The Cochrane database of systematic reviewsOct 8, 2025

Taking breaks to prevent muscle and joint problems in healthy workers

Circadian Biology Weekly Brief ↗PubMed ↗DOI ↗

Updated Apr 2, 2026

Abstract

Nine randomized controlled trials involving 626 workers assessed the effects of work-break interventions on musculoskeletal disorders.

Work-related musculoskeletal disorders accounted for around 27% of all work-related illnesses in the UK, resulting in 6.6 million lost working days.
Changes in work-break frequency may have little to no effect on the onset of musculoskeletal neck and back pain, but the evidence is very uncertain.
The intensity of overall musculoskeletal pain and back discomfort may also show little to no change with additional work-breaks, according to the very uncertain evidence.
Different types of work-breaks, including active and cognitive breaks, may have minimal impact on physiological musculoskeletal fatigue, though confidence in the findings is low.
All assessed outcomes were judged to have some bias concerns or to be at high risk of bias, leading to a classification of the evidence as 'very low certainty'.
Further high-quality studies with larger sample sizes and diverse worker populations are needed to clarify the effectiveness of work-break interventions.

Simplified

RATIONALE: Work-related musculoskeletal disorders are amongst the leading causes of occupational sick leave worldwide and account for a high share of absenteeism. For example, in the UK in 2021 to 2022, musculoskeletal disorders were estimated to account for around 27% of all work-related illnesses and result in 6.6 million lost working days. Several workplace interventions are available for reducing the high prevalence of work-related musculoskeletal disorders. We focused on work-breaks as an organisational intervention for primary prevention. This is an update of a Cochrane review first published in 2019.

OBJECTIVES: To assess the effects of different work-break interventions for preventing work-related musculoskeletal symptoms and disorders in healthy workers, when compared to conventional or alternative work-break interventions.

SEARCH METHODS: We searched for randomised controlled trials in CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, SCOPUS, Web of Science, ClinicalTrials.gov, and the WHO ICTRP, up to 31 May 2024.

ELIGIBILITY CRITERIA: We included randomised controlled trials (RCTs) of work-break interventions at workplaces for preventing work-related musculoskeletal symptoms and disorders amongst workers. The studies were eligible for inclusion if they intervened on work-break frequency, duration, or type, compared to conventional or alternative work-break interventions, and when the investigated population included healthy adult workers who were free of musculoskeletal complaints during study enrolment, without any restrictions on sex or occupation.

OUTCOMES: Our critical outcomes were newly diagnosed musculoskeletal disorders or symptoms, and intensity of musculoskeletal symptoms (including pain, discomfort, or physiological fatigue). Our important outcomes were productivity or work performance, and workload as a measure of strain.

RISK OF BIAS: We judged the risk of bias in the outcomes of the included studies using the Cochrane RoB 2 tool.

SYNTHESIS METHODS: Two review authors independently screened search records or full texts for study eligibility, extracted data, and assessed risk of bias. We contacted authors for additional data where required. We used the random-effects model for meta-analyses, producing risk ratios (RR) for dichotomous outcomes and mean differences (MD) or standardised mean differences (SMD) for continuous outcomes. We rated the certainty of evidence using GRADE.

INCLUDED STUDIES: We included nine RCTs (three of which were new in this update) with 626 workers (at least 75% of whom were female, and 98% of whom were office workers). The trials were conducted in high-income or higher-middle-income countries. Four of the RCTs used a parallel design; two used a cross-over design; one was a mixture of parallel and cross-over; and two were cluster-RCTs. Intervention periods ranged from one day to six months. Six studies investigated work-break frequencies, two investigated work-break types, and one investigated both. None of the studies investigated work-break durations. One study could not be included in the meta-analyses because no detailed results were reported or available. We judged all outcomes to have some bias concerns or to be at high risk of bias.

