Quality of life and physical activity levels of musculoskeletal disorders in workers exposed to high and low frequency magnetic fields: A comparative study

Abstract

Background

The increased use of electronic devices and technological advances has led to greater exposure to electromagnetic fields (EMF) in various occupational environments.

Objectives

The study's objective was to assess the effect of work-related musculoskeletal disorders (WMSD) on the quality of life and physical activity levels of individuals exposed to high-frequency magnetic fields.

Methods

The mean age of one hundred and twenty EMF exposed workers was 37.44 ± 9.16 years. The following were assessed: musculoskeletal symptoms in the last 12 months (using the Extended Nordic Musculoskeletal Questionnaire Version (ENMQ) and the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ), working posture (Ovako Working Posture Analysis System (OWAS), physical activity level (International Physical Activity Questionnaire Short Form (IPAQ-Sf), and quality of life (World Health Organization Quality of Life Scale (WHOQOL-Bref).

Results

The highest prevalence rate of ENMQ in the last 12 months was 77.5% (n = 31) in the low back region and 50% (n = 20) in the shoulder region in those exposed to high-grade magnetic fields. The mean scores of WHOQOL-Bref were given for those exposed to high and low magnetic fields and those not exposed to magnetic fields (M ± SD: 63.51 ± 8.35; 73.27 ± 9.37; 76.43 ± 8.43, respectively).

Conclusion

The prevalence of WMSD in workers was found to be highest in the low back, shoulder, and hand region in HF-MF workers. LF-MF group, the highest concentration was found to be highest in the neck region. Prevalence rates have been reported for different body sites, with the highest prevalence rates observed in the group exposed to HF-MF. Quality of life was found to be lower in the group exposed to HF-MF.

Keywords

musculoskeletal system musculoskeletal diseases magnetic field occupational disease health-Related quality of life exercise

1. Introduction

Physical activity has a positive effect on psychophysical health. In fact, it contributes to improving the functioning of the cardiovascular system; strengthening bones, muscles and joints; and maintaining a healthy body weight. Thus, it plays an important role in reducing and preventing the risk of chronic pathology.¹ Quality of life is defined as the sum of separately scored symptoms and functional domains.² The multidimensional approach includes physical health, psychological state, social relationships, and environment, as recommended by the World Health Organization.This study also utilised this model.³

In recent years, due to the proliferation of electronic devices and technological advances, exposure to electromagnetic fields (EMF) has increased in various occupational settings.⁴ The deployment of new wireless technologies and smart applications without precise knowledge of their impact on health poses new challenges for medicine and society. EMFs are radiated from radio Wi-Fi access points. They are also radiated from routers and broadcast antennas.⁴ EMF, including static, low-frequency and radiofrequency magnetic fields, has the potential to cause negative biological effects on human cells and tissues.^5,6

EMFs are generated in two ways: alternating fields (which vary with frequency) and static fields, which originate from both natural and artificial sources. Alternating magnetic fields vary in intensity and direction over time, and the frequency of this oscillation is measured in hertz (Hz). Common sources include electrical power systems (e.g., power lines and household appliances), radio frequency devices and industrial equipment. The behavior of these fields is highly dependent on their frequency. For example, low frequency EMF, such as 50–60 Hz from power lines, is relatively weak, but is constantly present in everyday life. High-frequency EMFs, such as those from radio waves or microwaves, can penetrate tissues and interact with biological systems. In contrast, static magnetic fields are constant. They are generated by permanent magnets or coils that carry direct currents.⁷ The Earth's magnetic field is a natural example of EMF. Strong EMFs are generated by medical diagnostic devices such as magnetic resonance imaging.

A form of energy travelling through space at the speed of light is contained in EMF, which consists of charged particles. EMF frequencies and amplitudes are expressed in hertz. High-frequency electric and magnetic fields are classified as intermediate frequency (3 kHz-10 MHz) and radio frequency (10 MHz-300 GHz).⁸ The frequency and terminology classification are based on the International Telecommunication Union statement.⁷ EMF in this frequency range are used extensively in technologies such as data transmission, communication and heating. Adverse health effects caused by exposure to EMF include the electrical stimulation of nerves and muscles at frequencies below 10 MHz, and tissue overheating at frequencies above 100 kHz. The frequency range of 100 kHz to 10 MHz is where both effects are observed.⁹ The EMF produced by various sources is classified as a low frequency between 0 Hz—100 kHz.¹⁰

The effects of EMF generated by ubiquitous high-voltage power lines on human health have been a growing concern over the last decade, with industrialisation developing rapidly.¹¹ The number of workers occupationally exposed to EMF is increasing steadily, with no signs of this trend abating. It is recognised that most workers are potentially exposed to a work-related risk. The US National Institute for Occupational Safety and Health says that almost everyone is exposed to electric and magnetic fields surrounding all electrical devices. Considering this, the prevalence of exposure to electric and low-frequency magnetic fields in many workplaces is almost 100% in modern urban areas.⁴ Areas exposed to high-freguency EMA include telecommunications infrastructure (satellite communications, broadcast antennas), medical equipment (MRI devices), and industrial environments (induction heaters and plasma generators), industrial factories workers.¹ In a large multicentre study involving nearly 10,000 cases and over 35,000 different occupations, Migault et al. (2019) applied a work exposure matrix to 468 occupational groups. Research shows that 62% of jobs come with exposure to high-frequency EMF.⁸

