  • musculoskeletal
  • physical work
  • epidemiology

Data availability statement

Data are available in a public, open access repository. Data are publicly available at

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Data availability statement

Data are available in a public, open access repository. Data are publicly available at

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  • Contributors CF and KMD designed and conceived the study, interpreted the data and wrote the manuscript. CP and JG conducted statistical analyses. AD interpreted the data and reviewed the manuscript. All authors have approved the final draft to be published.

  • Funding CF is supported by grant T32 HL07342-41 from the National Heart, Lung, and Blood Institute/National Institutes of Health. KMD is supported by grant R01-HL134985 from the National Heart, Lung, and Blood Institute/National Institutes of Health.

  • Competing interests None declared.

  • Patient and public involvement statement This research was done without patient involvement. Patients were not invited to comment on the study design and were not consulted to develop patient relevant outcomes or interpret the results. Patients were not invited to contribute to the writing or editing of this document for readability or accuracy.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.