Mitigating occupational hazards: the impact of physical activity on surgeons’ physical and mental health — a scoping review

Abstract

Background

Surgeons work in high-pressure, high-risk environments, which can lead to physical and mental health challenges. Physical activity (PA) has known benefits for health, stress reduction, and professional performance. However, despite these benefits, research on surgeons’ engagement in PA and its impact on their well-being is limited. Promoting PA is crucial for improving both their health and professional performance, as it can help reduce burnout and enhance job satisfaction, ultimately benefiting patient care.

Objectives

This scoping review aims to (1) map the existing literature on PA interventions or observational studies related to surgeons’ physical and mental health and (2) identify research gaps and future directions.

Methods

A systematic search was conducted in databases including PubMed, Scopus, Web of Science, and CNIK. Studies published in English and Chinese on surgeons’ physical and/or mental health concerning PA were included. Two reviewers independently screened titles, abstracts, and full texts for eligibility. Of the initial 7717 records screened, 19 studies were included. Data were extracted and synthesized according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines.

Results

19 studies were included, covering interventional studies, cross-sectional surveys, and qualitative research. Preliminary findings suggest that regular PA is associated with reduced stress, improved cardiovascular health, and better musculoskeletal outcomes in surgeons. However, heterogeneity in study designs and lack of standardized outcome measures limit definitive conclusions.

Conclusions

The evidence indicates potential benefits of PA for surgeons’ physical and mental health, yet robust, high-quality studies remain scarce. Future research should focus on developing standardized interventions, consistent outcome measures, and larger sample sizes. Addressing barriers such as time constraints and workload is crucial for implementing PA programs in surgical practice.

Introduction

As guardians of public health, the well-being of healthcare workers affects their personal quality of life and directly influences the quality of medical services and patient safety [1]. In recent years, the health issues of healthcare workers, particularly their physical and mental health under high-intensity work environments, have increasingly attracted attention from both academia and the field [2–5]. Studies have shown that the health status of healthcare workers is closely related to their work efficiency, job satisfaction, and patient treatment outcomes [6, 7].

As a distinct subgroup among healthcare professionals, surgeons face unique physical and mental health challenges due to the nature of their work [8, 9]. Surgical procedures often demand high levels of concentration, fine motor skills, and prolonged physical exertion from surgeons [10]. Additionally, surgeons typically work irregular hours and frequently respond to unexpected medical emergencies, significantly elevating their occupational stress levels [11]. In such a high-intensity and high-risk working environment, surgeons are exposed to multiple health risks, such as musculoskeletal disorders from prolonged static postures [12], sleep disturbances due to irregular schedules [13], mental fatigue from cognitive overload [14], and psychological stress arising from strained doctor-patient relationships [15]. These combined factors contribute to significant physiological and psychological stress in surgeons. Rather than suggesting that surgeons are inherently more susceptible to chronic maladaptive fatigue than other healthcare professionals, it is important to recognize that stress induced maladaptive fatigue results from prolonged exposure to unresolved stressors and insufficient recovery. According to foundational models of stress physiology, maladaptive stress responses arise when an individual’s perceived demands exceed their ability to cope, with neurophysiological processes of allostatic overload contributing to fatigue and downstream inflammatory responses [16, 17]. Chronic work demands without adequate recovery can lead to persistent exhaustion, reduced coping capacity, and maladaptive fatigue patterns similar to those observed in other high stress professions. These theoretical models provide a physiological rationale for considering fatigue and stress in surgeons as consequences of prolonged stress exposure and recovery imbalance [18]. A systematic review found that patient complications negatively affect surgeons’ mental health, professional functioning, and personal lives, triggering emotions such as anxiety and guilt, and altering both their work and lifestyle habits [19]. The research highlights the need for healthcare institutions and professional organizations to address this issue by providing practical support and training to help surgeons cope with occupational psychological stress [20].

With the continuous improvement of society and living standards, public expectations for healthcare services and the standards for health needs are also rising. As key players in healthcare delivery, surgeons face increasingly demanding professional responsibilities and growing public expectations. This not only heightens their occupational stress but also exacerbates their physical and mental health challenges. Existing studies have shown that surgeons’ health is closely linked to the quality of healthcare services and patient safety. If their physical and mental well-being is not effectively supported over time, it may not only affect their personal quality of life but also negatively affect the overall functioning of the healthcare system [21].