Injuries or dysfunctions affecting the muscles, bones, nerves, tendons, ligaments, joints, cartilage and spinal discs are known as musculoskeletal disorders (MSD). MSD, which can manifest itself with pain, restriction of movement or injuries due to exposure to EMF, psychosocial and physical risks during work activities, are among the common health problems among workers. Repetitive forceful movements, overuse, poor posture, and ergonomic inadequacies play an important role in the formation of work-related musculoskeletal disorders (WMSD).¹² Therefore, numerous research areas are encouraged to develop strategies aimed at improving general industrial factories work.⁴ These innovations alter the conventional form of industrial work (e.g., robots, exoskeletons). They influence the development of WMSD due to changing physical and psychosocial demands related to work.¹³

EMF exposure is a reality for workers in various fields, including health, due to devices and work environments. Although the musculoskeletal system problems caused by the magnetic field to which most occupational groups are exposed are estimated, its impact on the quality of life and physical activity level is not known. Examining the literature revealed that few studies on the subject were available, and no study on the MSD of employees working in high magnetic fields was found.^11,14,15 The aim of this study was to examine the prevalence of MSD, quality of life, and physical activity levels among employees exposed to high-low frequency magnetic fields.

2. Methods

2.1 Participants and recruitment method

G*Power 3.1.9.7 power analysis program; F test, ANOVA: Fixed effects, special, main effects and interactions effect size 0.35, standard error 0.05, and power 95% were calculated. It was calculated that the study should include 109 participants. To account for the possibility of non-response and an insufficient number of responses, 120 participants were included in the study using the random sampling method, by adding 10% to the sample size.¹⁶

Inclusion Criteria: Working in the private and public sectors in Turkey for an average of 8 h per day and 40 h per week in total, having the ability to read and understand Turkish, working full-time, and being employed for at least two years.¹⁷ Exclusion Criteria: The patient must have taken antioxidant medications or supplements and undergone medical imaging (e.g., X-rays or CT scans) in the last two months. Having experienced significant accidents, traumas or medical conditions leading to permanent musculoskeletal disability, being pregnant or breastfeeding, having a history of previous surgery, having radicular pain and current lower extremity symptoms, having cardiopulmonary and genetic disease with reduced activity tolerance, having participated in any clinical trial or physical therapy treatment in the last 30 days.^18,19 The purpose of the study and the necessary details were explained to all participants, and the study included them, contingent on their signing the consent form.

2.2 Study design

The subjects were evaluated by a physiotherapist or a physical medicine and rehabilitation physician. In this comparative study, hospital workers and welding workers working in the company (Konya) who were exposed to EMF were included. These participants came to the physiotherapy unit of State Hospital between September 2024 and April 2025. In the initial plan of our research, the plan was to include the employees working in Seydişehir Aluminum Plant who were exposed to a high magnetic field. Since permission could not be obtained, the authorities of company (Konya) were contacted and were provided with information about the research. Participants were recruited from resistance welders exposed to high frequency magnetic fields (HF-MFs).^8,14,20,21 After obtaining permission, eligible employees were included in the study. This study, 1 group of 40 (welders) HF-MF, 2 groups of 40 low frequency magnetic field (LF-MF) exposed (working in the physical therapy unit of the hospital) and 3 groups of 40 healthy individuals (active computer and auxiliary health personnel (security, cleaning, etc.) who were not exposed to magnetic field) were included in the study. HF-MF were not exposed to excessive noise or any chemicals.

Necmettin Erbakan University Health Sciences Scientific Research Ethics Committee (Decision No:2023/512, Date: 05.07.2023) gave its ethical approval. Participants who met the inclusion criteria based on the Declaration of Helsinki were given the chance to volunteer their data through face-to-face interviews.²² All participants were given both verbal and written consent. Information about the study was provided verbally and in writing.

2.3 Outcome measurements

Socio-demographic information (age, height, weight, BMI, occupation, income and expenditure balance, employment status, educational status) was recorded. Participants diagnosed with WMSD were assessed using the Extended Nordic Musculoskeletal Questionnaire Version (ENMQ) and the Cornell Musculoskeletal Disorders Questionnaire (CMDQ). The participants’ working posture was evaluated using the Ovako Working Posture Analysis System (OWAS). The physical activity level of the study participants was assessed using the International Physical Activity Questionnaire short form, commonly referred to as the IPAQ-Sf. Meanwhile, the quality of life experienced by participants was measured using the World Health Organization Quality of Life Scale, also known as the WHOQOL-Bref. These scales were preferred because they were used as measurement tools in similar studies.^4,10,17,18

The development of ENMQ was initiated by Kuorinka et al. in 1987. ENMQ is a self-administered questionnaire, or one administered in person. The questionnaire provides reliable data on the onset and prevalence of WMSD in nine body regions, including the neck, shoulders, upper back, elbows, wrists/hands, lower back, hips/thighs, and ankles/feet at four different time points (lifetime, annual, monthly, and current).²³ It encompasses inquiries pertaining to symptoms experienced by individuals within the preceding 12 months, within the past seven days, and limitations in activity levels over the 12-month period.^24,25 Turkish validity and reliability were previously assessed by Alaca et al.²⁶

CMDQ was developed by Hedge et al. (1999), Director of the Human Factors and Ergonomics Laboratory at Cornell University, and assesses the frequency, severity and impact on work performance of pain, soreness or discomfort in 11 different body regions (neck, shoulder, back, wrist, forearm, hip, upper leg, knee, lower leg) during the last working week.²⁷ Weight scores are calculated separately for frequency, severity, and pain-related disability. These questionnaires are for research screening purposes and not for diagnostic purposes. The scores were analyzed in four ways. The total score is calculated by counting the number of symptoms per person and summing the rating values for each person: Never = 0; 1–2 times a week = 1.5; 3–4 times a week = 3.5; Every day = 5; Several times a day = 10. Multiply the above Frequency score (0, 1.5, 3.5, 5, 10) by the Discomfort score (1, 2, 3) and the Interference score (1, 2, 3). The higher the score, the higher the frequency and severity of pain and its impact on work performance. The assessment of Turkish validity and reliability was conducted by Erdinç et al. (2011).²⁸

