Orthopaedic disorders, encompassing a wide spectrum of musculoskeletal issues such as osteoarthritis, lower back pain, osteoporosis, and postural abnormalities, are becoming increasingly prevalent worldwide due to sedentary lifestyles, aging populations, and lack of preventive care. In India, the burden of these conditions is exacerbated by limited awareness, delayed health-seeking behavior, and inadequate emphasis on preventive strategies. Scientific evidence strongly supports that regular physical activity plays a pivotal role in maintaining musculoskeletal health, improving joint mobility, strengthening bones and muscles, and reducing the risk of chronic orthopaedic conditions. However, despite its proven benefits, physical activity remains undervalued in daily life, particularly in non-urban regions.1-5

Himachal Pradesh, a hilly state in northern India, presents unique lifestyle patterns due to its terrain, rural predominance, and cultural practices. While the landscape may encourage natural physical exertion in daily routines, modernization, urban migration, and changing occupational structures have led to increasingly sedentary habits, even in rural communities. Consequently, the risk of orthopaedic disorders is rising, especially among middle-aged and older adults. Compounding this trend is the general lack of public knowledge regarding the preventive role of physical activity, which often leads to reliance on curative rather than proactive health behaviors.6-8

In this context, assessing public awareness about the significance of physical activity in preventing orthopaedic ailments is essential for guiding health promotion strategies and early intervention efforts. Despite multiple national campaigns advocating exercise and movement for overall well-being, specific attention to orthopaedic prevention remains limited in public discourse.9,10 There is a pressing need to understand how residents of Himachal Pradesh perceive the link between regular physical activity and bone and joint health, and whether demographic factors influence this awareness. Therefore, the present study aims to evaluate the knowledge, attitudes, and practices of the adult population in Himachal Pradesh regarding physical activity as a preventive tool against orthopaedic disorders. The findings are intended to inform regional health education campaigns and policy interventions aimed at fostering musculoskeletal well-being through active living.

This descriptive, cross-sectional study was conducted to evaluate the awareness of adults in Himachal Pradesh regarding the role of physical activity in preventing orthopaedic disorders. The aim was to understand the population's knowledge, attitudes, and self-reported practices concerning physical activity as a preventive measure against musculoskeletal problems such as joint stiffness, osteoporosis, postural imbalances, and chronic back or neck pain.

Study Area and Population

The study targeted adults aged 18 years and above residing in various districts of Himachal Pradesh, including both rural and urban areas. Participants represented diverse socio-economic, educational, and occupational backgrounds. Individuals with formal medical or physiotherapy education were excluded to ensure the responses reflected general public knowledge.

Sample Size and Sampling Technique

A total of 400 participants were included in the study. The sample size was determined using a 95% confidence level, 5% margin of error, and an assumed 50% awareness level. A purposive and convenience sampling method was adopted. The digital nature of the survey allowed broad dissemination across different regions of the state.

Data Collection Tool

Data were collected using a structured questionnaire created through Google Forms. The questionnaire was developed in both English and Hindi to ensure clarity and accessibility for participants with varying literacy levels. It was circulated via WhatsApp, email, and social media platforms. The tool was validated through expert consultation with orthopaedic surgeons, physiotherapists, and public health professionals to ensure relevance and accuracy.

The questionnaire included three key sections:

1. Socio-Demographic Profile – capturing age, gender, education level, occupation, residence, and marital status.
2. Awareness Assessment – comprising 20 multiple-choice questions assessing knowledge of physical activity’s benefits for joint flexibility, bone density, postural alignment, and prevention of musculoskeletal disorders.
3. Behavior and Attitudes – evaluating participants’ engagement in physical activity, perceived barriers, and sources of health information.

Pilot Testing

A pilot test was conducted on 30 individuals from different backgrounds to assess the clarity, flow, and digital accessibility of the questionnaire. Minor modifications were made to improve language simplicity and relevance based on feedback.

Scoring and Classification

Each correct response in the awareness section was awarded one point, with a total possible score of 20. Awareness levels were classified as:

• Very Good: 17–20
• Good: 13–16
• Fair: 9–12
• Poor: 0–8

This classification helped analyze awareness trends across different demographic segments.

Ethical Considerations

The study was conducted in accordance with the Declaration of Helsinki. Participation was voluntary, and informed electronic consent was obtained prior to beginning the survey. Anonymity and confidentiality of participants' responses were strictly maintained.

