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Bottom line
Across seven RCTs of seated office workers, workplace exercise interventions appeared to reduce musculoskeletal pain and disorders, but a high risk of bias in most studies and wide variation in methods mean the findings should be treated as suggestive, not conclusive.
Preliminary evidencePublished
Evidence hierarchy
Study participants
Symptomatic office workers from various sectors who spend most of their working hours seated
Study Summary
This systematic review evaluated whether exercise interventions performed at the workplace help treat musculoskeletal disorders in office workers who spend most of the workday seated. Seven randomised controlled trials (967 participants total, published 2010-2018) met the inclusion criteria and were grouped into three categories: multiple body regions, neck and shoulder, and lower back. All seven studies reported that workplace exercise interventions were effective in reducing musculoskeletal disorders and pain compared with other interventions or no-intervention control groups. However, because of substantial heterogeneity in interventions, outcomes and analyses, no meta-analysis was possible, and six of the seven trials carried a high risk of bias, so the authors caution that no firm conclusions can be drawn.
Key Findings
| Finding | Detail | Impact |
|---|---|---|
| All seven included RCTs reported workplace exercise reduced musculoskeletal disorders and pain | The seven studies (967 participants) concluded that workplace exercise interventions were effective in reducing musculoskeletal disorders and pain in the neck and shoulder, lower back and upper limbs compared with other types of interventions or with control groups receiving no intervention. | High |
| Six of seven studies had a high risk of bias, limiting confidence | Using the revised Cochrane Risk of Bias 2 (RoB-2) tool, high risk of bias was found in six of the seven studies, mainly because participants and/or instructors were not blinded in the measurement of the outcome. Only Andersen et al (2010) blinded participants via cluster randomisation. The authors state no firm conclusions could be drawn. | High |
| Brief, frequent exercise sessions may be a practical workplace option | Interventions ranged widely, from 10-15 s stretches every 6 min during work to 20 min strength routines three times a week. The reviewed studies showed no difference in exercise physiological adaptations between longer, low-frequency sessions and shorter, high-frequency sessions; brief sessions with higher weekly frequency could produce improvements without prolonged interruption of work, though further investigation is needed. | Medium |
| Strength and scapular training showed benefit for neck and shoulder pain | Shariat et al (2018) found significant pain reduction at 6 months in the neck (MD -10.55; 95% CI -14.36 to -6.74) and shoulders versus control. Andersen et al (2014) reported a significant reduction in neck/shoulder pain (p<0.01) and an increased lower trapezius pressure pain threshold (129 kPa; 95% CI 31 to 227 kPa) with scapular function training over 10 weeks. | Medium |
| Exercise reduced disability in low back pain studies | Kaeding et al (2017) using whole-body vibration showed a 1.8-point mean difference on the Roland-Morris Disability Questionnaire (95% CI 0.2 to 3.4, p=0.027) and Oswestry improvement (p=0.002) versus control. del Pozo-Cruz et al (2013) reported reduced Oswestry disability and reduced chronicity risk over a 9-month web-based exercise programme. | Medium |
| Heterogeneity prevented meta-analysis | Because of significant heterogeneity in the workplace exercise interventions, outcome measures and statistical analyses, a meta-analysis was not possible; a narrative synthesis was performed following the SWiM guideline. | Medium |
The seven studies (967 participants) concluded that workplace exercise interventions were effective in reducing musculoskeletal disorders and pain in the neck and shoulder, lower back and upper limbs compared with other types of interventions or with control groups receiving no intervention.
Using the revised Cochrane Risk of Bias 2 (RoB-2) tool, high risk of bias was found in six of the seven studies, mainly because participants and/or instructors were not blinded in the measurement of the outcome. Only Andersen et al (2010) blinded participants via cluster randomisation. The authors state no firm conclusions could be drawn.
Interventions ranged widely, from 10-15 s stretches every 6 min during work to 20 min strength routines three times a week. The reviewed studies showed no difference in exercise physiological adaptations between longer, low-frequency sessions and shorter, high-frequency sessions; brief sessions with higher weekly frequency could produce improvements without prolonged interruption of work, though further investigation is needed.
Shariat et al (2018) found significant pain reduction at 6 months in the neck (MD -10.55; 95% CI -14.36 to -6.74) and shoulders versus control. Andersen et al (2014) reported a significant reduction in neck/shoulder pain (p<0.01) and an increased lower trapezius pressure pain threshold (129 kPa; 95% CI 31 to 227 kPa) with scapular function training over 10 weeks.
Kaeding et al (2017) using whole-body vibration showed a 1.8-point mean difference on the Roland-Morris Disability Questionnaire (95% CI 0.2 to 3.4, p=0.027) and Oswestry improvement (p=0.002) versus control. del Pozo-Cruz et al (2013) reported reduced Oswestry disability and reduced chronicity risk over a 9-month web-based exercise programme.
Because of significant heterogeneity in the workplace exercise interventions, outcome measures and statistical analyses, a meta-analysis was not possible; a narrative synthesis was performed following the SWiM guideline.
Strengths
- First systematic review to focus exclusively on exercise interventions performed at employees' own workplaces for treating musculoskeletal disorders in symptomatic office workers
- Search strategy developed with an expert documentalist across six databases (PubMed, CINAHL Plus, Cochrane, Scopus, ISI WoS, PeDRO) and followed PRISMA and PRESS standards
- Rigorous and consistent inclusion/exclusion criteria, dual independent reviewers, and pre-registered protocol (PROSPERO CRD42020177462)
- Used the revised Cochrane RoB-2 tool to transparently assess and report risk of bias
- Provides specific data on intervention characteristics (volume, intensity, frequency, duration) useful for designing workplace programmes
Limitations
- High overall risk of bias: six of seven studies were rated high risk, mainly due to lack of blinding of participants and/or instructors
- Substantial heterogeneity in interventions, outcome measures and statistical methods prevented a meta-analysis
- Small number of eligible RCTs and small sample sizes in most studies
- Only studies in English and Spanish were included, so relevant articles in other languages may have been missed
- Some included studies used non-validated scales
- Diversity in comparison/control groups makes it hard to attribute effects to specific interventions
- Included studies were conducted in high- and middle-upper-income countries, so results may not generalise to low- and middle-income settings
Key Takeaways for Patients
What This Means for You
- 01Doing exercise at your workplace, such as stretching or strength routines, may help reduce neck, shoulder, upper-limb and lower-back pain in people who sit at a desk most of the day.
- 02Short exercise sessions done more often during the week may be just as helpful as longer, less frequent sessions and are easier to fit around work.
- 03Several types of exercise showed benefit, including stretching, strength and scapular (shoulder-blade) training, and trunk-stabilising routines.
- 04The evidence is encouraging but not definitive: most of the studies had quality problems and used different methods, so these results should be viewed with caution.
- 05If you have ongoing pain, exercise relief may take time and a healthcare professional can help tailor a safe, sustainable routine.