OWAS working posture was formalized in 1974 in Finland, specifically in OVAKO OY, a leading European manufacturer of steel bars and sections. This posture analysis system was used to assess workload.²⁴ OWAS is an observational working posture analysis method that evaluates the load on the musculoskeletal system and the posture of the worker.²⁹ In this study, data were evaluated separately for back, upper extremity, lower extremity, and load bearing.³⁰ Four risk categories were then created. The first consideration is related to normal postures without recommendations for corrective activities. The second and third categories relate to slightly risky postures with recommendations for corrective actions to be taken in the medium term. The fourth category refers to unacceptable postures with recommendations for immediate corrective actions.²⁹

Cross-cultural application is possible with the generic tool WHOQOL-Bref. The questionnaire assesses quality of life in four areas: physical health, psychological health, social relationships, and environment. It has a simple response format and allows for detailed differentiation of quality of life between individuals.³¹ The health-related quality of life scale was developed by the World Health Organization (WHO), and its validity and reliability were evaluated by Eser et al.³² The scale can be applied to non-elderly adults. The scale has also been applied to health care workers. Since each domain independently expresses the quality of life, domain scores are calculated between 4 to 20. The higher the score, the better the quality of life, which is why it is important to keep score.³¹

Researchers from various countries developed a standardized instrument for physical activity measurement called IPAQ-Sf, with the support of the WHO. Sağlam et al.³³ tested the validity and reliability of the Turkish versions of the long and short forms of the scale. Participants provided information on their average levels of vigorous and moderate physical activity, walking and sitting time. Seven questions provide information on physical activity (PA) intensity and sedentary time by the frequency and duration of activities. Reported amounts were recorded in minutes per week, except for sitting time, which was reported in minutes per day. The 7-day IPAQ-Sf is a standardised measurement tool of physical activity behaviour in different populations.³⁴ The overall physical activity score is created by multiplying times by metabolic equivalents per activity and then adding together the results of all items. However, the question on sitting is not included in the physical activity score, which is a problem.³⁵

2.4 Statistical evaluation of the data

All statistical analyses were performed using SPSS for Windows version 29.00. The descriptive statistical data was expressed in two ways: for measured values, it was expressed as the mean and standard deviation (mean ± SD); for nominal values, it was expressed as the number (n) and percentage (%) . The results were evaluated at a 95% confidence interval, and the significance level was set at 0.05. The normality of the data distribution was assessed through the Kolmogorov-Smirnov test and Skewness and Kurtosis tests (±2 thresholds).³⁶ Scale results were found to be normally distributed. A one-way ANOVA test was used to determine the difference between the CMDQ, IPAQ-sf and WHOQOL-Bref groups, with the results showing that there were significant differences. OWAS results were determined by a chi-square test among groups.³⁷ If a difference was found, a post hoc test with Bonferroni correction was used to determine which groups differed. Eta squared (η²) was used as an effect size. Generally, an effect size is considered weak if the η² value is less than 0.01, moderate if it is 0.06, and strong if it is greater than 0.14. The data were normally distributed. Pearson correlation analysis was used. Pearson correlation analysis was also used to investigate the relationships between the ENMQ, IPAQ-sf, and WHOQOL-BREF. The following categories were used to interpret correlation coefficients: strong = −1.0 to −0.5 or 1.0 to 0.5; moderate = −0.5 to −0.3 or 0.3 to 0.5; weak = −0.3 to −0.1 or 0.1 to 0.3; and no correlation or very weak = −0.1 to 0.1.³⁸

3. Results

A total of 120 participants between the ages of 18–56 years, with HF-MF (n = 40), LF-MF (n = 40), and a control group consisting of employees not exposed to magnetic fields (n = 40), were included in the study. The mean age of the participants was HF-MF = 36.60 ± 10.80, LF-MF = 36.90 ± 8.53, Control=38.82 ± 8.14 years, and body mass index were HF-MF = 23.40 ± 12.75, LF-MF = 25.28 ± 4.66, Control=26.03 ± 4.66 kg/m2 (Table 1). Among the participants, 72.5% in the LF-MF group were married, 100% in the HF-MF group were male, 100% in the LF-MF group were university graduates, and 70% in the HF-MF group had more income than expenses.

Table 1.
Physical ve sociodemographic characteristics of the partipants (n = 120).

HF-MFM ± Sd LF-MFM ± Sd (n = 40) ControlM ± Sd (n = 40) Anova Test

F p

Age (year) 36.60 ± 10.80 36.90 ± 8.53 38.82 ± 8.14 0.693 0.507

Height (m²) 1.81 ± 0.06 1.69 ± 0.96 1.71 ± 0.09 23.678 <.001

Body weight (kg) 77.07 ± 10.12 72.62 ± 15.55 76.47 ± 13.07 1.357 0.261

BMI (kg/m²) 23.40 ± 2.75 25.28 ± 4.66 26.03 ± 4.38 4.535 0.013

Marital Status (n = 40) (%) (n = 40) (%) (n = 40) (%) x² p

Married 22 (55.00) 29 (72.5) 26 (65.00) 4.247 0.374

Single 18 (45.00) 11 (12.5) 14 (35.00)

Gender

Female 0 (0.00) 25 (62.5) 14 (35.00) 35.783 <.001

Male 40 (100.00) 15 (37.5) 26 (65.00)

Education level

Primary school 14 (35.00) 0 (0.00) 2 (5.00)

Middle school 14 (35.00) 0 (0.00) 0 (0.00) 116.08 <.001

High school 8 (20.00) 0 (0.00) 25 (62.50)