SYNTHESIS OF RESULTS: We assessed the evidence available for all comparisons and outcomes as 'very low certainty'. Changes in frequency of work-breaks Compared to conventional work-breaks, additional work-breaks may make little to no difference to the new onset of musculoskeletal neck pain (RR 0.82, 95% CI 0.53 to 1.28; 1 study, 147 participants) or back pain (RR 0.58, 95% CI 0.30 to 1.11; 1 study, 147 participants), but the evidence is very uncertain. Likewise, additional work-breaks may make little to no difference to the intensity of musculoskeletal overall pain (MD -1.01, 95% CI -2.84 to 0.82; 1 study, 39 participants) or the intensity of musculoskeletal back discomfort (SMD -0.04, 95% CI -0.24 to 0.17; 5 studies, 372 participants), but the evidence is very uncertain. Additional work-breaks may reduce the intensity of musculoskeletal back pain (MD -0.91, 95% CI -1.45 to -0.38; 1 study, 147 participants), but the evidence is very uncertain. Intensity of overall physiological musculoskeletal fatigue and adverse effects were not measured in the studies investigating frequency of work-breaks. Additional higher-frequency work-breaks may make little to no difference to the intensity of musculoskeletal back discomfort, compared to additional lower-frequency work-breaks (MD 18.60, 95% CI -47.07 to 84.27, 1 study, 10 participants), but the evidence is very uncertain. Our other critical outcomes were not measured in this study. Changes in type of work-breaks The studies that evaluated different types of work-breaks assessed only one of our critical outcomes. Active work-breaks may make little to no difference to the intensity of physiological musculoskeletal fatigue compared to conventional work-breaks (SMD -0.23, 95% CI -0.55 to 0.10; 2 studies, 146 participants), but the evidence is very uncertain. Cognitive work-breaks may make little to no difference to the intensity of physiological musculoskeletal fatigue compared to conventional work-breaks (SMD -0.18, 95% CI -0.57 to 0.21; 2 studies, 141 participants), but the evidence is very uncertain. Active work-breaks may make little to no difference to the intensity of physiological musculoskeletal fatigue compared to cognitive work-breaks (SMD -0.03, 95% CI -0.37 to 0.30; 2 studies, 137 participants), but the evidence is very uncertain.

AUTHORS' CONCLUSIONS: The evidence is very uncertain about the effect of additional work-breaks on the intensity of musculoskeletal back and neck pain and on productivity. The evidence is very uncertain about the effect of different work-break types on newly diagnosed musculoskeletal symptoms and on the intensity of musculoskeletal symptoms. Further high-quality studies are needed to determine the effectiveness of different frequencies, durations, and types of work-breaks amongst workers for preventing musculoskeletal disorders and symptoms, with much larger sample sizes than the studies included in this review. Furthermore, studies should consider worker populations other than office workers.

FUNDING: This Cochrane review update was internally funded by institutional resources.

REGISTRATION: Original review (2019): https://doi.org/10.1002/14651858.CD012886.pub2 Original protocol (2017): https://doi.org/10.1002/14651858.CD012886.

Funding

Competing interests

Tessy Luger: our institute receives an unrestricted grant by Südwestmetall (employers' association of the metal and electric industry Baden‐Württemberg), which covered about half of the costs of the Institute for several years. The cooperation treaty between Südwestmetall, University of Tübingen, Medical Faculty of the University of Tübingen, and University Hospital of Tübingen rules all aspects that are necessary to secure the 'unrestrictedness', and a board of independent trustees monitors this regulation. Stefan Ferenchak: our institute receives an unrestricted grant by Südwestmetall (employers' association of the metal and electric industry Baden‐Württemberg), which covered about half of the costs of the Institute for several years. The cooperation treaty between Südwestmetall, University of Tübingen, Medical Faculty of the University of Tübingen, and University Hospital of Tübingen rules all aspects that are necessary to secure the 'unrestrictedness', and a board of independent trustees monitors this regulation. Monika A. Rieger: our institute receives an unrestricted grant by Südwestmetall (employers' association of the metal and electric industry Baden‐Württemberg), which covered about half of the costs of the Institute for several years. The cooperation treaty between Südwestmetall, University of Tübingen, Medical Faculty of the University of Tübingen, and University Hospital of Tübingen rules all aspects that are necessary to secure the 'unrestrictedness', and a board of independent trustees monitors this regulation. Benjamin Steinhilber: our institute receives an unrestricted grant by Südwestmetall (employers' association of the metal and electric industry Baden‐Württemberg), which covered about half of the costs of the Institute for several years. The cooperation treaty between Südwestmetall, University of Tübingen, Medical Faculty of the University of Tübingen, and University Hospital of Tübingen rules all aspects which are necessary to secure the 'unrestrictedness', and a board of independent trustees monitors this regulation.

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Taking breaks to prevent muscle and joint problems in healthy workers

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