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Counseling to change the lifestyle of sedentary workers on musculoskeletal pain: systematic review

ABSTRACT

BACKGROUND AND OBJECTIVES:

Musculoskeletal pain (MSP) in sedentary workers is a cause of absenteeism, high health costs and is relate to their lifestyle and work. Systematic reviews of interventions on the condition of MSP in this population are based on work equipment and do not present consensus on the type of intervention and its effectiveness. Terefore, the objective was to analyze the evidence of intervention studies that included education strategies to change the lifestyle of sedentary workers on the reduction of MSP.

CONTENTS:

This systematic review follows the recommendations of PRISMA 2020. Searches were conducted until April 2021 in the PubMed, BIREME and Scielo databases, in order to identify randomized or non-randomized clinical trials published between January 1999 and April 2021. Indexed search descriptors were used and eligibility criteria were defined according to the PICOS strategy. The risk of bias was assessed using the PEDro scale. Eight randomized clinical trials published between 2004 and 2020, conducted in Europe, Asia, the United States and Australia involving 1,871 people (35 to 52 years old) were included. Interventions ranged from two weeks to 12 months. Five studies showed a higher number of women. In addition to lifestyle counseling, three studies addressed work characteristics (time in sitting posture, body posture) and three others investigated issues related to pain (symptoms, neck/shoulder anatomy and self-management). Six interventions were effective to reduce the intensity and frequency of MSP in the cervical and lumbar regions of the spine, shoulders and thoracic spine, which used counseling to increase the practice of physical activity, stress control, healthy eating, decreased alcohol consumption and smoking. Six studies presented medium/low bias risk in the following items: occult allocation, baseline comparability, blinding (individuals, therapists and evaluators), adequate follow-up and intention to treat analysis; and two studies presented medium/high risk in the same items, except in baseline comparability.

CONCLUSION:

Workplace interventions that include education strategies and counseling for lifestyle changes are effective for reducing the intensity and frequency of MSP in sedentary workers.

PROSPERO registration: CRD42022342636.

HIGHLIGHTS

  • Lifestyle education can reduce musculoskeletal pain in workers.

  • Physical activity and stress control contribute to reducing pain intensity.

  • The workplace is a potent environment for decreasing musculoskeletal pain.

INTRODUCTION

Musculoskeletal problems comprise more than 150 disorders that affect the locomotor system, being characterized by pain and mobility limitations, and may reduce the ability to work11 World Health Organization. Musculoskeletal conditions [Internet]. 2021 [citado 22 de dezembro de 2021]. Disponível em: https://www.who.int/news-room/fact-sheets/detail/musculoskeletal-conditions.
https://www.who.int/news-room/fact-sheet...
. A systematic analysis of data from the 2019 Global Burden of Disease Study showed that approximately 1.71 billion people worldwide had problems associated with musculoskeletal pain (MSP)22 Cieza A, Causey K, Kamenov K, Hanson S W, Chatterji S, Vos T. Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2021;396(10267):2006-17., which had a 58% increase over the past two decades, with women having a higher incidence than men, and the conditions of low back pain, neck pain, rheumatoid arthritis, osteoarthritis, and gout were the five with the highest occurrence33 Jin Z, Wang D, Zhang H, Liang J, Feng X, Zhao J, Sun L. Incidence trend of five common musculoskeletal disorders from 1990 to 2017 at the global, regional and national level: results from the global burden of disease study 2017. Ann Rheum Dis. 2020;79(8):1014-22.. The prevalence of MSP In Brazil ranged from 16% to 82%44 Aguiar D P, Souza C P, Barbosa WJ, Santos-Júnior F F, Oliveira AS. Prevalence of chronic pain in Brazil: systematic review. BrJP. 2021;4(3):257-67., which is a public health problem. According to Brazilian Social Security data, musculoskeletal problems such as back pain, hand, wrist, knee and leg injuries are the most prevalent causes of work disability55 Oliveira PRA, Portela MC, Corrêa Filho HR, Souza WR. Nexo Técnico Epidemiológico Previdenciário (NTEP): risco das sete atividades econômicas e condições incapacitantes mais frequentes, Brasil, 2000-2016. Cad Saúde Pública. 2021;37(5):e00191119., and sedentary workers (administrative or ofice services) were the ones who presented the highest number of days of absence from work due to these problems66 Haefiner R, Kalinke L P, Felli VEA, Mantovani M F, Consonni D, Sarquis LMM. Absenteeism due to musculoskeletal disorders in Brazilian workers: thousands of days missed at work. Rev Bras Epidemiol. 2018;21:e180003.. This situation leads to loss of productivity and high costs to public health77 Carregaro RL, Tottoli CR, Rodrigues D da S, Bosmans JE, da Silva EN, van Tulder M. Low back pain should be considered a health and research priority in Brazil: Lost productivity and healthcare costs between 2012 to 2016. PLoS One. 2020;15(4):e0230902..

MSP outcomes in workers are related to their lifestyle88 Nahas M V. Atividade física, saúde e qualidade de vida: conceitos e sugestões para um estilo de vida ativo. 7a ed. Florianópolis: Ed. do Autor; 2017. 362p., including low level of physical activity (PA), inadequate eating habits, high body mass, difficult stress control, sedentary behavior and social factors such as the work activity performed88 Nahas M V. Atividade física, saúde e qualidade de vida: conceitos e sugestões para um estilo de vida ativo. 7a ed. Florianópolis: Ed. do Autor; 2017. 362p., 99 Crawford J, Davis A. Work-related musculoskeletal disorders: why are they still so prevalent? Evidence from a literature review [Internet]. European Agency for Safety and Health at Work – EU-OSHA. 2020 [citado 6 de dezembro de 2021]. Disponível em: https://osha.europa.eu/en/publications/work-related-musculoskeletal-disorders-why-are-they-still-so-prevalent-evidence/view.
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, 1010 Kok J, Vroonhof P, Snijders J, Roullis G, Clarke M, Peereboom K, et al. Work-related musculoskeletal disorders: prevalence, costs and demographics in the EU. Safety and health at work EU-OSHA [Internet]. 2019 [citado 6 de dezembro de 2021]. Disponível em: https://osha.europa.eu/en/publications/msds-facts-and-figures-overview-pre-valence-costs-and-demographics-msds-europe/view.
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, 1111 Shiri R, Lallukka T, Rahkonen O, Leino-Arjas P. Excess body mass and leisure time physical activity in the incidence and persistence of chronic pain. Pain Med. 2020;21(11):3094-101.. Regarding sedentary workers, the literature shows that besides long periods of sitting and inadequate body postures, other factors such as PA, obesity and psychosocial factors (stress, low social support and mental health problems) are related to the onset of MSP99 Crawford J, Davis A. Work-related musculoskeletal disorders: why are they still so prevalent? Evidence from a literature review [Internet]. European Agency for Safety and Health at Work – EU-OSHA. 2020 [citado 6 de dezembro de 2021]. Disponível em: https://osha.europa.eu/en/publications/work-related-musculoskeletal-disorders-why-are-they-still-so-prevalent-evidence/view.
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,1212 Celik S, Celik K, Dirimese E, Taşdemir N, Arik T, Büyükkara İ. Determination of pain in musculoskeletal system reported by ofice workers and the pain risk factors. Int J Occup Med Environ Health. 2018;31(1):91-111.,1313 Bontrup C, Taylor WR, Fliesser M, Visscher R, Green T, Wippert P-M, et al. Low back pain and its relationship with sitting behaviour among sedentary ofice workers. Appl Ergon. 2019;81:102894..

The European Agency for Safety and Health at Work (EU-OSHA)99 Crawford J, Davis A. Work-related musculoskeletal disorders: why are they still so prevalent? Evidence from a literature review [Internet]. European Agency for Safety and Health at Work – EU-OSHA. 2020 [citado 6 de dezembro de 2021]. Disponível em: https://osha.europa.eu/en/publications/work-related-musculoskeletal-disorders-why-are-they-still-so-prevalent-evidence/view.
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conducted a scoping review study with the working population of 28 countries in the European Community that showed 30% of workers spending between 25% and 75% of their working time in a sitting posture, which is a risk factor for the onset of pain, especially in the neck, shoulders, upper limbs, lumbar, and upper back regions99 Crawford J, Davis A. Work-related musculoskeletal disorders: why are they still so prevalent? Evidence from a literature review [Internet]. European Agency for Safety and Health at Work – EU-OSHA. 2020 [citado 6 de dezembro de 2021]. Disponível em: https://osha.europa.eu/en/publications/work-related-musculoskeletal-disorders-why-are-they-still-so-prevalent-evidence/view.
https://osha.europa.eu/en/publications/w...
,1212 Celik S, Celik K, Dirimese E, Taşdemir N, Arik T, Büyükkara İ. Determination of pain in musculoskeletal system reported by ofice workers and the pain risk factors. Int J Occup Med Environ Health. 2018;31(1):91-111.,1313 Bontrup C, Taylor WR, Fliesser M, Visscher R, Green T, Wippert P-M, et al. Low back pain and its relationship with sitting behaviour among sedentary ofice workers. Appl Ergon. 2019;81:102894..

