Exercise Interventions to Improve Surgeon Ergonomics: A Systematic Review

INTRODUCTION: Awareness of work-related musculoskeletal disorders in surgeons is rising. Surgical ergonomics seeks to reduce this burden of disease and optimize surgeon health and career longevity. Most of the existing literature focuses on awareness of ergonomic principles or intraoperative microbreaks as strategies to improve surgeon ergonomics. Exercise may have untapped potential as a tool to reduce the physical strain of operating on surgeons. OBJECTIVE: Our aim was to systematically review the literature to identify peer-reviewed comparative studies of surgeon exercise as an intervention to improve surgical ergonomics. METHODS: We conducted a systematic review of 4 literature databases (PubMed, Embase, SCOPUS, and Cochrane Library) from inception through June 2025. Following PRISMA guidelines, 2 authors independently screened abstracts and full-text papers for inclusion in the review. Studies were excluded if they exclusively focused on education or microbreaks as the intervention or if they were written in a language other than English. Data was extracted for a narrative summary of the literature. Meta-analysis could not be performed due to the heterogeneity of study outcomes. Evidence quality was assessed using the GRADE approach. RESULTS: After deduplication, 144 citations were reviewed, and 5 studies (278 surgeons) met inclusion criteria. There was 1 multicenter randomized controlled trial, 3 pre-post studies, and 1 prospective interventional trial. The exercise regimens were all designed to target high-risk areas, including the back, neck, and shoulders, and most were designed in conjunction with physical therapists. Four of the 5 studies also combined the exercise intervention with different ergonomic intervention, like education or a patient-positioning protocol. There were no active control groups (all controls were usual practice or pre-intervention). Reported outcomes varied widely and included musculoskeletal pain, prevalence of work-related musculoskeletal disorders, muscle activity by electromyography, and subjective improvement in surgeon physical performance. All studies favored the exercise intervention over control or pre-intervention. Most evidence was low quality. CONCLUSIONS: Exercise shows promise as an intervention to improve surgeon ergonomics. Current evidence is limited by small sample sizes, heterogeneous outcomes, and lack of active control groups. Future trials are needed to measure exercise’s impact more precisely and identify the optimal approach.Figure 1Table 1