University above 4 (10.00) 40 (100.00) 13 (32.50)

Income-Expense Balance

Income > expense 28 (70.00) 15 (37.50) 13 (32.50)

Equal 8 (20.00) 18 (45.00) 12 (30.00) 18.569 <.001

Income < expense 4 (10.00) 7 (17.50) 15 (37.50)

	HF-MFM ± Sd	LF-MFM ± Sd (n = 40)	ControlM ± Sd (n = 40)	Anova Test
Age (year)	36.60 ± 10.80	36.90 ± 8.53	38.82 ± 8.14	0.693	0.507
Height (m²)	1.81 ± 0.06	1.69 ± 0.96	1.71 ± 0.09	23.678	<.001
Body weight (kg)	77.07 ± 10.12	72.62 ± 15.55	76.47 ± 13.07	1.357	0.261
BMI (kg/m²)	23.40 ± 2.75	25.28 ± 4.66	26.03 ± 4.38	4.535	0.013
Marital Status	(n = 40) (%)	(n = 40) (%)	(n = 40) (%)	x²	p
Married	22 (55.00)	29 (72.5)	26 (65.00)	4.247	0.374
Single	18 (45.00)	11 (12.5)	14 (35.00)
Gender
Female	0 (0.00)	25 (62.5)	14 (35.00)	35.783	<.001
Male	40 (100.00)	15 (37.5)	26 (65.00)
Education level
Primary school	14 (35.00)	0 (0.00)	2 (5.00)
Middle school	14 (35.00)	0 (0.00)	0 (0.00)	116.08	<.001
High school	8 (20.00)	0 (0.00)	25 (62.50)
University above	4 (10.00)	40 (100.00)	13 (32.50)
Income-Expense Balance
Income > expense	28 (70.00)	15 (37.50)	13 (32.50)
Equal	8 (20.00)	18 (45.00)	12 (30.00)	18.569	<.001
Income < expense	4 (10.00)	7 (17.50)	15 (37.50)

HF-MF:Workers exposed to high frequency magnetic fields, LF-MF: Workers exposed to low frequency magnetic fields, Control: Group not exposed to frequency magnetic fields BMİ: Body mass index, H: Hours, M: Mean, Sd: Standard Deviation, F: One-Way ANOVA, x²: Pearson Chi-Square test, p: P value, Significant differences between groups in terms of magnetic field: p < 0.05).

The prevalence of WMSD in the last 12 months assessed by ENMQ is quite high, and the specific prevalence rates for different body regions of the workers are given in 3 groups (Table 2). In the HF-MF group: the highest prevalence was in the shoulder region 47.5% (n = 19), hands 30% (n = 12), low back 75% (n = 30), hips 17.5% (n = 7), ankles 20% (n = 8). In the LF-MF group, the highest rates were neck 60% (n = 24); upper back 35% (n = 14); elbow 15% (n = 6); and knee 32.5% (n = 13) (Table 2). It was determined that the participants gave similar answers to ENMQ questions, such as “Have you had any problems in the last 12 months?” (Table 2). It was determined that WMSD had a higher rate in the last 12 months than in the last 4 weeks (Table 2).

Table 2.

Extended version of the nordic musculoskeletal questionnaire parameters of musculoskeletal disorders of participants in percentage (%) (n = 120).