In this context, the workplace is presented as an appropriate environment for interventions to beneft the worker’s health1414 Ogata AJN. Promoção da saúde no ambiente de trabalho. Rev Bras Med Trab. 2018;16(s1):41-2., which is recognized by the World Health Organization1515 World Health Organization. Preventing Noncommunicable Diseases in the Workplace through Diet and Physical Activity. WHO/World Economic Forum Report of a Joint Event. World Health Organization / World Economic Forum, Geneva [Internet]. Geneva: World Health Organization; 2008 [citado 6 de dezembro de 2021]. Disponível em: https://apps.who.int/iris/bitstream/handle/10665/43825/9789241596329_eng.pdf;jsessionid=4A6074B9BE2CCD95BE7696C8BEC62893?sequence=1.
https://apps.who.int/iris/bitstream/hand...
and by the EU-OSHA99 Crawford J, Davis A. Work-related musculoskeletal disorders: why are they still so prevalent? Evidence from a literature review [Internet]. European Agency for Safety and Health at Work – EU-OSHA. 2020 [citado 6 de dezembro de 2021]. Disponível em: https://osha.europa.eu/en/publications/work-related-musculoskeletal-disorders-why-are-they-still-so-prevalent-evidence/view.
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,1616 EU-OSHA. European Agency for Safety and Health at Work (European Union). Conversation starters for workplace discussions about musculoskeletal disorders. Safety and health at work EU-OSHA [Internet]. 2019 [citado 6 de dezembro de 2021]. Disponível em: https://osha.europa.eu/en/publications/conversation-starters-wor-kplace-discussions-about-musculoskeletal-disorders.
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as a suitable place to promote PA, healthy eating and to reduce MSP, especially in sedentary or ofice workers99 Crawford J, Davis A. Work-related musculoskeletal disorders: why are they still so prevalent? Evidence from a literature review [Internet]. European Agency for Safety and Health at Work – EU-OSHA. 2020 [citado 6 de dezembro de 2021]. Disponível em: https://osha.europa.eu/en/publications/work-related-musculoskeletal-disorders-why-are-they-still-so-prevalent-evidence/view.
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,1515 World Health Organization. Preventing Noncommunicable Diseases in the Workplace through Diet and Physical Activity. WHO/World Economic Forum Report of a Joint Event. World Health Organization / World Economic Forum, Geneva [Internet]. Geneva: World Health Organization; 2008 [citado 6 de dezembro de 2021]. Disponível em: https://apps.who.int/iris/bitstream/handle/10665/43825/9789241596329_eng.pdf;jsessionid=4A6074B9BE2CCD95BE7696C8BEC62893?sequence=1.
https://apps.who.int/iris/bitstream/hand...
,1616 EU-OSHA. European Agency for Safety and Health at Work (European Union). Conversation starters for workplace discussions about musculoskeletal disorders. Safety and health at work EU-OSHA [Internet]. 2019 [citado 6 de dezembro de 2021]. Disponível em: https://osha.europa.eu/en/publications/conversation-starters-wor-kplace-discussions-about-musculoskeletal-disorders.
https://osha.europa.eu/en/publications/c...
. Regarding pain, the strategies to reduce it must consider the risk and protection factors against it, such as changes in lifestyle (PA, eating habits, reduction of alcohol and tobacco consumption, and stress control), and address issues related to work and workers, such as sitting time and postural control in the sitting position99 Crawford J, Davis A. Work-related musculoskeletal disorders: why are they still so prevalent? Evidence from a literature review [Internet]. European Agency for Safety and Health at Work – EU-OSHA. 2020 [citado 6 de dezembro de 2021]. Disponível em: https://osha.europa.eu/en/publications/work-related-musculoskeletal-disorders-why-are-they-still-so-prevalent-evidence/view.
https://osha.europa.eu/en/publications/w...
,1616 EU-OSHA. European Agency for Safety and Health at Work (European Union). Conversation starters for workplace discussions about musculoskeletal disorders. Safety and health at work EU-OSHA [Internet]. 2019 [citado 6 de dezembro de 2021]. Disponível em: https://osha.europa.eu/en/publications/conversation-starters-wor-kplace-discussions-about-musculoskeletal-disorders.
https://osha.europa.eu/en/publications/c...
.

These strategies should be presented in the form of counseling, lectures, courses, group talks1616 EU-OSHA. European Agency for Safety and Health at Work (European Union). Conversation starters for workplace discussions about musculoskeletal disorders. Safety and health at work EU-OSHA [Internet]. 2019 [citado 6 de dezembro de 2021]. Disponível em: https://osha.europa.eu/en/publications/conversation-starters-wor-kplace-discussions-about-musculoskeletal-disorders.
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, ofering healthy foods in the workplace cafeterias, making available living spaces for PA practice, providing gym equipment in the ofice space1515 World Health Organization. Preventing Noncommunicable Diseases in the Workplace through Diet and Physical Activity. WHO/World Economic Forum Report of a Joint Event. World Health Organization / World Economic Forum, Geneva [Internet]. Geneva: World Health Organization; 2008 [citado 6 de dezembro de 2021]. Disponível em: https://apps.who.int/iris/bitstream/handle/10665/43825/9789241596329_eng.pdf;jsessionid=4A6074B9BE2CCD95BE7696C8BEC62893?sequence=1.
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, offering exercise programs, and education about psychosocial risk factors for MSP related to individual life, the work environment, as well as stress control99 Crawford J, Davis A. Work-related musculoskeletal disorders: why are they still so prevalent? Evidence from a literature review [Internet]. European Agency for Safety and Health at Work – EU-OSHA. 2020 [citado 6 de dezembro de 2021]. Disponível em: https://osha.europa.eu/en/publications/work-related-musculoskeletal-disorders-why-are-they-still-so-prevalent-evidence/view.
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,1717 Bülow K, Lindberg K, Vaegter HB, Juhl CB. Efectiveness of pain neurophysiology education on musculoskeletal pain: a systematic review and meta-analysis. Pain Med. 2021;22(4):891-904.,1818 da Costa FM, de Barros N F, de Oliveira HC, Alexandre NMC. Efects of an intervention program with health education and hatha yoga on the health of professionals with musculoskeletal symptoms. Rev Bras Med Trab. 2020;18(2):114-24..

However, a systematic review study of reviews showed that a large proportion of interventions for lifestyle changes carried out in the workplace used strategies based on individuals or on adjustments to the environment. Furthermore, few review studies evaluated broad intervention strategies aimed at total worker health, which was also observed in studies that evaluated MSP as an outcome, especially in sedentary workers1919 Proper KI, van Oostrom SH. The effectiveness of workplace health promotion interventions on physical and mental health outcomes - a systematic review of reviews. Scand J Work Environ Health. 2019;45(6):546-59..

Other review studies that evaluated interventions on MSP in the workplace in this population did not present consensus on the intervention models and their effectiveness2020 Parry S P, Coenen P, Shrestha N, O’Sullivan PB, Maher CG, Straker LM. Workplace interventions for increasing standing or walking for decreasing musculoskeletal symptoms in sedentary workers. Cochrane Database Syst Rev. 2019;2019(11):CD012487.,2121 Hoe VC, Urquhart DM, Kelsall HL, Zamri EN, Sim MR. Ergonomic interventions for preventing work-related musculoskeletal disorders of the upper limb and neck among ofice workers. Cochrane Database Syst Rev. 2018;10(10):CD008570.. Terefore, the objective was to analyze the evidence of intervention studies that included education strategies for lifestyle changes in sedentary workers in order to obtain a reduction in MSP.

CONTENTS

This systematic review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 statement: an updated guideline for reporting systematic reviews2222 Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372(n71):1-9. (checklist - Appendix 1). It was registered in the International prospective register of systematic reviews (PROSPERO) database, number CRD420223426362323 Jerônimo J, Lopes S, Siqueira F, Silva M. Counseling for musculoskeletal pain in sedentary workers: a systematic review [Internet]. 2022 [citado 15 de julho de 2022]. Disponível em: https://www.crd.york.ac.uk/prospero/display_record.php?Recor-dID=342636.
https://www.crd.york.ac.uk/prospero/disp...
, and was based on the following guiding question: what are the characteristics of intervention studies that used, among other strategies, lifestyle change counseling for sedentary workers to prevent musculoskeletal pain?

Search strategy

Searches were performed in English in the electronic database Medline/Pubmed (04/14/2021), in English and Portuguese in the Latin American and Caribbean Center on Health Sciences Information/BIREME (04/14/2021) and in the Scientific Eletronic Library Online/SciELO (04/15/2021). A time limit between Januar y 1, 1999, until the search dates in April 2021 was applied. For the searches, descriptors indexed in Medical Subject Headings (MeSH) and Health Sciences Descriptors (DeCS) were used, with the following combinations: 1) motor activity OR physical activity OR exercise AND occupational health AND pain; 2) motor activity OR physical activity OR exercise AND occupational health AND musculoskeletal pain; 3) motor activity OR physical activity OR exercise AND occupational health AND musculoskeletal pain AND counseling; 4) motor activity OR physical activity OR exercise AND occupational health AND musculoskeletal pain AND universities; 5) motor activity OR physical activity OR exercise AND occupational health AND musculoskeletal pain AND healthy diet; 6) motor activity OR physical activity OR exercise AND occupational health AND musculoskeletal pain AND body composition; 7) motor activity OR physical activity OR exercise AND occupational health AND pain AND healthy diet; 8) motor activity OR physical activity OR exercise AND occupational health AND pain AND body composition.

Eligibility criteria

Inclusion and exclusion criteria were defined according to the PICOS strategy2222 Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372(n71):1-9.,2424 Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):2-9. (Population, Intervention, Comparator, Outcome and Study design). Participants were to be sedentary workers (performing their activities in the sitting position, such as ofice or administrative services) at work, 18 years of age or older, recruited from the workplace, without a medical diagnosis for any type of disease or problem related to MSP, and who were not under treatment during the study period.

The interventions should be on site or during working hours and contain counseling (regardless of the medium used) for lifestyle changes (PA, eating habits, stress control, sedentary behavior). In addition to the intervention group, the studies should have one or more comparison groups (control or other intervention) and have as primary or secondary endpoint the reduction of the MSP evaluated in at least two periods. Intervention studies (randomized or non randomized clinical trials)2525 Del Duca G, Hallal P. Introdução à epidemiologia. Em: Florindo AA, Hallal PC, organizadores Epidemiologia da Atividade Física. São Paulo: Editora Atheneu; 2011. 1-24p., published in English or Portuguese, were eligible. Cross-sectional studies, cohorts, reviews, case-controls, guidelines, instrument/questionnaire validation studies, studies with patients in treatment, research protocols, interviews, books, theses, dissertations, monographs, letters to the editor, and theoretical essays were excluded. Also were excluded intervention studies not conducted with sedentary workers, studies in which the intervention or part of the intervention was conducted outside the workplace or outside working hours, studies with multi-component interventions that did not present components for lifestyle behavior change, (e.g. only application of PA or physical exercise or only changes in the work environment), studies that did not evaluate MSP, repeated studies (same sample and same intervention), and studies written in languages other than English or Portuguese.

Selection process, data extraction and risk of bias

The process of study selection, data extraction, and risk of bias assessment was carried out independently by two reviewers (JSJ and SVL), and doubts were resolved by consensus and, when necessary, with the help of a third reviewer (MCS). The records identifed in the electronic databases were exported to the EndNote X4 reference manager. After exclusion of duplicates, titles, abstracts, and full texts of eligible articles were read. Manual searches on reference lists of the selected studies were performed and the same selection process was applied.

Data were extracted and registered in a form created by the authors, which contained the variables of interest: author, year of publication, country of realization, type of study, objective, sample size, population, age, gender, characteristics of the intervention (number of groups, strategy, period, and number of evaluations), and results on the MSP (quantification and body regions). The data were synthesized and presented in the form of text; flow chart for the selection of the studies; a table for the description of the interventions; main results (proportions and p-value for the degree of significance of diference between groups); and a table for the risk of bias. To assess the risk of bias of the studies included in the review, the Physiotherapy Evidence Database (PEDro) scale2626 Shiwa SR, Costa LOP, Costa L da CM, Moseley A, Hespanhol Junior LC, Venâncio R, et al. Reproducibility of the Portuguese version of the PEDro Scale. Cad Saúde Pública. 2011;27(10):2063-8. was used. The first criterion of the scale is not computed, so trials can be scored from zero to 10 points, and the higher the score, the lower the risk of bias. The PEDro scale was translated into Brazilian Portuguese and tested against the English version, demonstrating adequate reproducibility and similarity2626 Shiwa SR, Costa LOP, Costa L da CM, Moseley A, Hespanhol Junior LC, Venâncio R, et al. Reproducibility of the Portuguese version of the PEDro Scale. Cad Saúde Pública. 2011;27(10):2063-8.. Furthermore, this scale shows moderate agreement with the risk of bias assessment tool used by the Cochrane Library4949 Moseley AM, Rahman P, Wells GA, Zadro JR, Sherrington C, Toupin-April K, et al. Agreement between the Cochrane risk of bias tool and Physiotherapy Evidence Database (PEDro) scale: A meta-epidemiological study of randomized controlled trials of physical therapy interventions. PLoS One. 2019;14(9):e0222770.. Although the scale is eficient and easy to apply, it does not allow inferences about the degree of evidence.

