Key messages
-
We did not find enough good‐quality evidence to draw reliable conclusions about the benefits and risks of different work-break interventions for preventing musculoskeletal symptoms and disorders (conditions that affect bones, joints, muscles, and connective tissues) in healthy workers.
-
One study showed that additional work-breaks may reduce the intensity of musculoskeletal back pain amongst office workers when compared to no additional work-breaks, but the evidence is very uncertain.
-
Larger studies are needed to provide better estimates of potential benefits and harms of different work-break interventions for preventing musculoskeletal symptoms and disorders. Future studies should also consider people who are in jobs that are not office-based.
What are work-related musculoskeletal disorders?
Work-related musculoskeletal disorders are a range of conditions that affect bones, joints, muscles, and connective tissues. They are a major problem for workers, employers, and society as a whole. The number of workers suffering from work-related musculoskeletal disorders is high. 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.
How might work-break interventions help prevent musculoskeletal disorders?
Sitting or standing in one position for a long time is a risk factor for developing work-related musculoskeletal disorders. Different work-break schedules are likely to interrupt or decrease long periods of repetitive or monotonous workloads during which workers may adopt static or awkward body postures. How long a work-break is and whether it is active (e.g. doing a specific mental or physical activity) or passive may also be important factors. Several studies have been carried out to test if varying the work-break schedule, or its length or content, can help reduce the risk of developing musculoskeletal disorders.
What did we want to find out?
We wanted to find out whether different frequencies, durations, and types of work-breaks can prevent work-related musculoskeletal symptoms and disorders amongst healthy workers compared to usual work-break schedules. We considered workers as healthy when they were free of musculoskeletal complaints when they enroled in the study.
What did we do?
We searched medical databases until 31 May 2024 to find studies where participants were allocated randomly to different groups to investigate work-break interventions that aimed to prevent work-related musculoskeletal disorders. We used a system known as GRADE to judge the reliability of the evidence.
What did we find?
We found nine studies that involved 626 workers in total, almost all of whom were office workers (98%). Most of the workers were female (at least 75%). The length of the interventions varied between one day and six months.
Effect of different work-break frequencies
Seven of the nine studies evaluated different work-break frequencies. There may be little to no difference between additional work-breaks and no additional work-breaks in their effect on the new onset of musculoskeletal pain or the intensity of musculoskeletal discomfort, although the evidence is very uncertain. However, additional work-breaks may reduce the intensity of musculoskeletal back pain compared to no additional work-breaks, although the evidence for this is also very uncertain.
Whether additional work-breaks are given more often (higher frequency) or less often (lower frequency) may have little to no effect on the intensity of musculoskeletal discomfort, but the evidence is very uncertain.
Effect of different work-break types
Three of the nine studies evaluated different work-break types. Active work-breaks (e.g. a low-intensity physical activity such as stretching) or cognitive work-breaks (e.g. mental activity such as relaxation or mindfulness) may have little to no effect on the intensity of musculoskeletal fatigue compared to passive work-breaks, but the evidence is very uncertain. Similarly, active work-breaks may have little to no effect on the intensity of musculoskeletal fatigue compared to cognitive work-breaks, but the evidence is uncertain.
What are the limitations of the evidence?
Our confidence in the evidence is very low. There were three main reasons for this: the studies were very small; the studies delivered work-break content to workers in different ways; and the key outcomes were based on self-reports by the study participants. Therefore, there is a need for high-quality studies with larger sample sizes to assess the effects of different work-break interventions at workplaces. Such studies could provide clearer insights into the potential benefits of varying the work-break schedule, length, or content for jobs requiring repetitive motions, as well as any possible harm from the interventions. The studies we found focused on office workers; in future studies, work-break interventions should take into account people who work in other types of jobs. Future studies could also investigate whether combining work-breaks with other interventions, such as ergonomic (i.e. designing the work environment and tasks based on individual worker needs) training or counselling, may help prevent the development of work-related musculoskeletal disorders.
How up to date is this evidence?
This review updates our previous review, which was published in 2019. The evidence is based on searches up to May 2024.