Parts of body		Have you ever had trouble (ache, pain or discomfort) in:	At the time of initial onset of the trouble, what was your age? (mean ± SD years)	Have you ever been hospitalised because of the trouble?	Have you ever had to change jobs or duties (even temporarily) because of the trouble?	Have you had trouble (ache, pain or discomfort) at anytime during the last 12 months?	Have you had trouble (ache, pain, discomfort) at any time during the last months (4 weeks)?	Have you had trouble (ache, pain, discomfor) today?	During the last 12 months have you at anytime:
Parts of body		Have you ever had trouble (ache, pain or discomfort) in:		Have you ever been hospitalised because of the trouble?				Have you had trouble (ache, pain, discomfor) today?	Been prevented from doing your normal work (at home or away from home) because of trouble?	Seen a doctor, physiothera- pist or other such person because of trouble?	Taken medication because of trouble?	Taken sick leave from work/studies because of trouble?
	HF-MF	27.5%	31.42 ± 8.05	0.0%	15.0%	27.5%	20.0%	12.5%	12.5%	5.0%	7.5%	12.5%
Neck	LF-MF	72.5%	28.45 ± 10.17	2.5%	7.5%	60.0%	30.0%	22.5%	12.5%	20.0%	25.0%	7.5%
	Control	45.0%	30.89 ± 29.00	0.0%	2.5%	37.5%	35.0%	12.5%	5.0%	17.5%	15.%	0.0%
	HF-MF	50.0%	28.85 ± 6.76	5.0%	20.0%	47.5%	42.5%	27.5%	12.5%	10.0%	5.0%	30.0%
Shoulders	LF-MF	30.0%	26.43 ± 14.11	2.5%	5.0%	27.5%	17.5%	10.0%	10.0%	12.5%	7.5%	5.0%
	Control	35.0%	29.00 ± 10.35	0.0%	5.0%	30.0%	25.0%	10.0%	5.0%	20.0%	12.5%	0.0%
	HF-MF	30.0%	27.18 ± 6.98	2.5%	10.0%	30.0%	25.0%	20.0%	10.0%	5.0%	5.0%	12.5%
Upper Back	LF-MF	37.5%	26.41 ± 11.51	0.0%	2.5%	35.0%	22.5%	7.5%	5.0%	10.0%	5.0%	5.0%
	Control	40.0%	30.35 ± 10.67	0.0%	2.5%	35.0%	25.0%	10.0%	0.0%	10.0%	10.0%	0.0%
	HF-MF	15.0%	29.00 ± 19.99	5.0%	7.5%	15.0%	15.0%	10.0%	12.5%	7.5%	5.0%	7.5%
Elbows	LF-MF	15.0%	39.06 ± 14.0	0.0%	2.5%	15.0%	12.5%	10.0%	2.5%	2.5%	2.5%	2.5%
	Control	7.5%	21.80 ± 20.52	0.0%	0.0%	5.0%	2.5%	2.5%	0.0%	0.0%	0.0%	0.0%
	HF-MF	32.5%	30.07 ± 8.36	7.5%	12.5%	30.0%	30.0%	22.5%	20.0%	10.0%	7.5%	15.0%
Hands	LF-MF	22.5%	30.00 ± 18.31	2.5%	0.0%	20.0%	7.5%	5.0%	5.0%	7.5%	2.5%	2.5%
	Control	15.0%	26.57 ± 12.13	0.0%	2.5%	10.0%	7.5%	2.5%	0.0%	5.0%	2.5	0.0%
	HF-MF	77.5%	27.06 ± 6.35	42.5%	70.0%	75.0%	77.5%	70.0%	57.5%	45.0%	17.5%	67.5%
Low Back	LF-MF	45.0%	26.05 ± 11.33	2.5%	5.0%	37.5%	17.5%	5.0%	15.0%	10.0%	10.0%	7.5%
	Control	52.5%	29.18 ± 9.55	2.5%	2.5%	35.0%	32.5%	10.0%	7.5%	10.0%	15.0%	0.0%
	HF-MF	17.5%	31.14 ± 3.18	12.5%	10.0%	17.5%	15.0%	12.5%	7.5%	7.5%	5.0%	15.0%
Hips	LF-MF	20.0%	23.00 ± 14.92	0.0%	2.5%	17.5%	15.0%	2.5%	0.0%	5.0%	5.0%	0.0%
	Control	15.0%	27.71 ± 14.87	0.0%	0.0%	10.%	5.0%	2.5%	0.0%	0.0%	0.0%	0.0%
	HF-MF	30.0%	32.75 ± 7.79	7.5%	10.0%	30.0%	25.0%	20.0%	15.0%	7.5%	7.5%	15.0%
Knees	LF-MF	30.0%	30.27 ± 15.03	5.0%	5.0%	32.5%	15.0%	5.0%	10.0%	12.5%	7.5%	7.5%
	Control	25.6%	29.90 ± 13.85	5.0%	2.5%	17.5%	15.0%	7.5%	2.5%	5.0%	2.5%	0.0%
	HF-MF	2.5%	25.00 ± 2.36	2.5%	2.5%	20.0%	0.0%	0.0%	0.0%	0.0%	0.0%	0.0%
Ankles	LF-MF	22.5%	26.90 ± 15.83	0.0%	0.0%	17.5%	10.0%	2.5%	5.0%	10.0%	2.5%	2.5%
	Control	10.0%	28.66 ± 14.30	0.0%	0.0%	2.5%	2.5%	5.0%	2.5%	2.5%	2.5%	0.0%

CMDQ total discomfort score was found to be significantly different between the groups in the neck (F = 4.481, p = 0.017), upper back (F = 11.635, p < .001) and low back (F = 11.174, p < .001). CMDQ score in the HF-MF group was 18.55 ± 12.03 in the neck, 17.96 ± 16.14 in the upper back, and 34.37 ± 26.07 in the low back. Among the groups, the highest frequency of CMDQ in the HF-MF group was 30.0% for the upper back, 30.0% for the right shoulder, and 77.5% for the low back. In the LF-MF group, the prevalence of CMDQ was 27.5% in the neck region (Table 3).

Table 3.

Cornell musculoskeletal discomfort questionnaires (CMDQ) total discomfort score felt by workers exposed to magnetic fields (n = 120).

Body parts referred to in the questionnaire	Workers exposed to magnetic fields	Frequency (n)	%	Discomfort score(Mean ± Std. Dev.)	Anova Test
Body parts referred to in the questionnaire	Workers exposed to magnetic fields	Frequency (n)	%	Discomfort score(Mean ± Std. Dev.)	F	p
	HF-MF	11	27.5	18.55 ± 12.03
Neck	LF-MF	22	55.0	8.89 ± 10.87	4.481	0.017
	Control	11	27.5	6.18 ± 7.24
	HF-MF	12	30.0	17.96 ± 16.44
Shoulder_R	LF-MF	10	25	9.95 ± 7.76	1.248	0.303
	Control	8	20	10.31 ± 13.54
	HF-MF	11	27.5	13.68 ± 7.22
Shoulder_L	LF-MF	5	12.5	12.50 ± 8.57	2.401	0.118
	Control	6	15.0	5.50 ± 7.16
	HF-MF	12	30.0	39.87 ± 8.48
Upper Back	LF-MF	13	27.5	7.69 ± 11.99	11.635	<.001
	Control	9	22.5	4.88 ± 6.30
	HF-MF	1	2.5	18.00
Upper arm_R	LF-MF	3	7.5	15.83 ± 21.04	0.659	0.557
	Control	4	10.0	5.37 ± 3.86
	HF-MF	6	15.0	28.5 ± 24.90
Upper arm_L	LF-MF	3	7.5	14.33 ± 22.23	0.163	0.860
	Control	1	2.5	1.5
	HF-MF	31	77.5	34.37 ± 26.07
Low back	LF-MF	16	40.0	9.71 ± 21.87	11.174	<.001
	Control	11	27.5	2.77 ± 1.64
	HF-MF	4	10.0	36.00 ± 19.25
Forearm_R	LF-MF	4	10.0	35.12 ± 40.20	0.393	0.735
	Control	1	2.5	10.00
	HF-MF	1	2.5	60.0
Forearm_L	LF-MF	1	2.5	40.0	0.448	0.647
	Control	0	0	0
	HF-MF	7	17.5	19.43 ± 12.16
Hip	LF-MF	6	15.0	14.92 ± 8.01	0.502	0.619
	Control	1	2.5	3.00
	HF-MF	7	17.5	7.71 ± 8.33
Knee_R	LF-MF	7	10.0	16.97 ± 21.69	2.217	0.159
	Control	3	7.5	20.50 ± 19.25
	HF-MF	4	10.0	17.25 ± 5.06
Knee_L	LF-MF	4	10.0	10.25 ± 10.14	5.038	0.026
	Control	5	12.5	12.90 ± 17.14
	HF-MF	0	0	0
Foot_R	LF-MF	1	2.5	18.0	1.037	0.355
	Control	1	2.5	1.5
	HF-MF	0	0	0
Foot_L	LF-MF	0	0	0
	Control	1	2.5	1.5
Total skoru		120	100	12.07 ± 14.06	0.264	0.780