RESULTS

The searches identifed 3.670 titles. After exclusion of duplicates, 2.026 studies were screened, of which 28 eligible full texts were read. In manual searches, 291 titles were identifed and seven eligible full texts were read. According to the eligibility criteria, 27 full texts were excluded and eight studies were selected (Figure 1).

Figure 1
PRISMA2222 Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372(n71):1-9. Flowchart of study selection.

The selected studies were published in the period from 2004 to 2020. All were characterized as randomized clinical trials2727 Bernaards CM, Ariëns GAM, Knol DL, Hildebrandt VH. The effectiveness of a work style intervention and a lifestyle physical activity intervention on the recovery from neck and upper limb symptoms in computer workers. Pain. 2007;132(1-2):142-53., 2828 Proper KI, de Bruyne MC, Hildebrandt VH, van der Beek AJ, Meerding WJ, van Mechelen W. Costs, benefts and effectiveness of worksite physical activity counseling from the employer’s perspective. Scand J Work Environ Health. 2004;30(1):36-46., 2929 Andersen LL, Jørgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjøgaard G. A Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc. 2008;40(6):983-90., 3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76., 3131 Sitthipornvorakul E, Sihawong R, Waongenngarm P, Janwantanakul P. The effects of walking intervention on preventing neck pain in ofice workers: a randomized controlled trial. J Occup Health. 2020;62(1):e12106., 3232 Tsauo JY, Lee HY, Hsu JH, Chen CY, Chen CJ. Physical exercise and health education for neck and shoulder complaints among sedentary workers. J Rehabil Med. 2004;36(6):253-7., 3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7., 3434 Johnston V, Gane EM, Brown W, Vicenzino B, Healy GN, Gilson N, Smith MD. Feasibility and impact of sit-stand workstations with and without exercise in ofice workers at risk of low back pain: a pilot comparative effectiveness trial. Appl Ergon. 2019;76:82-9., with two or more groups, and had MSP as the primary endpoint. The body regions evaluated were cervical2727 Bernaards CM, Ariëns GAM, Knol DL, Hildebrandt VH. The effectiveness of a work style intervention and a lifestyle physical activity intervention on the recovery from neck and upper limb symptoms in computer workers. Pain. 2007;132(1-2):142-53.,2929 Andersen LL, Jørgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjøgaard G. A Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc. 2008;40(6):983-90., 3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76., 3131 Sitthipornvorakul E, Sihawong R, Waongenngarm P, Janwantanakul P. The effects of walking intervention on preventing neck pain in ofice workers: a randomized controlled trial. J Occup Health. 2020;62(1):e12106., 3232 Tsauo JY, Lee HY, Hsu JH, Chen CY, Chen CJ. Physical exercise and health education for neck and shoulder complaints among sedentary workers. J Rehabil Med. 2004;36(6):253-7., shoulders2727 Bernaards CM, Ariëns GAM, Knol DL, Hildebrandt VH. The effectiveness of a work style intervention and a lifestyle physical activity intervention on the recovery from neck and upper limb symptoms in computer workers. Pain. 2007;132(1-2):142-53.,2929 Andersen LL, Jørgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjøgaard G. A Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc. 2008;40(6):983-90.,3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76.,3232 Tsauo JY, Lee HY, Hsu JH, Chen CY, Chen CJ. Physical exercise and health education for neck and shoulder complaints among sedentary workers. J Rehabil Med. 2004;36(6):253-7., upper limbs2727 Bernaards CM, Ariëns GAM, Knol DL, Hildebrandt VH. The effectiveness of a work style intervention and a lifestyle physical activity intervention on the recovery from neck and upper limb symptoms in computer workers. Pain. 2007;132(1-2):142-53.,2828 Proper KI, de Bruyne MC, Hildebrandt VH, van der Beek AJ, Meerding WJ, van Mechelen W. Costs, benefts and effectiveness of worksite physical activity counseling from the employer’s perspective. Scand J Work Environ Health. 2004;30(1):36-46., thoracic3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76.,3232 Tsauo JY, Lee HY, Hsu JH, Chen CY, Chen CJ. Physical exercise and health education for neck and shoulder complaints among sedentary workers. J Rehabil Med. 2004;36(6):253-7. and lumbar3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76.,3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7.,3434 Johnston V, Gane EM, Brown W, Vicenzino B, Healy GN, Gilson N, Smith MD. Feasibility and impact of sit-stand workstations with and without exercise in ofice workers at risk of low back pain: a pilot comparative effectiveness trial. Appl Ergon. 2019;76:82-9. spine. Tey involved a total of 1.871 subjects, aged 35 to 52 years, who worked in ofices in different places: public administration2727 Bernaards CM, Ariëns GAM, Knol DL, Hildebrandt VH. The effectiveness of a work style intervention and a lifestyle physical activity intervention on the recovery from neck and upper limb symptoms in computer workers. Pain. 2007;132(1-2):142-53., 2828 Proper KI, de Bruyne MC, Hildebrandt VH, van der Beek AJ, Meerding WJ, van Mechelen W. Costs, benefts and effectiveness of worksite physical activity counseling from the employer’s perspective. Scand J Work Environ Health. 2004;30(1):36-46., 2929 Andersen LL, Jørgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjøgaard G. A Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc. 2008;40(6):983-90., universities3131 Sitthipornvorakul E, Sihawong R, Waongenngarm P, Janwantanakul P. The effects of walking intervention on preventing neck pain in ofice workers: a randomized controlled trial. J Occup Health. 2020;62(1):e12106.,3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7.,3434 Johnston V, Gane EM, Brown W, Vicenzino B, Healy GN, Gilson N, Smith MD. Feasibility and impact of sit-stand workstations with and without exercise in ofice workers at risk of low back pain: a pilot comparative effectiveness trial. Appl Ergon. 2019;76:82-9., public telecommunications services3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76. and airline companies3232 Tsauo JY, Lee HY, Hsu JH, Chen CY, Chen CJ. Physical exercise and health education for neck and shoulder complaints among sedentary workers. J Rehabil Med. 2004;36(6):253-7..

In five studies, was observed a higher frequency of women in the samples: 64%2929 Andersen LL, Jørgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjøgaard G. A Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc. 2008;40(6):983-90., 76% in the intervention group and 78% in the control group3131 Sitthipornvorakul E, Sihawong R, Waongenngarm P, Janwantanakul P. The effects of walking intervention on preventing neck pain in ofice workers: a randomized controlled trial. J Occup Health. 2020;62(1):e12106., 56%3232 Tsauo JY, Lee HY, Hsu JH, Chen CY, Chen CJ. Physical exercise and health education for neck and shoulder complaints among sedentary workers. J Rehabil Med. 2004;36(6):253-7., 78%3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7. and 69%3434 Johnston V, Gane EM, Brown W, Vicenzino B, Healy GN, Gilson N, Smith MD. Feasibility and impact of sit-stand workstations with and without exercise in ofice workers at risk of low back pain: a pilot comparative effectiveness trial. Appl Ergon. 2019;76:82-9.. Among these, four trials showed pain intensity reduction effects in the cervical2929 Andersen LL, Jørgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjøgaard G. A Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc. 2008;40(6):983-90.,3131 Sitthipornvorakul E, Sihawong R, Waongenngarm P, Janwantanakul P. The effects of walking intervention on preventing neck pain in ofice workers: a randomized controlled trial. J Occup Health. 2020;62(1):e12106., shoulder and thoracic spine3232 Tsauo JY, Lee HY, Hsu JH, Chen CY, Chen CJ. Physical exercise and health education for neck and shoulder complaints among sedentary workers. J Rehabil Med. 2004;36(6):253-7., and lumbar3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7. regions. There were patients with different degrees of MSP in six selected studies2727 Bernaards CM, Ariëns GAM, Knol DL, Hildebrandt VH. The effectiveness of a work style intervention and a lifestyle physical activity intervention on the recovery from neck and upper limb symptoms in computer workers. Pain. 2007;132(1-2):142-53., 2828 Proper KI, de Bruyne MC, Hildebrandt VH, van der Beek AJ, Meerding WJ, van Mechelen W. Costs, benefts and effectiveness of worksite physical activity counseling from the employer’s perspective. Scand J Work Environ Health. 2004;30(1):36-46., 2929 Andersen LL, Jørgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjøgaard G. A Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc. 2008;40(6):983-90., 3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76., 3131 Sitthipornvorakul E, Sihawong R, Waongenngarm P, Janwantanakul P. The effects of walking intervention on preventing neck pain in ofice workers: a randomized controlled trial. J Occup Health. 2020;62(1):e12106., 3232 Tsauo JY, Lee HY, Hsu JH, Chen CY, Chen CJ. Physical exercise and health education for neck and shoulder complaints among sedentary workers. J Rehabil Med. 2004;36(6):253-7., including no pain at all, who were analyzed together in both intervention and control groups. Tat is, in both group types in these six studies, there were subjects with MSP (symptomatic) and subjects without MSP (asymptomatic). In two studies3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7.,3434 Johnston V, Gane EM, Brown W, Vicenzino B, Healy GN, Gilson N, Smith MD. Feasibility and impact of sit-stand workstations with and without exercise in ofice workers at risk of low back pain: a pilot comparative effectiveness trial. Appl Ergon. 2019;76:82-9., the subjects were symptomatic and asymptomatic, respectively (Table 1). In the first group, the inclusion criterion was to have chronic pain (≥ 3 months) and in the second was to have no pain in the past 12 months. The interventions lasted from 2 weeks3232 Tsauo JY, Lee HY, Hsu JH, Chen CY, Chen CJ. Physical exercise and health education for neck and shoulder complaints among sedentary workers. J Rehabil Med. 2004;36(6):253-7. to 12 months2929 Andersen LL, Jørgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjøgaard G. A Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc. 2008;40(6):983-90. and used intervention strategies containing lifestyle counseling (PA2727 Bernaards CM, Ariëns GAM, Knol DL, Hildebrandt VH. The effectiveness of a work style intervention and a lifestyle physical activity intervention on the recovery from neck and upper limb symptoms in computer workers. Pain. 2007;132(1-2):142-53., 2828 Proper KI, de Bruyne MC, Hildebrandt VH, van der Beek AJ, Meerding WJ, van Mechelen W. Costs, benefts and effectiveness of worksite physical activity counseling from the employer’s perspective. Scand J Work Environ Health. 2004;30(1):36-46., 2929 Andersen LL, Jørgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjøgaard G. A Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc. 2008;40(6):983-90., 3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76., 3131 Sitthipornvorakul E, Sihawong R, Waongenngarm P, Janwantanakul P. The effects of walking intervention on preventing neck pain in ofice workers: a randomized controlled trial. J Occup Health. 2020;62(1):e12106., 3232 Tsauo JY, Lee HY, Hsu JH, Chen CY, Chen CJ. Physical exercise and health education for neck and shoulder complaints among sedentary workers. J Rehabil Med. 2004;36(6):253-7., 3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7., 3434 Johnston V, Gane EM, Brown W, Vicenzino B, Healy GN, Gilson N, Smith MD. Feasibility and impact of sit-stand workstations with and without exercise in ofice workers at risk of low back pain: a pilot comparative effectiveness trial. Appl Ergon. 2019;76:82-9., diet2828 Proper KI, de Bruyne MC, Hildebrandt VH, van der Beek AJ, Meerding WJ, van Mechelen W. Costs, benefts and effectiveness of worksite physical activity counseling from the employer’s perspective. Scand J Work Environ Health. 2004;30(1):36-46.,3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7., stress2828 Proper KI, de Bruyne MC, Hildebrandt VH, van der Beek AJ, Meerding WJ, van Mechelen W. Costs, benefts and effectiveness of worksite physical activity counseling from the employer’s perspective. Scand J Work Environ Health. 2004;30(1):36-46.,3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76.,3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7., alcohol consumption2828 Proper KI, de Bruyne MC, Hildebrandt VH, van der Beek AJ, Meerding WJ, van Mechelen W. Costs, benefts and effectiveness of worksite physical activity counseling from the employer’s perspective. Scand J Work Environ Health. 2004;30(1):36-46.,3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7. and smoking2828 Proper KI, de Bruyne MC, Hildebrandt VH, van der Beek AJ, Meerding WJ, van Mechelen W. Costs, benefts and effectiveness of worksite physical activity counseling from the employer’s perspective. Scand J Work Environ Health. 2004;30(1):36-46.,3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7.); physical exercise2929 Andersen LL, Jørgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjøgaard G. A Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc. 2008;40(6):983-90.,3232 Tsauo JY, Lee HY, Hsu JH, Chen CY, Chen CJ. Physical exercise and health education for neck and shoulder complaints among sedentary workers. J Rehabil Med. 2004;36(6):253-7.,3434 Johnston V, Gane EM, Brown W, Vicenzino B, Healy GN, Gilson N, Smith MD. Feasibility and impact of sit-stand workstations with and without exercise in ofice workers at risk of low back pain: a pilot comparative effectiveness trial. Appl Ergon. 2019;76:82-9. and electronic media with information on stress control, health promotion3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76. and how to increase the number of daily steps3131 Sitthipornvorakul E, Sihawong R, Waongenngarm P, Janwantanakul P. The effects of walking intervention on preventing neck pain in ofice workers: a randomized controlled trial. J Occup Health. 2020;62(1):e12106.. In addition to these components, three studies used advice related to work characteristics (sitting time3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7.,3434 Johnston V, Gane EM, Brown W, Vicenzino B, Healy GN, Gilson N, Smith MD. Feasibility and impact of sit-stand workstations with and without exercise in ofice workers at risk of low back pain: a pilot comparative effectiveness trial. Appl Ergon. 2019;76:82-9., sedentary behavior3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7., body posture during work2727 Bernaards CM, Ariëns GAM, Knol DL, Hildebrandt VH. The effectiveness of a work style intervention and a lifestyle physical activity intervention on the recovery from neck and upper limb symptoms in computer workers. Pain. 2007;132(1-2):142-53.) and three addressed issues related to MSP (symptoms2828 Proper KI, de Bruyne MC, Hildebrandt VH, van der Beek AJ, Meerding WJ, van Mechelen W. Costs, benefts and effectiveness of worksite physical activity counseling from the employer’s perspective. Scand J Work Environ Health. 2004;30(1):36-46., anatomy of the neck and shoulder3232 Tsauo JY, Lee HY, Hsu JH, Chen CY, Chen CJ. Physical exercise and health education for neck and shoulder complaints among sedentary workers. J Rehabil Med. 2004;36(6):253-7. and self-management of pain3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7.).

