Can exercise improve surgical ergonomics? A systematic review.

BACKGROUND: Exercise may have untapped potential as a tool to reduce the physical strain of operating and optimize surgeon career longevity. This study aims 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 through July 2026 following PRISMA guidelines. Studies of non-exercise interventions for surgical ergonomics were excluded as were studies not written in English. Meta-analysis could not be performed due to the heterogeneity of study outcomes. Data were extracted for a narrative summary of the literature. Evidence quality was assessed using JBI critical appraisal tools for individual studies and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach for the body of evidence. RESULTS: 185 citations were reviewed, and 6 studies (n=282 surgeons) met inclusion criteria: 1 multicenter randomized controlled trial, 4 pre-post studies, and 1 prospective interventional trial. All control groups were usual practice or pre-intervention. All studies favored the exercise intervention over control/pre-intervention. Exercise regimens targeted high-risk areas including back, neck, and shoulders, and most were designed in conjunction with physical therapists. 5 of the 6 studies combined exercise with another intervention such as education or a patient-positioning protocol. Reported outcomes varied widely and included musculoskeletal pain/disorders, muscle activity by EMG, and subjective improvement in physical performance. Most evidence was mostly moderate quality. CONCLUSION: Exercise-based interventions may improve surgeon ergonomics. Evidence is limited by small samples, heterogeneous outcomes, and lack of active control groups. Future trials are needed to identify the optimal exercise approach. TRIAL REGISTRATION: PROSPERO 2025 Registration: CRD420251075237 ( https://www.crd.york.ac.uk/PROSPERO/view/CRD420251075237 ).