Heart rate variability as an objective biomarker for work-related musculoskeletal disorder risk: a cross-sectional study of Hong Kong (China) professionals

Abstract

Aim: To examine whether heart rate variability (HRV) parameters predict work-related musculoskeletal disorder (WMSD) risk profiles in Hong Kong (China) professionals and provide incremental predictive validity beyond self-reported perceived stress.

Methods: A cross-sectional study recruited 105 full-time office workers from Hong Kong’s financial, legal, healthcare, technology sectors, and other professionals across five corporate sites between December 2025 and February 2026. Participants completed HRV assessment using a photoplethysmography device (5-minute resting protocol plus 1-minute deep breathing protocol), the Perceived Stress Scale-14 (PSS-14), a musculoskeletal pain questionnaire, postural assessment (forward head posture index, thoracic kyphosis angle), and a sedentary behavior inventory. Pearson correlation, hierarchical multiple regression, mediation analysis (PROCESS Model 4), and moderation analysis (PROCESS Model 1) examined associations between HRV parameters, perceived stress, postural variables, and pain outcomes. Statistical significance was set at p < 0.05.

Results: HRV parameters were significantly negatively correlated with pain intensity (r = –0.31, p < 0.001) and multi-site pain burden (r = –0.38, p < 0.001). Normalized coherence emerged as the strongest HRV predictor of pain severity (β = –0.29, p < 0.001), explaining 11.4% additional variance beyond PSS-14 alone. Forward head posture and thoracic kyphosis statistically mediated the coherence–neck/shoulder pain association. Daily sedentary hours moderated the HRV-pain association, with workers exceeding 8 hours of seated work showing the strongest autonomic–musculoskeletal risk profiles.

Conclusions: HRV parameters, particularly normalized coherence, are associated with WMSD-relevant pain outcomes in Hong Kong office workers and capture variance not explained by self-reported stress alone. These findings support HRV as a potentially useful objective complement to existing WMSD risk-screening approaches in sedentary professional populations, although longitudinal validation is required before clinical application.

Keywords

heart rate variability / work-related musculoskeletal disorders / perceived stress / ergonomic risk / autonomic nervous system / sedentary behavior / occupational health / Hong Kong (China)

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