Table 1
Description of the studies selected in this review (n = 8)

All of the eight studies selected contained advice for the practice of PA2727 Bernaards CM, Ariëns GAM, Knol DL, Hildebrandt VH. The effectiveness of a work style intervention and a lifestyle physical activity intervention on the recovery from neck and upper limb symptoms in computer workers. Pain. 2007;132(1-2):142-53., 2828 Proper KI, de Bruyne MC, Hildebrandt VH, van der Beek AJ, Meerding WJ, van Mechelen W. Costs, benefts and effectiveness of worksite physical activity counseling from the employer’s perspective. Scand J Work Environ Health. 2004;30(1):36-46., 2929 Andersen LL, Jørgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjøgaard G. A Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc. 2008;40(6):983-90., 3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76., 3131 Sitthipornvorakul E, Sihawong R, Waongenngarm P, Janwantanakul P. The effects of walking intervention on preventing neck pain in ofice workers: a randomized controlled trial. J Occup Health. 2020;62(1):e12106., 3232 Tsauo JY, Lee HY, Hsu JH, Chen CY, Chen CJ. Physical exercise and health education for neck and shoulder complaints among sedentary workers. J Rehabil Med. 2004;36(6):253-7., 3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7., 3434 Johnston V, Gane EM, Brown W, Vicenzino B, Healy GN, Gilson N, Smith MD. Feasibility and impact of sit-stand workstations with and without exercise in ofice workers at risk of low back pain: a pilot comparative effectiveness trial. Appl Ergon. 2019;76:82-9. or application of physical exercises2929 Andersen LL, Jørgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjøgaard G. A Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc. 2008;40(6):983-90.,3232 Tsauo JY, Lee HY, Hsu JH, Chen CY, Chen CJ. Physical exercise and health education for neck and shoulder complaints among sedentary workers. J Rehabil Med. 2004;36(6):253-7.,3434 Johnston V, Gane EM, Brown W, Vicenzino B, Healy GN, Gilson N, Smith MD. Feasibility and impact of sit-stand workstations with and without exercise in ofice workers at risk of low back pain: a pilot comparative effectiveness trial. Appl Ergon. 2019;76:82-9.. Six showed statistically significant effects on the intensity and frequency of MSP2727 Bernaards CM, Ariëns GAM, Knol DL, Hildebrandt VH. The effectiveness of a work style intervention and a lifestyle physical activity intervention on the recovery from neck and upper limb symptoms in computer workers. Pain. 2007;132(1-2):142-53.,2929 Andersen LL, Jørgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjøgaard G. A Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc. 2008;40(6):983-90., 3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76., 3131 Sitthipornvorakul E, Sihawong R, Waongenngarm P, Janwantanakul P. The effects of walking intervention on preventing neck pain in ofice workers: a randomized controlled trial. J Occup Health. 2020;62(1):e12106., 3232 Tsauo JY, Lee HY, Hsu JH, Chen CY, Chen CJ. Physical exercise and health education for neck and shoulder complaints among sedentary workers. J Rehabil Med. 2004;36(6):253-7., 3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7., of which five showed a reduction in the workers’ pain in the cervical2727 Bernaards CM, Ariëns GAM, Knol DL, Hildebrandt VH. The effectiveness of a work style intervention and a lifestyle physical activity intervention on the recovery from neck and upper limb symptoms in computer workers. Pain. 2007;132(1-2):142-53.,2929 Andersen LL, Jørgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjøgaard G. A Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc. 2008;40(6):983-90.,3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76., shoulder2727 Bernaards CM, Ariëns GAM, Knol DL, Hildebrandt VH. The effectiveness of a work style intervention and a lifestyle physical activity intervention on the recovery from neck and upper limb symptoms in computer workers. Pain. 2007;132(1-2):142-53.,3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76.,3232 Tsauo JY, Lee HY, Hsu JH, Chen CY, Chen CJ. Physical exercise and health education for neck and shoulder complaints among sedentary workers. J Rehabil Med. 2004;36(6):253-7., thoracic3232 Tsauo JY, Lee HY, Hsu JH, Chen CY, Chen CJ. Physical exercise and health education for neck and shoulder complaints among sedentary workers. J Rehabil Med. 2004;36(6):253-7. and lumbar spine3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76.,3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7. regions. One study showed a lower frequency of cervical pain3131 Sitthipornvorakul E, Sihawong R, Waongenngarm P, Janwantanakul P. The effects of walking intervention on preventing neck pain in ofice workers: a randomized controlled trial. J Occup Health. 2020;62(1):e12106.. Table 1 presents the characteristics of the selected studies, as well as the detailed description of the intervention and its main results on MSP.

Regarding the risk of bias, according to the PEDro scale, the scores of the selected studies ranged from four points, in two studies,2828 Proper KI, de Bruyne MC, Hildebrandt VH, van der Beek AJ, Meerding WJ, van Mechelen W. Costs, benefts and effectiveness of worksite physical activity counseling from the employer’s perspective. Scand J Work Environ Health. 2004;30(1):36-46.,3232 Tsauo JY, Lee HY, Hsu JH, Chen CY, Chen CJ. Physical exercise and health education for neck and shoulder complaints among sedentary workers. J Rehabil Med. 2004;36(6):253-7. to eight points, in two others,3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7.,3434 Johnston V, Gane EM, Brown W, Vicenzino B, Healy GN, Gilson N, Smith MD. Feasibility and impact of sit-stand workstations with and without exercise in ofice workers at risk of low back pain: a pilot comparative effectiveness trial. Appl Ergon. 2019;76:82-9., with the others reaching five3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76.,3131 Sitthipornvorakul E, Sihawong R, Waongenngarm P, Janwantanakul P. The effects of walking intervention on preventing neck pain in ofice workers: a randomized controlled trial. J Occup Health. 2020;62(1):e12106. or six points2727 Bernaards CM, Ariëns GAM, Knol DL, Hildebrandt VH. The effectiveness of a work style intervention and a lifestyle physical activity intervention on the recovery from neck and upper limb symptoms in computer workers. Pain. 2007;132(1-2):142-53.,2929 Andersen LL, Jørgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjøgaard G. A Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc. 2008;40(6):983-90.. Of the eight selected studies, six showed medium/low risk of bias (≥ five points)2727 Bernaards CM, Ariëns GAM, Knol DL, Hildebrandt VH. The effectiveness of a work style intervention and a lifestyle physical activity intervention on the recovery from neck and upper limb symptoms in computer workers. Pain. 2007;132(1-2):142-53.,2929 Andersen LL, Jørgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjøgaard G. A Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc. 2008;40(6):983-90., 3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76., 3131 Sitthipornvorakul E, Sihawong R, Waongenngarm P, Janwantanakul P. The effects of walking intervention on preventing neck pain in ofice workers: a randomized controlled trial. J Occup Health. 2020;62(1):e12106.,3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7.,3434 Johnston V, Gane EM, Brown W, Vicenzino B, Healy GN, Gilson N, Smith MD. Feasibility and impact of sit-stand workstations with and without exercise in ofice workers at risk of low back pain: a pilot comparative effectiveness trial. Appl Ergon. 2019;76:82-9.. On the other hand, half of the studies2727 Bernaards CM, Ariëns GAM, Knol DL, Hildebrandt VH. The effectiveness of a work style intervention and a lifestyle physical activity intervention on the recovery from neck and upper limb symptoms in computer workers. Pain. 2007;132(1-2):142-53.,2828 Proper KI, de Bruyne MC, Hildebrandt VH, van der Beek AJ, Meerding WJ, van Mechelen W. Costs, benefts and effectiveness of worksite physical activity counseling from the employer’s perspective. Scand J Work Environ Health. 2004;30(1):36-46.,3131 Sitthipornvorakul E, Sihawong R, Waongenngarm P, Janwantanakul P. The effects of walking intervention on preventing neck pain in ofice workers: a randomized controlled trial. J Occup Health. 2020;62(1):e12106.,3232 Tsauo JY, Lee HY, Hsu JH, Chen CY, Chen CJ. Physical exercise and health education for neck and shoulder complaints among sedentary workers. J Rehabil Med. 2004;36(6):253-7. did not achieve adequate follow-up of participants and three studies did not use intention-to-treat analysis2828 Proper KI, de Bruyne MC, Hildebrandt VH, van der Beek AJ, Meerding WJ, van Mechelen W. Costs, benefts and effectiveness of worksite physical activity counseling from the employer’s perspective. Scand J Work Environ Health. 2004;30(1):36-46.,3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76.,3232 Tsauo JY, Lee HY, Hsu JH, Chen CY, Chen CJ. Physical exercise and health education for neck and shoulder complaints among sedentary workers. J Rehabil Med. 2004;36(6):253-7.. Table 2 presents the detailed score for each of the criteria.