HF-MF:Workers exposed to high frequency magnetic fields, LF-MF: Workers exposed to low frequency magnetic fields, Control: Group not exposed to frequency magnetic fields, n: The number of participants. M: Mean. Std Dev: Standard Deviation, R: Right L: Left, F: One-Way ANOVA, p: P value, Significant differences between groups in terms of magnetic field: p < 0.05).

There was no significant difference between the groups in terms of OWAS working posture, back posture (p = 0.066), or arm position. However, there was a significant difference between the groups in terms of leg stance (p=<.001) and weight lifted (p=<.001) (Table 4). When they were working, it was seen that 72.5% (n = 29) of the HF-MF group, 90.00% (n = 36) of the LF-MF group, and 70.00% (n = 28) of the control group had their backs straight.

Table 4.

OWAS working posture (n = 120).

Working Posture	Workers exposed to magnetic fields		Frequency (n)	%	Chi-Square Test
Working Posture	Workers exposed to magnetic fields		Frequency (n)	%	Value	p
Back Posture	HF-MF	Upright back	29	72.5
	HF-MF	Bent back	11	27.5
	LF-MF	Upright back	36	90.0	5.448^a	0.066
	LF-MF	Bent back	4	10.00
	Control	Upright back	28.0	70.0
	Control	Bent back	12.0	30.00
Arm Position	HF-MF	Upright back	40	100.00
	LF-MF	Upright back	40	100.00
	Control	Upright back	40	100.00
Leg Stance	HF-MF	Sitting	28	70.0	39.658^b	<.001
	HF-MF	Standing on two straight legs	12	30.0
	LF-MF	Sitting	7	17.5
		Standing on two straight legs	32	80.0
		Standing on one straight legs	1	2.5
	Control	Sitting	26	65.0
		Standing on two straight legs	10	25.0
		Walking	4	10.0
Liftable Weight	HF-MF	Greater than 20 kg	40	100.0
	LF-MF	Less or equal to 10 kg	36	90.0
		Between 10 and 20 kg	3	7.5	117.326^c	<.001
		Greater than 20 kg	1	2.5
	Control	Less or equal to 10 kg	39.0	97.5
	Control	Between 10 and 20 kg	1	2.5

HF-MF:Workers exposed to high frequency magnetic fields, LF-MF: Workers exposed to low frequency magnetic fields, Control: Group not exposed to frequency magnetic fields a: 0 cells (0.0%) have an expected count less than 5. The minimum expected count is 9.00. b: 6 cells (50.0%) have an expected count less than 5. The minimum expected count is 0.33. c: 3 cells (33.3%) have an expected count less than 5. The minimum expected count is 1.33. p: P value, Significant differences between groups in terms of magnetic field: p < 0.05)

Quality of life, as measured by the WHOQOL-BREF, was found to have a significant, albeit moderate, correlation with the prevalence of MSD among workers exposed to magnetic fields in the knee region of the HF-MF group (r = -0.319, p = 0.045), the neck region of the LF-MF group (r = -0.319, p = 0.045) and the shoulder region of the control group (r = -0.161, p = 0.018) (see Table 5). In other body regions, no significant relationship was found between WHOQOL-Bref scores and workers’ exposure to magnetic fields (p > 0.005). The prevalence of MSD among workers exposed to magnetic fields was found to have no significant relationship with their physical activity level, as assessed by IPAQ-SF (p > 0.05) (see Table 5).

Table 5.

The relationship between musculoskeletal disorders, quality of life and physical activity levels of workers exposed to magnetic fields (n = 120).

Extended Version of the Nordic Musculoskeletal Questionnaire (Have you had trouble (ache, pain or discomfort) at anytime during the last 12 months?)	World Health Organization Quality Of Life Scale Brief Version
	HF-MF		LF-MF		Control
	r	p	r	p	r	p
Neck	−0.238	0.139	−0.356*	0.024	−.0.246	0.126
Shoulders	−0.093	0.567	−0.182	0.261	−0.338	0.033
Upper Back	−0.033	0.839	−0.175	0.280	−0.216	0.181
Elbows	−0.036	0.823	−0.176	0.277	0.030	0.855
Hands	−0.057	0.728	−0.173	0.285	0.090	0.579
Low Back	−0.038	0.818	−0.110	0.501	−0.005	0.978
Hips	−0.023	0.889	−0.100	0.540	−0.047	0.773
Knees	−0.319*	0.045	−0.093	0.570	−0.214	0.185
Ankles			−0.091	0.576	−0.049	0.766

