The purpose of this study was to clarify the change in symptoms, behavior, and feeling with acupuncture and the relationship between the changes and physical activity level in middle-aged and elderly people with musculoskeletal pain.
 The Subjects were 55 (26 males and 29 females, aged 65.0±12.2 years) middle-aged and elderly people with musculoskeletal pain who have been treated with acupuncture. We investigated the change in their symptoms, behavior, and feeling (symptoms, frequency of other treatments, exercise, frequency of going out and taking trips, general feeling, confidence in physical fitness, and coping with the prospects for the symptoms) with acupuncture using an unsigned self-administered question naire. In addition, the health-related quality-of-life was evaluated with SF-8 and the physical activity level was assessed with the Short Version of the International Physical Activity Questionnaire.
 The subjects mostly recognized that their symptoms, behavior, and feeling had a tendency to improve or remain unchanged with acupuncture. Evaluation of the relationship between the changes with acupuncture and walking physical activity showed that the subjects who felt their frequency of exercise or of going out or taking trips tended to increase with acupuncture treatment showed a significantly higher physical activity level than those who stated there was no change or a decreasing tendency (p<0.05). Similarly, the subjects whose assessment for the general feeling or coping with the prospects for symptoms was a tendency to irnprove with acupuncture showed a significantly higher physical activity level than those whose assessment was no change or deleterious change (p<0.05).
 These results indicate that acupuncture might have a positive affect on their symptoms, behavior, and feeling, and also provide opportunities to increase walking physical activity in middle-aged and elderly people with skeletai and muscular disorders.