Read the full abstract
Work-related musculoskeletal disorders are a group of musculoskeletal disorders that comprise one of the most common disorders related to occupational sick leave worldwide. Musculoskeletal disorders accounted for 21% to 28% of work absenteeism days in 2017/2018 in the Netherlands, Germany and the UK. There are several interventions that may be effective in tackling the high prevalence of work-related musculoskeletal disorders among workers, such as physical, cognitive and organisational interventions. In this review, we will focus on work breaks as a measure of primary prevention, which are a type of organisational intervention.
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 strategy
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.
Selection criteria
We included randomised controlled trials (RCTs) of work-break interventions for preventing work-related musculoskeletal symptoms and disorders among workers. The studies were eligible for inclusion when intervening on work-break frequency, duration and/or type, compared to conventional or an alternate work-break intervention. We included only those studies in which the investigated population included healthy, adult workers, who were free of musculoskeletal complaints during study enrolment, without restrictions to sex or occupation. The primary outcomes were newly diagnosed musculoskeletal disorders, self-reported musculoskeletal pain, discomfort or fatigue, and productivity or work performance. We considered workload changes as secondary outcomes.
Data collection and analysis
Two review authors independently screened titles, abstracts and full texts for study eligibility, extracted data and assessed risk of bias. We contacted authors for additional study data where required. We performed meta-analyses, where possible, and we assessed the overall quality of the evidence for each outcome of each comparison using the five GRADE considerations.
Main results
We included six studies (373 workers), four parallel RCTs, one cross-over RCT, and one combined parallel plus cross-over RCT. At least 295 of the employees were female and at least 39 male; for the remaining 39 employees, the sex was not specified in the study trial. The studies investigated different work-break frequencies (five studies) and different work-break types (two studies). None of the studies investigated different work-break durations. We judged all studies to have a high risk of bias. The quality of the evidence for the primary outcomes of self-reported musculoskeletal pain, discomfort and fatigue was low; the quality of the evidence for the primary outcomes of productivity and work performance was very low. The studies were executed in Europe or Northern America, with none from low- to middle-income countries. One study could not be included in the data analyses, because no detailed results have been reported.
Changes in the frequency of work breaks
There is low-quality evidence that additional work breaks may not have a considerable effect on musculoskeletal pain, discomfort or fatigue, when compared with no additional work breaks (standardised mean difference (SMD) -0.08; 95% CI -0.35 to 0.18; three studies; 225 participants). Additional breaks may not have a positive effect on productivity or work performance, when compared with no additional work breaks (SMD -0.07; 95% CI -0.33 to 0.19; three studies; 225 participants; very low-quality evidence).
We found low-quality evidence that additional work breaks may not have a considerable effect on participant-reported musculoskeletal pain, discomfort or fatigue (MD 1.80 on a 100-mm VAS scale; 95% CI -41.07 to 64.37; one study; 15 participants), when compared to work breaks as needed (i.e. microbreaks taken at own discretion). There is very low-quality evidence that additional work breaks may have a positive effect on productivity or work performance, when compared to work breaks as needed (MD 542.5 number of words typed per 3-hour recording session; 95% CI 177.22 to 907.78; one study; 15 participants).
Additional higher frequency work breaks may not have a considerable effect on participant-reported musculoskeletal pain, discomfort or fatigue (MD 11.65 on a 100-mm VAS scale; 95% CI -41.07 to 64.37; one study; 10 participants; low-quality evidence), when compared to additional lower frequency work breaks. We found very low-quality evidence that additional higher frequency work breaks may not have a considerable effect on productivity or work performance (MD -83.00 number of words typed per 3-hour recording session; 95% CI -305.27 to 139.27; one study; 10 participants), when compared to additional lower frequency work breaks.
Changes in the duration of work breaks
No trials were identified that assessed the effect of different durations of work breaks.
Changes in the type of work break
We found low-quality evidence that active breaks may not have a considerable positive effect on participant-reported musculoskeletal pain, discomfort and fatigue (MD -0.17 on a 1-7 NRS scale; 95% CI -0.71 to 0.37; one study; 153 participants), when compared to passive work breaks.
Relaxation work breaks may not have a considerable effect on participant-reported musculoskeletal pain, discomfort or fatigue, when compared to physical work breaks (MD 0.20 on a 1-7 NRS scale; 95% CI -0.43 to 0.82; one study; 97 participants; low-quality evidence).
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