Table 2
Bias risk analysis of the studies included in the review (n=8)

DISCUSSION

In addition to advice on lifestyle changes, the selected studies applied educational strategies on work characteristics and on MSP, as suggested by the literature on workplace interventions for sedentary workers99 Crawford J, Davis A. Work-related musculoskeletal disorders: why are they still so prevalent? Evidence from a literature review [Internet]. European Agency for Safety and Health at Work – EU-OSHA. 2020 [citado 6 de dezembro de 2021]. Disponível em: https://osha.europa.eu/en/publications/work-related-musculoskeletal-disorders-why-are-they-still-so-prevalent-evidence/view.
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,1515 World Health Organization. Preventing Noncommunicable Diseases in the Workplace through Diet and Physical Activity. WHO/World Economic Forum Report of a Joint Event. World Health Organization / World Economic Forum, Geneva [Internet]. Geneva: World Health Organization; 2008 [citado 6 de dezembro de 2021]. Disponível em: https://apps.who.int/iris/bitstream/handle/10665/43825/9789241596329_eng.pdf;jsessionid=4A6074B9BE2CCD95BE7696C8BEC62893?sequence=1.
https://apps.who.int/iris/bitstream/hand...
,1616 EU-OSHA. European Agency for Safety and Health at Work (European Union). Conversation starters for workplace discussions about musculoskeletal disorders. Safety and health at work EU-OSHA [Internet]. 2019 [citado 6 de dezembro de 2021]. Disponível em: https://osha.europa.eu/en/publications/conversation-starters-wor-kplace-discussions-about-musculoskeletal-disorders.
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. This shows that all the selected studies have a workplace education aspect, which, according to EU-OSHA1616 EU-OSHA. European Agency for Safety and Health at Work (European Union). Conversation starters for workplace discussions about musculoskeletal disorders. Safety and health at work EU-OSHA [Internet]. 2019 [citado 6 de dezembro de 2021]. Disponível em: https://osha.europa.eu/en/publications/conversation-starters-wor-kplace-discussions-about-musculoskeletal-disorders.
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, can present very satisfactory results in the prevention of MSP.

Five of the eight included studies showed a higher frequency of women in the samples2929 Andersen LL, Jørgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjøgaard G. A Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc. 2008;40(6):983-90.,3131 Sitthipornvorakul E, Sihawong R, Waongenngarm P, Janwantanakul P. The effects of walking intervention on preventing neck pain in ofice workers: a randomized controlled trial. J Occup Health. 2020;62(1):e12106., 3232 Tsauo JY, Lee HY, Hsu JH, Chen CY, Chen CJ. Physical exercise and health education for neck and shoulder complaints among sedentary workers. J Rehabil Med. 2004;36(6):253-7., 3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7., 3434 Johnston V, Gane EM, Brown W, Vicenzino B, Healy GN, Gilson N, Smith MD. Feasibility and impact of sit-stand workstations with and without exercise in ofice workers at risk of low back pain: a pilot comparative effectiveness trial. Appl Ergon. 2019;76:82-9.. These results may indicate that women are more related to the MSP outcome than men, either because they have more symptoms of musculoskeletal problems, or because they are more often employed in administrative and sedentary jobs. In the same way, EU-OSHA reports show that women are more affected by musculoskeletal problems than men1010 Kok J, Vroonhof P, Snijders J, Roullis G, Clarke M, Peereboom K, et al. Work-related musculoskeletal disorders: prevalence, costs and demographics in the EU. Safety and health at work EU-OSHA [Internet]. 2019 [citado 6 de dezembro de 2021]. Disponível em: https://osha.europa.eu/en/publications/msds-facts-and-figures-overview-pre-valence-costs-and-demographics-msds-europe/view.
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, and among the risk factors for MSP are gender and time spent sitting at work99 Crawford J, Davis A. Work-related musculoskeletal disorders: why are they still so prevalent? Evidence from a literature review [Internet]. European Agency for Safety and Health at Work – EU-OSHA. 2020 [citado 6 de dezembro de 2021]. Disponível em: https://osha.europa.eu/en/publications/work-related-musculoskeletal-disorders-why-are-they-still-so-prevalent-evidence/view.
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. The agency stated that although men are more likely to report MSP-related problems, especially back pain, women have a higher prevalence of neck, shoulder and upper limb problems99 Crawford J, Davis A. Work-related musculoskeletal disorders: why are they still so prevalent? Evidence from a literature review [Internet]. European Agency for Safety and Health at Work – EU-OSHA. 2020 [citado 6 de dezembro de 2021]. Disponível em: https://osha.europa.eu/en/publications/work-related-musculoskeletal-disorders-why-are-they-still-so-prevalent-evidence/view.
https://osha.europa.eu/en/publications/w...
,1010 Kok J, Vroonhof P, Snijders J, Roullis G, Clarke M, Peereboom K, et al. Work-related musculoskeletal disorders: prevalence, costs and demographics in the EU. Safety and health at work EU-OSHA [Internet]. 2019 [citado 6 de dezembro de 2021]. Disponível em: https://osha.europa.eu/en/publications/msds-facts-and-figures-overview-pre-valence-costs-and-demographics-msds-europe/view.
https://osha.europa.eu/en/publications/m...
.

Nonetheless, one of the studies included in the EU-OSHA review99 Crawford J, Davis A. Work-related musculoskeletal disorders: why are they still so prevalent? Evidence from a literature review [Internet]. European Agency for Safety and Health at Work – EU-OSHA. 2020 [citado 6 de dezembro de 2021]. Disponível em: https://osha.europa.eu/en/publications/work-related-musculoskeletal-disorders-why-are-they-still-so-prevalent-evidence/view.
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, which evaluated 12,426 workers from 18 countries, including ofice workers, identifed a significant association between female gender and low back pain disability. In addition, the report showed that 31% of female workers in the European community reported spending more than 75% of their working time sitting, while the frequency of men for sitting time at work was 25%99 Crawford J, Davis A. Work-related musculoskeletal disorders: why are they still so prevalent? Evidence from a literature review [Internet]. European Agency for Safety and Health at Work – EU-OSHA. 2020 [citado 6 de dezembro de 2021]. Disponível em: https://osha.europa.eu/en/publications/work-related-musculoskeletal-disorders-why-are-they-still-so-prevalent-evidence/view.
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.

In the same way, a study3535 Chen Y, Moutal A, Navratilova E, Kopruszinski C, Yue X, Ikegami M, et al. The prolactin receptor long isoform regulates nociceptor sensitization and opioid-induced hyperalgesia selectively in females. Sci Transl Med. 2020;12(529):eaay7550. showed that the prolactin hormone, produced by women during pregnancy, is released in excess in stressful situations. The authors observed that, in these situations, the increase in this hormone can produce a greater sensation of nonspecific pain, which does not determine, but may contribute to the multifactorial explanation of the fact that women feel more pain than men, resulting in higher frequencies of MSP in females.

Other studies with interventions in the workplace carried out with sedentary workers also presented a higher frequency of women in the samples. In one study3636 Edwardson CL, Yates T, Biddle SJH, Davies MJ, Dunstan DW, Esliger DW, et al. Efectiveness of the Stand More AT (SMArT) Work intervention: cluster randomised controlled trial. BMJ. 2018;363:k3870., 79% of the sample was composed of women and reductions were observed in the time spent sitting and in musculoskeletal problems. In another study1313 Bontrup C, Taylor WR, Fliesser M, Visscher R, Green T, Wippert P-M, et al. Low back pain and its relationship with sitting behaviour among sedentary ofice workers. Appl Ergon. 2019;81:102894., 62.5% of the participants were female, and the authors verifed a direct association between time spent sitting and chronic low back pain. Another study3737 Kettunen O, Vuorimaa T, Vasankari T. A 12-month exercise intervention decreased stress symptoms and increased mental resources among working adults - Results perceived after a 12-month follow-up. Int J Occup Med Environ Health. 2015;28(1):157-68. showed that 61.7% of the sample was composed of women.