Data Analysis

Collected data were exported from Google Forms to Microsoft Excel and analyzed using Epi Info Version 7. Descriptive statistics such as frequencies and percentages were used to summarize the data. Chi-square tests were applied to evaluate associations between awareness scores and socio-demographic variables, with a p-value < 0.05 considered statistically significant.

Table 1 outlines the demographic profile of the 400 respondents surveyed in the study. The age distribution was balanced, with the highest representation from participants aged 46 and above (30.7%), followed by those aged 26–35 years (29.0%) and 36–45 years (24.5%), indicating a wide coverage across adult age groups. Gender distribution was nearly even, with males comprising 51.8% and females 48.3%. Educational background varied significantly, with a notable proportion of respondents having completed secondary education (34.3%) and undergraduate degrees (29.3%), though a concerning 23.8% had only primary or no formal education. In terms of occupation, the private sector (21.5%), government employees (17.0%), and homemakers (19.8%) were prominent, showing diversity in employment types. Rural respondents formed a majority (56.0%), highlighting the importance of understanding health awareness in non-urban populations. Most participants were married (65.5%), followed by unmarried individuals (28.0%). This demographic mix provides a strong foundation for exploring variations in physical activity awareness across different socio-economic and geographic segments.

Table 1: Socio-Demographic Characteristics of Participants (n = 400)

Table 2 presents the findings from 20 awareness-based questions evaluating participants’ knowledge of the benefits of physical activity in preventing orthopaedic disorders. Correct response rates ranged from 62.8% to 75.3%, indicating generally moderate to high levels of awareness. The majority (75.3%) correctly acknowledged that regular physical activity can prevent bone and joint issues. High awareness was also seen for the benefits of walking (73.5%), improving joint flexibility (72.0%), and managing back pain through exercise (70.3%). However, fewer participants identified correct frequencies of physical activity (62.8%) and specific types of beneficial exercises like weight-bearing activities (65.8%). A notable portion also lacked clarity on the integration of stretching and rehabilitation in orthopedic health. Overall, while most participants had a fair understanding of the link between physical activity and musculoskeletal well-being, the findings emphasize a need for targeted health education focused on practical aspects and frequency of physical activity.

Table 2: Awareness Questions on Role of Physical Activity in Preventing Orthopaedic Disorders (n = 400)

Table 3 summarizes the overall knowledge scores derived from the 20-item questionnaire. About 30.5% of the participants fell into the “Very Good” awareness category (scores 17–20), while 35.8% scored in the “Good” range (13–16), making up more than two-thirds of the total sample. Meanwhile, 22.8% demonstrated only “Fair” knowledge (9–12), and 11.0% were classified under “Poor” awareness (scores below 9). These results indicate that although a substantial proportion of the population understands the orthopedic benefits of physical activity, nearly one-third still require significant educational reinforcement. The distribution of scores supports the hypothesis that while awareness is growing, disparities remain—particularly among underserved or less-educated demographics.

Table 3: Knowledge Score Classification among Participants (n = 400)

Table 4 explores the statistical associations between awareness levels and socio-demographic variables. Age showed a significant correlation (p = 0.021), with the 26–35 and 36–45 age groups displaying the highest awareness, while those aged 46 and above had the largest share of Fair and Poor scores. Education level emerged as the strongest predictor of awareness (p < 0.001), with participants holding undergraduate and postgraduate degrees largely concentrated in the “Very Good” and “Good” categories, in contrast to lower scores among those with limited or no formal education. Occupational status was also a significant factor (p = 0.033); government employees, students, and private sector workers had better awareness than homemakers and retired individuals. Residence showed a significant urban–rural disparity (p = 0.039), with urban respondents performing better overall. Gender differences were not statistically significant (p = 0.198), suggesting that awareness campaigns could be equally effective across both sexes. These insights underscore the need for targeted interventions tailored to rural, older, and less-educated populations to bridge the existing knowledge gaps.

Table 4: Association between Knowledge Score and Socio-Demographic Variables (n = 400)

This study provides a detailed snapshot of public awareness regarding the preventive role of physical activity in orthopaedic health among adults in Himachal Pradesh. The overall findings indicate a moderately high level of awareness, with a majority of participants scoring in the "Very Good" and "Good" categories. Participants demonstrated strong knowledge in areas such as the role of exercise in joint flexibility, posture improvement, and the prevention of osteoporosis and age-related bone deterioration. The recognition that walking and brisk physical activities contribute to bone strength further reflects a growing public understanding of the value of daily movement for musculoskeletal health.