	International Physical Activity Questionnaire Short-Form
	HF-MF		LF-MF		Control
	r	p	r	p	r	p
Neck	0.182	0.261	−0.038	0.818	−0.065	0.691
Shoulders	−0.178	0.272	−0.252	0.116	0.116	0.477
Upper Back	0.104	0.523	−0.064	0.697	−0.077	0.636
Elbows	−0.024	0.882	−0.255	0.113	0.144	0.375
Hands	−0.196	0.225	0.119	0.464	0.101	0.535
Low Back	0.160	0.324	0.069	0.671	−0.114	0.485
Hips	0.154	0.343	0.194	0.231	−0.437	0.505
Knees	0.106	0.513	0.185	0.253	0.137	0.400
Ankles			0.054	0.740	0.201	0.203

HF-MF:Workers exposed to high frequency magnetic fields, LF-MF: Workers exposed to low frequency magnetic fields, Control: Group not exposed to frequency magnetic fields, r: Pearson's rank correlation coefficient, p: P value, Significant differences between groups in terms of magnetic field: p < 0.05).

Table 6.

World Health Organization Quality of Life Scale (WHOQOL-Bref) and International Physical Activity Questionnaire Short Form (IPAQ-Sf) cross-group comparison.

Scale	HF-MFM ± Sd (n = 40)	LF-MFM ± Sd (n = 40)	ControlM ± Sd (n = 40)	Anova Test
Scale	HF-MFM ± Sd (n = 40)	LF-MFM ± Sd (n = 40)	ControlM ± Sd (n = 40)	*F	p	pη2
WHOQOL-Bref	63.51 ± 8.36	73.27 ± 9.37	76.44 ± 8.43	23.809	<.001	0.289
IPAQ-Sf	9287.07 ± 2153.22	3227.18 ± 2239.24	4827.85 ± 2458.21	75.407	<.001	0.563

Multiple comparisons by groups on WHOQOL-Bref, IPAQ-sf scores
		Mean Difference	Std. Error	p^b	95%Confidence Interval
		Mean Difference	Std. Error	p^b	Lover Bound	Upper Bound
WHOQOL-Bref	(HF-MF)- (LF-MF)	−9.763*	1.953	<.001	−14.506	−5.194
	(HF-MF)-(Control)	−12.926*	1.953	<.001	−17.669	−8.183
	(LF-MF)-(Control)	−3.163	1.953	0.324	−7.9067	1.580
IPAQ-sf	(HF-MF)- (LF-MF)	6059.892*	551.425	<0.001	4817.70	7302.09
	(HF-MF)-(Control)	4459.225*	551.425	<0.001	3217.03	5701.42
	(LF-MF)-(Control)	−1600.67*	551.425	0.007	−2842.86	−358.47

WHOQOL-Bref: World Health Organization Quality of Life Instrument, IPAQ-Sf: International Physical Activity Questionnaire Short Form, HF-MF:Workers exposed to high frequency magnetic fields, LF-MF: Workers exposed to low frequency magnetic fields, Control: Group not exposed to frequency magnetic fields, *F: One way ANOVA, p: P value, pη²: Partial eta squared., Std: Standard, p: P value. Based on estimated marginal means, The mean difference is significant at the .05 level. *Adjustment for multiple comparisons: Bonferroni.

A significant disparity was observed in the WHOQOL-Bref and IPAQ-Sf scores between the two groups of employees exposed to magnetic fields (F:23.809, p < .001; F:75.407, p < .001, respectively) (Table 6). WHOQOL-Bref averages in the HF-MF:63.51 ± 8.36 group and IPAQ-Sf averages in the LF-MF: 32.27.18 ± 22.39.24 group were the lowest. The highest difference between the groups in WHOQOL-Bref averages was found in the (HF-MF)-(Control) = -12.926* group, and the highest difference between the groups in IPAQ-Sf averages was found in the (HF-MF) -(LF-MF) = 6059.892 group (p < .001) (Table 6).

4. Discussion

This study is innovative that comparatively evaluates the prevalence of WMSD, quality of life, and physical activity level among workers exposed to both high and low magnetic fields. The prevalence of WMSD in EMF workers was found to be highest in the low back, shoulder, and hand regions among HF-MF workers. LF-MF group, it was found to be highest in the neck region. The prevalence of WMSD was found to be elevated in the HF-MF and LF-MF cohorts in comparison with the control group. The HF-MF cohort demonstrated the highest prevalence of WMSD of all the cohorts. CMDQ discomfort score was higher in HF-MF workers compared to other groups. This shows that WMSD occurring in HF-MF workers are at a higher risk. It is thought that the highest prevalence of WMSD in the lower back region in HF-MF workers may be due to their working posture and performing heavy work requiring more physical activity than other groups. Hosseinabad et al. (2019) reported that the prevalence of MSD in the last six months in power plant workers exposed to extremely low-frequency EMF was 65% in general. The upper back (43.4%) and neck (36.8%) constituted the areas most affected by WMSD.¹⁷ Although the prevalence was lower in the neck region in the compared study, it is thought that this may be due to the questioning of the last 6 months, instead of the last 12 months. It is interesting to note that Li et al. (2024) found that the prevalence of WMSDs among healthcare workers in medical radiation environments was 11.4% in the neck region, which was higher than that in other body regions.³⁹ Prevalence rates of WMSDs were higher in nuclear medicine (18.7%) and radiotherapy (20%) than in other groups.³⁹ Jacquier-Bret et al. (2023) found in a systematic review that the prevalence of WMSD with body area work among health professionals was highest in the neck and low back region.⁴⁰ In their systematic review, Xiongda et al. reported that the 12-month overall prevalence of WMSD among workers in the Chinese automobile manufacturing industry varied significantly, ranging from 28.5% to 84.0%.⁴¹ Surel et al. (2025) found that studies on the prevalence of WMSD in healthcare personnel working in the operating room indicated that the highest prevalence was in the neck, 72.4%, and the waist, 74.6%.⁴² The total score of CMDQ discomfort in healthcare personnel working in the operating room is 75.00. Our results are like Jacquier-Bret et al., Surel et al., and Xiongda He et al. in terms of the highest prevalence rates.