Although these results reflect the reality of European female workers, they corroborate the findings of the present systematic review, showing that female ofice workers in other continents are also more affected by musculoskeletal pain than men, since four of the five studies with the highest number of women were conducted outside the European continent3131 Sitthipornvorakul E, Sihawong R, Waongenngarm P, Janwantanakul P. The effects of walking intervention on preventing neck pain in ofice workers: a randomized controlled trial. J Occup Health. 2020;62(1):e12106., 3232 Tsauo JY, Lee HY, Hsu JH, Chen CY, Chen CJ. Physical exercise and health education for neck and shoulder complaints among sedentary workers. J Rehabil Med. 2004;36(6):253-7., 3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7., 3434 Johnston V, Gane EM, Brown W, Vicenzino B, Healy GN, Gilson N, Smith MD. Feasibility and impact of sit-stand workstations with and without exercise in ofice workers at risk of low back pain: a pilot comparative effectiveness trial. Appl Ergon. 2019;76:82-9.. In addition, the findings also showed that both specific exercises for the neck, shoulder, and lower back2929 Andersen LL, Jørgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjøgaard G. A Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc. 2008;40(6):983-90.,3232 Tsauo JY, Lee HY, Hsu JH, Chen CY, Chen CJ. Physical exercise and health education for neck and shoulder complaints among sedentary workers. J Rehabil Med. 2004;36(6):253-7.,3434 Johnston V, Gane EM, Brown W, Vicenzino B, Healy GN, Gilson N, Smith MD. Feasibility and impact of sit-stand workstations with and without exercise in ofice workers at risk of low back pain: a pilot comparative effectiveness trial. Appl Ergon. 2019;76:82-9. and generic PA advice, such as for walking2929 Andersen LL, Jørgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjøgaard G. A Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc. 2008;40(6):983-90.,3131 Sitthipornvorakul E, Sihawong R, Waongenngarm P, Janwantanakul P. The effects of walking intervention on preventing neck pain in ofice workers: a randomized controlled trial. J Occup Health. 2020;62(1):e12106.,3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7., can be effective to reduce MSP in women. All of the eight selected studies contained PA-related components, with advice to practice PA2727 Bernaards CM, Ariëns GAM, Knol DL, Hildebrandt VH. The effectiveness of a work style intervention and a lifestyle physical activity intervention on the recovery from neck and upper limb symptoms in computer workers. Pain. 2007;132(1-2):142-53., 2828 Proper KI, de Bruyne MC, Hildebrandt VH, van der Beek AJ, Meerding WJ, van Mechelen W. Costs, benefts and effectiveness of worksite physical activity counseling from the employer’s perspective. Scand J Work Environ Health. 2004;30(1):36-46., 2929 Andersen LL, Jørgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjøgaard G. A Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc. 2008;40(6):983-90., 3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76., 3131 Sitthipornvorakul E, Sihawong R, Waongenngarm P, Janwantanakul P. The effects of walking intervention on preventing neck pain in ofice workers: a randomized controlled trial. J Occup Health. 2020;62(1):e12106., 3232 Tsauo JY, Lee HY, Hsu JH, Chen CY, Chen CJ. Physical exercise and health education for neck and shoulder complaints among sedentary workers. J Rehabil Med. 2004;36(6):253-7., 3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7., 3434 Johnston V, Gane EM, Brown W, Vicenzino B, Healy GN, Gilson N, Smith MD. Feasibility and impact of sit-stand workstations with and without exercise in ofice workers at risk of low back pain: a pilot comparative effectiveness trial. Appl Ergon. 2019;76:82-9. or practice of physical exercises2929 Andersen LL, Jørgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjøgaard G. A Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc. 2008;40(6):983-90.,3232 Tsauo JY, Lee HY, Hsu JH, Chen CY, Chen CJ. Physical exercise and health education for neck and shoulder complaints among sedentary workers. J Rehabil Med. 2004;36(6):253-7.,3434 Johnston V, Gane EM, Brown W, Vicenzino B, Healy GN, Gilson N, Smith MD. Feasibility and impact of sit-stand workstations with and without exercise in ofice workers at risk of low back pain: a pilot comparative effectiveness trial. Appl Ergon. 2019;76:82-9., of which six studies2727 Bernaards CM, Ariëns GAM, Knol DL, Hildebrandt VH. The effectiveness of a work style intervention and a lifestyle physical activity intervention on the recovery from neck and upper limb symptoms in computer workers. Pain. 2007;132(1-2):142-53.,2929 Andersen LL, Jørgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjøgaard G. A Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc. 2008;40(6):983-90., 3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76., 3131 Sitthipornvorakul E, Sihawong R, Waongenngarm P, Janwantanakul P. The effects of walking intervention on preventing neck pain in ofice workers: a randomized controlled trial. J Occup Health. 2020;62(1):e12106., 3232 Tsauo JY, Lee HY, Hsu JH, Chen CY, Chen CJ. Physical exercise and health education for neck and shoulder complaints among sedentary workers. J Rehabil Med. 2004;36(6):253-7., 3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7. showed reduction of the workers’ pain. Exposures to the practice or advice to practice ranged from two weeks of exercise, with recommendations to continue the practice for a period of three months3232 Tsauo JY, Lee HY, Hsu JH, Chen CY, Chen CJ. Physical exercise and health education for neck and shoulder complaints among sedentary workers. J Rehabil Med. 2004;36(6):253-7., to twelve months2929 Andersen LL, Jørgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjøgaard G. A Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc. 2008;40(6):983-90.. In three studies2929 Andersen LL, Jørgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjøgaard G. A Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc. 2008;40(6):983-90.,3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76.,3232 Tsauo JY, Lee HY, Hsu JH, Chen CY, Chen CJ. Physical exercise and health education for neck and shoulder complaints among sedentary workers. J Rehabil Med. 2004;36(6):253-7., the exercises were for the cervical areas (flexion, extension and rotation) and shoulders (lateral and frontal elevation) and for relaxation, to be done three times a week (three sets of fifteen repetitions)2929 Andersen LL, Jørgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjøgaard G. A Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc. 2008;40(6):983-90. to every day, once or twice a day (10 repetitions in 15-20 minute sessions)3232 Tsauo JY, Lee HY, Hsu JH, Chen CY, Chen CJ. Physical exercise and health education for neck and shoulder complaints among sedentary workers. J Rehabil Med. 2004;36(6):253-7.. In another study3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76., the advice to practice relaxation exercises was done with an electronic device that was accessible during the entire time of the study. The other three studies2727 Bernaards CM, Ariëns GAM, Knol DL, Hildebrandt VH. The effectiveness of a work style intervention and a lifestyle physical activity intervention on the recovery from neck and upper limb symptoms in computer workers. Pain. 2007;132(1-2):142-53.,3131 Sitthipornvorakul E, Sihawong R, Waongenngarm P, Janwantanakul P. The effects of walking intervention on preventing neck pain in ofice workers: a randomized controlled trial. J Occup Health. 2020;62(1):e12106.,3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7. ofered recommendations for general PA of moderate to vigorous intensity on commuting, occupational, household and leisure (walking, cycling, gardening, household chores, sports and increasing daily steps).

These findings suggest that there was adherence to PA practice and are in line with what has been reported in the literature on PA practice and pain reduction3838 Rice D, Nijs J, Kosek E, Wideman T, Hasenbring MI, Koltyn K, et al. Exercise-induced hypoalgesia in pain-free and chronic pain populations: state of the art and future directions. J Pain. 2019;20(11):1249-66.. The neurophysiological explanation for the post-PH hypoalgesia occurs due to the production of endogenous opioids and the increase of neurotransmitters, the catecholamines (dopamine and noradrenaline). This neurophysiological mechanism causes an increase in the pain threshold due to the reduction in the excitability of the plasma membrane of the neuron, especially in aferent nerve fibers of type A that have greater sensitivity. Thus, the higher the PA level of the individual, the higher the production of β-endorphins (endogenous opioids), which act in the descending mechanisms in the spinal cord, reducing the perception of pain3838 Rice D, Nijs J, Kosek E, Wideman T, Hasenbring MI, Koltyn K, et al. Exercise-induced hypoalgesia in pain-free and chronic pain populations: state of the art and future directions. J Pain. 2019;20(11):1249-66..

Among the six studies that showed significant reductions in workers’ MSP, four were effective in reducing pain intensity2727 Bernaards CM, Ariëns GAM, Knol DL, Hildebrandt VH. The effectiveness of a work style intervention and a lifestyle physical activity intervention on the recovery from neck and upper limb symptoms in computer workers. Pain. 2007;132(1-2):142-53.,2929 Andersen LL, Jørgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjøgaard G. A Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc. 2008;40(6):983-90.,3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76.,3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7., three of them in the intensity of neck pain2727 Bernaards CM, Ariëns GAM, Knol DL, Hildebrandt VH. The effectiveness of a work style intervention and a lifestyle physical activity intervention on the recovery from neck and upper limb symptoms in computer workers. Pain. 2007;132(1-2):142-53.,2929 Andersen LL, Jørgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjøgaard G. A Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc. 2008;40(6):983-90.,3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76., which contained in their interventions components about neck posture, PA, resistance exercises for the neck, and stress management. As already shown, the occurrence of MSP in sedentary workers is influenced by lifestyle factors (PA, body mass index-BMI, stress management) and work factors (sitting time and inadequate body postures)88 Nahas M V. Atividade física, saúde e qualidade de vida: conceitos e sugestões para um estilo de vida ativo. 7a ed. Florianópolis: Ed. do Autor; 2017. 362p., 99 Crawford J, Davis A. Work-related musculoskeletal disorders: why are they still so prevalent? Evidence from a literature review [Internet]. European Agency for Safety and Health at Work – EU-OSHA. 2020 [citado 6 de dezembro de 2021]. Disponível em: https://osha.europa.eu/en/publications/work-related-musculoskeletal-disorders-why-are-they-still-so-prevalent-evidence/view.
https://osha.europa.eu/en/publications/w...
, 1010 Kok J, Vroonhof P, Snijders J, Roullis G, Clarke M, Peereboom K, et al. Work-related musculoskeletal disorders: prevalence, costs and demographics in the EU. Safety and health at work EU-OSHA [Internet]. 2019 [citado 6 de dezembro de 2021]. Disponível em: https://osha.europa.eu/en/publications/msds-facts-and-figures-overview-pre-valence-costs-and-demographics-msds-europe/view.
https://osha.europa.eu/en/publications/m...
, 1111 Shiri R, Lallukka T, Rahkonen O, Leino-Arjas P. Excess body mass and leisure time physical activity in the incidence and persistence of chronic pain. Pain Med. 2020;21(11):3094-101., 1212 Celik S, Celik K, Dirimese E, Taşdemir N, Arik T, Büyükkara İ. Determination of pain in musculoskeletal system reported by ofice workers and the pain risk factors. Int J Occup Med Environ Health. 2018;31(1):91-111., 1313 Bontrup C, Taylor WR, Fliesser M, Visscher R, Green T, Wippert P-M, et al. Low back pain and its relationship with sitting behaviour among sedentary ofice workers. Appl Ergon. 2019;81:102894..

These results are confirmed by a prospective cohort study1111 Shiri R, Lallukka T, Rahkonen O, Leino-Arjas P. Excess body mass and leisure time physical activity in the incidence and persistence of chronic pain. Pain Med. 2020;21(11):3094-101. with 18.562 workers, which showed protection for MSP in any body region, in physically active individuals and risk in overweight and obese. Moreover, physically inactive and obese individuals had a higher risk of chronic pain. Another study3939 Chowdhury SK, Zhou Y, Wan B, Reddy C, Zhang X. Neck strength and endurance and associated personal and work-related factors. Hum Factors. 2021 [citado 28 de dezembro de 2021]. Disponível em: https://journals.sagepub.com/ doi/10.1177/0018720820983635. Epub ahead of print.
https://journals.sagepub.com/ doi/10.117...
showed that, in sedentary workers, neck posture is a determinant for the production of strength and resistance in the cervical region, physical abilities which are related to the appearance of pain in this body area. The authors suggest that if such a work-related factor is identifed, it is possible to modify it and, thus, reduce the appearance of work-related neck pain in the target population. However, other factors are related to the management of MSP in workers, such as stress control inside and outside the workplace. Three studies included in this review ofered information on stress management, which showed reductions in the frequency and intensity of pain in the lumbar, cervical, and shoulder regions2828 Proper KI, de Bruyne MC, Hildebrandt VH, van der Beek AJ, Meerding WJ, van Mechelen W. Costs, benefts and effectiveness of worksite physical activity counseling from the employer’s perspective. Scand J Work Environ Health. 2004;30(1):36-46.,3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76.,3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7.. One of these studies2828 Proper KI, de Bruyne MC, Hildebrandt VH, van der Beek AJ, Meerding WJ, van Mechelen W. Costs, benefts and effectiveness of worksite physical activity counseling from the employer’s perspective. Scand J Work Environ Health. 2004;30(1):36-46., which ofered information on stress management at work, showed a reduction in the presence of MSP in both the Intervention Group (received printed material and lectures) and the Control Group, which received only printed material with the same information, which demonstrates the relevance of information on stress management for reducing MSP.