Despite this encouraging baseline, notable gaps persist—particularly in knowledge about the optimal frequency of physical activity, identification of weight-bearing exercises, and misconceptions about the role of stretching and physical rehabilitation. For instance, fewer than two-thirds of participants correctly identified that exercise should be performed at least five times per week to benefit bone health. These gaps highlight the difference between general awareness and specific, actionable understanding, which is essential to convert knowledge into effective daily habits.

Sociodemographic variables revealed distinct patterns influencing awareness. Education was the most significant determinant, with participants holding higher academic qualifications demonstrating consistently better scores. This is consistent with previous public health research showing a positive correlation between education and health literacy. Similarly, younger and middle-aged adults (especially those between 26 and 45 years) outperformed older age groups, who ironically stand to benefit the most from preventive orthopaedic behaviors. This age-related disparity suggests that while younger populations may have better access to digital information and wellness campaigns, older adults may require more targeted, in-person education interventions.

Occupation also influenced awareness levels, with students, government employees, and private-sector workers showing higher scores than homemakers, self-employed individuals, and retirees. These occupational trends may reflect differential access to workplace health information, internet usage, and formal education. Furthermore, the study underscored the urban–rural divide, with urban participants demonstrating significantly better awareness than their rural counterparts. Given that over half the participants were from rural areas, this finding stresses the urgent need for decentralized, community-level health education programs.

Interestingly, gender was not a statistically significant factor in awareness levels, suggesting that public health messaging related to physical activity has been relatively gender-neutral in its reach. However, slightly higher scores among men might reflect disparities in social roles, access to health services, or exposure to external information sources.

Another critical insight from the questionnaire responses was the persistence of misconceptions—particularly the belief that individuals with arthritis or older adults should avoid physical activity. Such misunderstandings can lead to avoidable disability and decreased quality of life. Similarly, the lower awareness regarding the role of rehabilitation exercises and stretching suggests a lack of familiarity with holistic musculoskeletal care approaches.

Overall, while awareness of the benefits of physical activity for orthopaedic health appears to be increasing in Himachal Pradesh, it remains unevenly distributed and lacks depth in practical application. Bridging this gap will require structured health communication strategies that are culturally appropriate, accessible in local languages, and tailored to the needs of less-educated, older, and rural populations. Emphasis should also be placed on correcting misconceptions and promoting safe, age-appropriate physical activity across all demographic segments.8-10

Limitations

This study, while insightful, had certain limitations. The use of a digital, self-administered questionnaire distributed through social media platforms may have excluded individuals without internet access or digital literacy, potentially underrepresenting older adults and those from remote rural areas. The convenience sampling method limits the generalizability of findings to the broader population of Himachal Pradesh. Additionally, the cross-sectional nature of the study captures awareness at a single point in time and does not assess changes over time or the impact of interventions. Finally, self-reported knowledge may be subject to social desirability bias, where participants respond based on perceived correctness rather than actual beliefs or behaviors.

The findings of this study reveal a moderately high level of public awareness in Himachal Pradesh regarding the role of physical activity in preventing orthopaedic disorders, particularly among educated, urban, and middle-aged populations. However, significant gaps remain, especially in rural areas and among individuals with limited formal education. Misconceptions regarding safe exercise practices, the frequency of physical activity, and the role of stretching and rehabilitation persist. These results underscore the need for targeted, demographically sensitive health education interventions that can bridge knowledge disparities and encourage the adoption of physical activity as a sustainable preventive strategy for musculoskeletal health.

Recommendations

To enhance public understanding and practical application of physical activity in orthopaedic health, it is recommended that state health authorities and community organizations implement culturally appropriate awareness campaigns in local languages, especially targeting rural and low-literacy populations. Integration of physical activity education into school curriculums, workplace wellness programs, and primary healthcare services can further reinforce preventive behaviors. Training community health workers to deliver interactive, age-specific workshops and demonstrations on safe exercises and posture techniques may increase outreach. Additionally, leveraging digital platforms with simplified content could help bridge access gaps while engaging younger audiences in proactive musculoskeletal health management.

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