This study, it was determined that the quality of life of the group exposed to high magnetic fields was lower than that of the other groups. In addition, it was found that there was a relationship between the prevalence of WMSD in the last 12 months and the quality of life in the knee region in the HF-MF group and the neck region in the LF-MF group. Rahimimoghadam et al. (2025) reported that even exposure to magnetic fields below the permissible limits may cause poor sleep quality. Although there was a significant difference in magnetic field exposure (MFE) in different parts of the body (p < 0.001), it was shown that exposure levels in the leg region were higher than in other parts of the body. As EMF exposure increases, it results in poorer sleep quality.⁴³ Monazzam et al. (2014) discovered that exposure level, sleep quality, and general health status of workers exposed to extremely low frequency magnetic fields in a petrochemical complex were not significantly correlated.⁴⁴ Weerasinghe et al. (2025) reported that a significant difference in deep sleep quality was observed between high and low MFE groups.⁴ Wróbel et al. (2008) found that among patients with diabetic polyneuropathy, the group exposed to LF-MF had a lower quality of life than control group.⁴⁵ When the literature was reviewed, no study examining the quality of life of workers exposed to high and low magnetic fields was found. Therefore, studies evaluating sleep quality were included. Studies have found that the quality of sleep of employees exposed to magnetic fields decreases. This study, the average quality of life of those exposed to high magnetic fields was lower than the other groups. It was determined that the physical activity results of the HF-MF group were higher than those of the other groups. This is thought to be due to the working conditions of the HF-MF group during the day. Welders in the HF-MF group have working conditions with higher levels of physical activity than users in other groups. In addition, it was found that there was no significant relationship between the prevalence of MSD in the last 12 months and the level of physical activity in all 3 groups. Yuzugullu (2023) found that there was a relationship between MSD seen in office workers and physical activity levels.⁴⁶ Hosuien et al. (2009) emphasized in their study that physical activity is an important tool to improve general health status in preventing health risks in employees exposed to electromagnetic fields.⁴⁷ Kunt et al. (2016) did not observe a significant difference between exposure to electromagnetic radiation, and dietary habits and physical activity levels in electrical workers.⁴⁸ When the literature was examined, no study examining the physical activity level of workers exposed to high, or low magnetic fields was found. For this reason, we endeavored to include the closest studies related to the subject.

The results obtained using ENMQ and CMDQ to assess musculoskeletal disorders were similar but not identical. This situation stems from the use of self-report scales. The literature emphasises that the inclusion or exclusion of the midpoint in rating scales requires careful consideration and stresses the necessity of using cognitive interviews to ensure that respondents understand the response options in the same way.⁴⁹ Precautions can be taken to prevent workers exposed to HF-MF from flexing their trunks. Working conditions should be designed to prevent excessive loads on their trunks.

It is important to note that the present study is not without its limitations. The first limitation is that the exposure of workers to magnetic fields was not measured with a separate device. Their line of work helped determine it. The second limitation is that further studies, including more workers exposed to magnetic fields, are needed to obtain more reliable data. In addition, self-report scales and no special sampling methods were used. There may be tests that involve significant individual assessment as measurement methods.

5. Conclusions

Prevalence of WMSD in EMF workers was found to be highest in the lumbar and shoulder regions in HF-MF workers, and in the neck region in the LF-MF group. The quality of life of the HF-MF group was lower than that of each of the other groups. In addition, there was a relationship between the prevalence of MSD in the last 12 months, and quality of life in the knee region in the HF-MF group and in the neck region in the LF-MF group. It was determined that the physical activity results of the HF-MF group were higher than the other groups. In addition, it was found that there was no significant relationship between the prevalence of MSD in the last 12 months and physical activity level among the three groups. Workers exposed to HF-MF have higher rates of WMSD than other groups. WMSD can be reduced by improving working conditions and reducing activities that require bending during the day. It can also be prevented by reducing exposure to HF-MF. There are very few studies on exposure to high magnetic fields in literature. In addition, although the negative aspects of exposure to high magnetic fields are known, there is not enough information about the specific effects. New research could focus on this issue.

Footnotes

Acknowledgements

The authors acknowledge and thank the contribution of participants to the study. This article was presented as an oral presentation under the title ‘’Investigation of the effect of musculoskeletal disorders on quality of life and physical activity level of employees exposed to high frequency magnetic field’’ at the 12. International European Conference On Interdisciplinary Scientific Research in Roma, Italy on July 11–13, 2025.

ORCID iD

Musa Çankaya

Ethics statement

Necmettin Erbakan University Health Sciences Scientific Research Ethics Committee (Decision No:2023/512, Date: 05.07.2023) gave its ethical approval.

Informed consent

All participants were given both verbal and written consent.

Author contribution statement

Musa ÇANKAYA (MÇ), Havva TURAÇ CİNGÖZ (HVC)

MÇ contributed to the formulation of the research design, coordination, and manuscript composition. MÇ and HTC participated in conceptualizing and designing the study, data collection, data analysis, and drafting the manuscript. MÇ contributed to the revision of the analytical framework and data interpretation. MÇ and HTC participated in data analysis and revising the manuscript. MÇ and HTC contributed to the study design and data collection. All authors reviewed and approved the final version of the manuscript.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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