On the other hand, the other two studies that used a stress control approach showed significant reductions in pain intensity3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76.,3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7.. It’s worth noting the study3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76., which compared two intervention groups and one Control Group. Unlike the other two studies2828 Proper KI, de Bruyne MC, Hildebrandt VH, van der Beek AJ, Meerding WJ, van Mechelen W. Costs, benefts and effectiveness of worksite physical activity counseling from the employer’s perspective. Scand J Work Environ Health. 2004;30(1):36-46.,3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7., this one3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76. delivered interventions focused on stress management with a broad health promotion approach, including relaxation exercises, and found reduced pain intensity for both groups compared to the control. The findings presented by these three studies2828 Proper KI, de Bruyne MC, Hildebrandt VH, van der Beek AJ, Meerding WJ, van Mechelen W. Costs, benefts and effectiveness of worksite physical activity counseling from the employer’s perspective. Scand J Work Environ Health. 2004;30(1):36-46.,3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76.,3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7. show that multiple interventions linking health promotion and lifestyles, including stress management inside and outside the workplace, can be effective in reducing the frequency and intensity of MSP, showing better results when the intervention is focused on stress management3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76..

In this sense, a review study1717 Bülow K, Lindberg K, Vaegter HB, Juhl CB. Efectiveness of pain neurophysiology education on musculoskeletal pain: a systematic review and meta-analysis. Pain Med. 2021;22(4):891-904. showed that educational processes about pain can reduce the intensity of MSP and psychological distress, a factor that is related to stress4040 Miranda FBG, Yamamura M, Pereira SS, Pereira C dos S, Protti-Zanatta S T, Costa MK, et al. Sofrimento psíquico entre os profissionais de enfermagem durante a pandemia da COVID-19: Scoping Review. Esc Anna Nery. 2021;25(spe):e20200363.. A randomized study1818 da Costa FM, de Barros N F, de Oliveira HC, Alexandre NMC. Efects of an intervention program with health education and hatha yoga on the health of professionals with musculoskeletal symptoms. Rev Bras Med Trab. 2020;18(2):114-24. showed that education about MSP, combined with exercises that contribute to stress control, such as those practiced in yoga, can also decrease MSP in workers, including sedentary workers1818 da Costa FM, de Barros N F, de Oliveira HC, Alexandre NMC. Efects of an intervention program with health education and hatha yoga on the health of professionals with musculoskeletal symptoms. Rev Bras Med Trab. 2020;18(2):114-24.. This finding corroborates the results of the three studies included in this review that used, as an intervention strategy, information about stress control2828 Proper KI, de Bruyne MC, Hildebrandt VH, van der Beek AJ, Meerding WJ, van Mechelen W. Costs, benefts and effectiveness of worksite physical activity counseling from the employer’s perspective. Scand J Work Environ Health. 2004;30(1):36-46.,3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76.,3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7..

Despite the described results, the relationship between the mentioned factors and the intensity of MSP is still a controversial issue. A systematic review study conducted by the Cochrane group, with interventions at the workplace in sedentary workers, found no relation between increased level of PA during the work shift (standing or walking) and reduced intensity of MSP2020 Parry S P, Coenen P, Shrestha N, O’Sullivan PB, Maher CG, Straker LM. Workplace interventions for increasing standing or walking for decreasing musculoskeletal symptoms in sedentary workers. Cochrane Database Syst Rev. 2019;2019(11):CD012487.. This finding contradicts half of the studies selected in this review, because four studies that contained in the interventions components to increase PA and that evaluated the intensity of MSP showed diferences between the groups, with significant reductions2727 Bernaards CM, Ariëns GAM, Knol DL, Hildebrandt VH. The effectiveness of a work style intervention and a lifestyle physical activity intervention on the recovery from neck and upper limb symptoms in computer workers. Pain. 2007;132(1-2):142-53.,2929 Andersen LL, Jørgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjøgaard G. A Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc. 2008;40(6):983-90.,3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76.,3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7..

The review proposed by the Cochrane group analyzed 10 studies with different designs and different intervention strategies2020 Parry S P, Coenen P, Shrestha N, O’Sullivan PB, Maher CG, Straker LM. Workplace interventions for increasing standing or walking for decreasing musculoskeletal symptoms in sedentary workers. Cochrane Database Syst Rev. 2019;2019(11):CD012487.. Four studies that evaluated the intensity of MSP contained intervention strategies focused on changes in the physical work environment, such as providing treadmill desks or standing workstations, and two studies focused on individual strategies, such as providing a PA tracker or a pedometer, which may explain the lack of association between increasing the level of PA and the intensity of MSP. It should be noted that Cochrane reviews employ methods that analyze the selected studies together, checking the strength of the evidence together.

However, five studies selected in the present review showed reduction in the intensity of MSP, which applied interventions directed to the individuals in an expanded manner, involving, besides PA in the occupational domain, the commuting, leisure and domestic domains2727 Bernaards CM, Ariëns GAM, Knol DL, Hildebrandt VH. The effectiveness of a work style intervention and a lifestyle physical activity intervention on the recovery from neck and upper limb symptoms in computer workers. Pain. 2007;132(1-2):142-53.,2929 Andersen LL, Jørgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjøgaard G. A Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc. 2008;40(6):983-90.,3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76.,3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7.,3434 Johnston V, Gane EM, Brown W, Vicenzino B, Healy GN, Gilson N, Smith MD. Feasibility and impact of sit-stand workstations with and without exercise in ofice workers at risk of low back pain: a pilot comparative effectiveness trial. Appl Ergon. 2019;76:82-9.. This may indicate that approaches involving the four PA domains and suggesting changes in the subjects’ lifestyles are effective in reducing pain intensity. According to EU-OSHA99 Crawford J, Davis A. Work-related musculoskeletal disorders: why are they still so prevalent? Evidence from a literature review [Internet]. European Agency for Safety and Health at Work – EU-OSHA. 2020 [citado 6 de dezembro de 2021]. Disponível em: https://osha.europa.eu/en/publications/work-related-musculoskeletal-disorders-why-are-they-still-so-prevalent-evidence/view.
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, the interventions to reduce MSP must consider the multifactorial character of pain, overcome the biomechanical perspective and incorporate intervention strategies that seek to understand and reach the MSP phenomenon in its totality, involving issues related to the subjects’ life and work style.

In addition, the literature presents other randomized clinical trials that evaluated ofice workers and contained in their intervention the component to increase PA, which showed reduction in pain intensity4141 Brakenridge CL, Chong YY, Winkler EAH, Hadgraft NT, Fjeldsoe BS, Johnston V, et al. Evaluating short-term musculoskeletal pain changes in desk-based workers receiving a workplace sitting-reduction intervention. Int J Environ Res Public Health. 2018;15(9):1975.,4242 Li Y, Tse MYM. An online pain education program for working adults: pilot randomized controlled trial. J Med Internet Res. 2020;22(1):e15071.. These studies also used broad strategies with approaches involving aspects related to increasing PA, including educational processes about risk and protection factors to prevent MSP, such as prolonged sitting time, knowledge about MSP (definition and symptoms, pain pathogenesis, relation with diseases, and physical and psychological impacts), non-pharmacological treatments (exercises, body posture, nutrition), and sleep and mood management, with moments for discussions about the topics addressed4141 Brakenridge CL, Chong YY, Winkler EAH, Hadgraft NT, Fjeldsoe BS, Johnston V, et al. Evaluating short-term musculoskeletal pain changes in desk-based workers receiving a workplace sitting-reduction intervention. Int J Environ Res Public Health. 2018;15(9):1975.,4242 Li Y, Tse MYM. An online pain education program for working adults: pilot randomized controlled trial. J Med Internet Res. 2020;22(1):e15071., strategies similar to those used by the authors3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76.,3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7..

Three studies showed greater effectiveness in reducing pain intensity with six months of intervention and with broad strategies through educational processes and counseling that suggest self-management of health-related behaviors, such as PA practice in leisure and commuting, food control, reduction in alcohol consumption, reduction in the smoking habit and stress self-management, inside and outside the workplace2929 Andersen LL, Jørgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjøgaard G. A Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc. 2008;40(6):983-90.,3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76.,3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7.. This could also be observed in the study2727 Bernaards CM, Ariëns GAM, Knol DL, Hildebrandt VH. The effectiveness of a work style intervention and a lifestyle physical activity intervention on the recovery from neck and upper limb symptoms in computer workers. Pain. 2007;132(1-2):142-53. that showed, through interactive meetings about body posture and lifestyle, a reduction in the intensity of MSP. However, the reduction was observed after the intervention period, i.e., after six months. This finding suggests that the subjects self-managed the information passed on to them. Moreover, studies2727 Bernaards CM, Ariëns GAM, Knol DL, Hildebrandt VH. The effectiveness of a work style intervention and a lifestyle physical activity intervention on the recovery from neck and upper limb symptoms in computer workers. Pain. 2007;132(1-2):142-53.,2929 Andersen LL, Jørgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjøgaard G. A Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc. 2008;40(6):983-90.,3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7. suggest that interventions with follow-up periods longer than six months may favor the assimilation of information and facilitate the acquisition and self-management of healthy habits. In this sense, the literature shows that self-selected exercise practice can present positive affective responses and greater pleasure during the practice4343 Lage FX de A, Amorim PR dos S, Moreira OC, Oliveira RAR de, Marins JCB. Exercício aeróbico e intensidade autosselecionada por mulheres: uma revisão sistemática. Saúde (Santa Maria). 2020;46(2):1-22., and perhaps the processes of choices and affective and pleasurable responses can explain the results presented.

These results indicate that self-management of information about MSP and related aspects (including PA and other lifestyle factors), as well as freedom of choice, both inside and outside the work environment, are important factors to consider in interventions aimed at reducing pain intensity.

Regarding the practice of physical exercises, three studies contained this component in the intervention, one for the lumbar region3434 Johnston V, Gane EM, Brown W, Vicenzino B, Healy GN, Gilson N, Smith MD. Feasibility and impact of sit-stand workstations with and without exercise in ofice workers at risk of low back pain: a pilot comparative effectiveness trial. Appl Ergon. 2019;76:82-9. and two2929 Andersen LL, Jørgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjøgaard G. A Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc. 2008;40(6):983-90.,3232 Tsauo JY, Lee HY, Hsu JH, Chen CY, Chen CJ. Physical exercise and health education for neck and shoulder complaints among sedentary workers. J Rehabil Med. 2004;36(6):253-7. for the cervical and shoulder regions. When the lumbar region is concerned, no diference was found between the evaluated groups3434 Johnston V, Gane EM, Brown W, Vicenzino B, Healy GN, Gilson N, Smith MD. Feasibility and impact of sit-stand workstations with and without exercise in ofice workers at risk of low back pain: a pilot comparative effectiveness trial. Appl Ergon. 2019;76:82-9.. The two studies that analyzed pain in the cervical and shoulder regions used, as an intervention strategy, specific resistance exercises for these areas, showing reduction in pain intensity2929 Andersen LL, Jørgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjøgaard G. A Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc. 2008;40(6):983-90. and frequency3232 Tsauo JY, Lee HY, Hsu JH, Chen CY, Chen CJ. Physical exercise and health education for neck and shoulder complaints among sedentary workers. J Rehabil Med. 2004;36(6):253-7.. These findings corroborate the results presented in the literature.

