Among 16,000+ adults aged 50+ with persistent pain drawn from the HRS (U.S.), ELSA (UK), and SHARE (Europe), physical activity was the only resource indicator—out of six prespecified candidates—to meet a stringent Holm-corrected significance threshold for predicting maintained independence in activities of daily living (ADL). The pooled risk ratio was 1.145 (95% CI: 1.097–1.195), meaning physically active older adults with chronic pain were roughly 14.5% more likely to remain fully independent across all five ADL domains at follow-up. Wealth, education, partner status, cognitive recall, and depressive symptom burden did not survive multiple-testing correction, though heterogeneity in those estimates warrants caution before dismissing them.
This finding matters because chronic pain is one of the most prevalent drivers of functional decline in aging populations, yet most interventions target pain relief rather than functional preservation. The result repositions physical activity as a resilience resource—not merely a pain-management tool—consistent with mechanistic literature linking movement to neuromuscular maintenance and inflammatory regulation. That said, this is an observational, non-causal study; reverse causation (healthier people exercise more) cannot be ruled out. Complete-case analysis and cohort-specific sample sizes introduce further limitations. Critically, this is a preprint posted on medRxiv and has not yet undergone peer review—findings should be interpreted cautiously. If replicated in randomized trials, the 14.5% functional-maintenance advantage would constitute a clinically meaningful, cost-accessible target for geriatric pain programs.