A systematic review study analyzing interventions performed at the workplace in ofice workers concluded that shoulder and neck exercises performed three times a week using light weights or elastic bands for 10 weeks were effective in reducing pain4444 Chen X, Coombes BK, Sjøgaard G, Jun D, O’Leary S, Johnston V. Workplace-based interventions for neck pain in ofice workers: systematic review and meta-analysis. Phys Ter. 2018;98(1):40-62.. This result was ratifed by the study2929 Andersen LL, Jørgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjøgaard G. A Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc. 2008;40(6):983-90. that used an intervention strategy similar to the one described above (elastic bands and light weights three times a week), observing a reduction in the pain intensity of the cervical region. On the other hand, another study3232 Tsauo JY, Lee HY, Hsu JH, Chen CY, Chen CJ. Physical exercise and health education for neck and shoulder complaints among sedentary workers. J Rehabil Med. 2004;36(6):253-7. also identifed a reduction in the percentage of subjects with shoulder and thoracic spine pain, however, in its intervention, the exercises were performed daily under the supervision of a physical therapist and the subjects who did them did not use any type of material to perform the activities.

In the present review, no Latin American studies were found and only two were conducted in low and middle income countries3131 Sitthipornvorakul E, Sihawong R, Waongenngarm P, Janwantanakul P. The effects of walking intervention on preventing neck pain in ofice workers: a randomized controlled trial. J Occup Health. 2020;62(1):e12106.,3232 Tsauo JY, Lee HY, Hsu JH, Chen CY, Chen CJ. Physical exercise and health education for neck and shoulder complaints among sedentary workers. J Rehabil Med. 2004;36(6):253-7.. However, the literature showed that in populations from low and middle-income countries, as well as in high-income countries, lifestyle factors of individuals, such as high BMI or obesity, the smoking habit, low level of PA and poor body posture are related to MSP99 Crawford J, Davis A. Work-related musculoskeletal disorders: why are they still so prevalent? Evidence from a literature review [Internet]. European Agency for Safety and Health at Work – EU-OSHA. 2020 [citado 6 de dezembro de 2021]. Disponível em: https://osha.europa.eu/en/publications/work-related-musculoskeletal-disorders-why-are-they-still-so-prevalent-evidence/view.
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,4545 Green BN, Johnson CD, Haldeman S, Kane EJ, Clay MB, Grifth EA, et al. The global spine care initiative: public health and prevention interventions for common spine disorders in low- and middle-income communities. Eur Spine J. 2018;27(6):838-50.. As measures to prevent MSP in low and middle-income country populations, the literature suggests the implementation of community-based interventions aimed at behavioral changes with the creation and maintenance of healthy habits4545 Green BN, Johnson CD, Haldeman S, Kane EJ, Clay MB, Grifth EA, et al. The global spine care initiative: public health and prevention interventions for common spine disorders in low- and middle-income communities. Eur Spine J. 2018;27(6):838-50.. However, there is a need to conduct further studies in countries with these characteristics.

An interesting point to note is that the studies included in this review presented intervention strategies that can be applied in other contexts, especially considering the pandemic moment by Covid-19, in which an increase in remote or home-based work was observed4646 Buomprisco G, Ricci S, Perri R, De Sio S. Health and telework: new challenges after COVID-19 pandemic. Eur J Env Publi. 2021;5(2):em0073., a period in which women’s reports indicated an increase in work overload due to the overlapping of tasks (work, children, and home). However, they also reported closeness with their children and husbands and more time for PA practice4747 Lemos AHDC, Barbosa ADO, Monzato P P. Mulheres em home ofice durante a pandemia da covid-19 e as configurações do confito trabalho-família. Rev Adm Empres. 2020;60(6):388-99.. On the other hand, when working at home during the pandemic, an increase in the presence of MSP, especially low back and neck pain4848 Moretti A, Menna F, Aulicino M, Paoletta M, Liguori S, Iolascon G. Characterization of home working population during COVID-19 emergency: a cross-sectional analysis. Int J Environ Res Public Health. 2020;17(17):6284., and an increased risk of developing musculoskeletal problems4646 Buomprisco G, Ricci S, Perri R, De Sio S. Health and telework: new challenges after COVID-19 pandemic. Eur J Env Publi. 2021;5(2):em0073., were both observed both, which suggests the need for interventions that can be performed in this context.

Regarding the evaluation of the risk of bias, it should be noted that the included studies used educational processes on MSP, which makes it difficult to blind participants and therapists, suggesting that the evaluation should be analyzed in a relative way. This review presents limitations and some strengths that deserve to be highlighted. First, a meta-analysis was not conducted, and the degree of certainty of the evidence was not evaluated, which makes it difficult to state the effect of all of them on the outcome. In addition, of the six studies that showed statistically significant effects on MSP2727 Bernaards CM, Ariëns GAM, Knol DL, Hildebrandt VH. The effectiveness of a work style intervention and a lifestyle physical activity intervention on the recovery from neck and upper limb symptoms in computer workers. Pain. 2007;132(1-2):142-53.,2929 Andersen LL, Jørgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjøgaard G. A Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc. 2008;40(6):983-90., 3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76., 3131 Sitthipornvorakul E, Sihawong R, Waongenngarm P, Janwantanakul P. The effects of walking intervention on preventing neck pain in ofice workers: a randomized controlled trial. J Occup Health. 2020;62(1):e12106., 3232 Tsauo JY, Lee HY, Hsu JH, Chen CY, Chen CJ. Physical exercise and health education for neck and shoulder complaints among sedentary workers. J Rehabil Med. 2004;36(6):253-7., 3333 Barone Gibbs B, Hergenroeder AL, Perdomo SJ, Kowalsky RJ, Delitto A, Jakicic JM. Reducing sedentary behaviour to decrease chronic low back pain: the stand back randomised trial. Occup Environ Med. 2018;75(5):321-7., in five2727 Bernaards CM, Ariëns GAM, Knol DL, Hildebrandt VH. The effectiveness of a work style intervention and a lifestyle physical activity intervention on the recovery from neck and upper limb symptoms in computer workers. Pain. 2007;132(1-2):142-53.,2929 Andersen LL, Jørgensen MB, Blangsted AK, Pedersen MT, Hansen EA, Sjøgaard G. A Randomized controlled intervention trial to relieve and prevent neck/shoulder pain. Med Sci Sports Exerc. 2008;40(6):983-90., 3030 Schell E, Teorell T, Hasson D, Arnetz B, Saraste H. Impact of a web-based stress management and health promotion program on neck-shoulder-back pain in knowledge workers? 12 month prospective controlled follow-up. J Occup Environ Med. 2008;50(6):667-76., 3131 Sitthipornvorakul E, Sihawong R, Waongenngarm P, Janwantanakul P. The effects of walking intervention on preventing neck pain in ofice workers: a randomized controlled trial. J Occup Health. 2020;62(1):e12106., 3232 Tsauo JY, Lee HY, Hsu JH, Chen CY, Chen CJ. Physical exercise and health education for neck and shoulder complaints among sedentary workers. J Rehabil Med. 2004;36(6):253-7. there were asymptomatic and symptomatic subjects, which were analyzed together, which may have affected the direction of the effect of the interventions. Other factors to report were the searches, conducted in three databases and with a time limit between 1999 and 2021, which may generate a publication bias of the selected studies. In addition, an inclusion criterion of this review was that the studies should be published in English or Portuguese, a criterion that may contribute to the aforementioned bias. Nevertheless, the databases used for the search are among the main ones in Latin America, the Caribbean, and in the international health context, which minimizes the chance that articles referring to this theme were not included in the selection.

As some of the study’s strengths, can be highlighted the use of solid methodological review techniques, such as the use of PRISMA2222 Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372(n71):1-9. guidelines for writing this report and completing its checklist (Appendix 1), the registration of the review in the PROSPERO2323 Jerônimo J, Lopes S, Siqueira F, Silva M. Counseling for musculoskeletal pain in sedentary workers: a systematic review [Internet]. 2022 [citado 15 de julho de 2022]. Disponível em: https://www.crd.york.ac.uk/prospero/display_record.php?Recor-dID=342636.
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database, the use of search descriptors indexed in MeSH and DeCS, the definition of eligibility criteria according to the PICOS strategy2222 Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372(n71):1-9.,2424 Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):2-9., the study selection process and other steps of the review made by two independent reviewers, the use of a tool for assessing the risk of bias in studies2626 Shiwa SR, Costa LOP, Costa L da CM, Moseley A, Hespanhol Junior LC, Venâncio R, et al. Reproducibility of the Portuguese version of the PEDro Scale. Cad Saúde Pública. 2011;27(10):2063-8. and the conclusions based on the quality of evidence. Future intervention studies with the objective of reducing MSP in sedentary workers should focus on the potential for MSP education strategies delivered in the workplace and be aimed at lifestyle changes for these individuals. In addition, researchers should direct greater attention to possible subject losses during the study and, to minimize the effect of such losses, employ intention-to-treat analysis.

CONCLUSION

Multi-component interventions carried out in the workplace and that include education strategies and counseling for lifestyle changes are effective in reducing the intensity and frequency of neck, shoulder, upper limb, and low back pain in sedentary workers. The need for more intervention studies with Latin American workers and those from low and middle-income countries is highlighted. Considering the heterogeneity of the studies regarding the ways of measuring the MSP outcome, the generalization about this review findings should be evaluated with caution.

ACKNOWLEDGMENTS

The authors would like to thank the Graduate Program in Physical Education (PPGEF) from the Physical Education School (ESEF) of the Federal University of Pelotas (UFPel), Exercise Physiology Study Group (GEFEX) and the Physical Activity Epidemiology Study Group (GEEAF).

Appendix 1


PRISMA checklist2222 Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372(n71):1-9.
  • Sponsoring sources: This work was carried out with support from the Coordination for the Improvement of Higher Education Personnel - Brazil (CAPES) - Funding Code 001.

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Publication Dates

  • Publication in this collection
    21 Nov 2022
  • Date of issue
    Jul-Sep 2022

History

  • Received
    29 Dec 2021
  • Accepted
    18 Aug 2022
Sociedade Brasileira para o Estudo da Dor Av. Conselheiro Rodrigues Alves, 937 Cj2 - Vila Mariana, CEP: 04014-012, São Paulo, SP - Brasil, Telefones: , (55) 11 5904-2881/3959 - São Paulo - SP - Brazil
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