Physical activity (PA) is widely recognized for its positive effects on physical health (e.g., cardiovascular health, musculoskeletal well-being) and mental health (e.g., stress reduction, mood improvement) [22–24]. In high-pressure professions such as law enforcement, military personnel, and office workers, PA interventions have been shown to reduce burnout and enhance resilience [25–31]. However, surgeons’ unique scheduling constraints and high work intensity may limit their ability to participate in regular exercise programs [32]. In response to this challenge, appropriately planned PA may offer surgeons physical and mental recuperation outside their demanding work, alleviating occupational burnout and psychological burden, and enhancing work efficiency and quality of life. Nevertheless, despite the positive effects of PA observed in various high-stress professions, research on PA interventions specifically targeting surgeons remains limited. This gap highlights the need for systematic reviews and practical guidance tailored to surgeons. Therefore, an in-depth exploration of the potential value of PA in the health management of surgeons is crucial for enhancing both their health outcomes and the quality of medical services.

To clarify the focus of this review, the central question can be framed as follows: What are the effects of physical activity on the physical and mental health of surgeons in high-stress environments? Based on this, the present study will focus on the potential positive role of PA in improving surgeons’ physical and mental health. PA has been widely demonstrated to enhance cardiovascular function [33], alleviate psychological stress [34], and improve musculoskeletal health [35], playing a vital role in promoting overall health. However, there is currently a lack of systematic reviews specifically targeting the surgical profession, and comprehensive synthesis and analysis remain insufficient. Therefore, systematically reviewing the evidence on the impact of PA on surgeons’ physical and mental health is crucial for addressing research gaps and informing future practice. Given the heterogeneity and diversity of existing literature, this study adopts a scoping review methodology to comprehensively evaluate current evidence on the effects of PA on surgeons’ physical and mental health, aiming to map the landscape of this research field and provide references for future empirical studies and clinical practice.

Methods

Study design

The protocol for this systematic review was registered on the Open Science Framework (OSF) platform under the code number DOI 10.17605/OSF.IO/J52Y7 (May 31, 2025). This review used the Scoping Review methodology, guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews) [36]. A scoping review is suitable for mapping broad research areas, identifying key concepts, and clarifying definitions [37].

Search and information sources

The review included studies published from the inception of each database up to September 25, 2025, sourced from PubMed, CNKI, Scopus, and Web of Science. Two independent investigators searched the databases. The following Medical Subject Headings terms from Index Medicus ‘Exercise’, ‘Surgeons’, and ‘Health’ were used, and the search equations from the different databases could be consulted in Table 1. This search provided 7717 results, filtered by the following eligibility criteria.

Table 1.

Databases and search equations

Databases	Search equations
Pubmed	(Surgeons[Title/Abstract]) AND (Exercise[Title/Abstract])
CNKI	(“Exercise“[Mesh]AND “Surgeons“[Mesh])
Scopus	TITLE-ABS-KEY (“exercise” AND “surgeons”)
Web of Science	exercise (Topic) and surgeons (Topic)

Eligibility criteria

The search criteria encompassed publications in both English and Chinese, from the inception of the relevant research until September 2025. This review specifically focused on surgeons across all specialties and levels of experience. The intervention encompassed any form of PA, whether structured or unstructured, including aerobic exercise, resistance training, or combined exercise. The outcome measures were the physical and mental health effects of PA interventions on surgeons. The included studies comprised interventional studies, cross-sectional surveys, and qualitative research, while meta-analyses, bibliographic reviews, protocols, publications without access to the full text, and case studies were excluded. Two independent investigators applied these criteria, and a third investigator reviewed the study in case of disagreement. Thus, Fig. 1 presents a flow diagram detailing the search process and the valid articles identified after applying these criteria.

Fig. 1.

Flow diagram of literature search

Methodological quality

Given the limited number of studies investigating the impact of PA on surgeons, as well as the diverse study designs included in this review—comprising observational studies, interventional studies, cross-sectional surveys, and qualitative research—a formal methodological quality assessment was not conducted, as the aim was to map existing evidence and identify knowledge gaps rather than to assess the risk of bias or evidence strength. Traditional evaluation tools are primarily designed for randomized controlled trials and may not apply to the varied methodologies included in this review. However, efforts were made to ensure the inclusion of studies with rigorous methodologies, and the findings should be interpreted within the context of these methodological variations.

Results

Search results

The initial search yielded 7717 articles (Fig. 1). After removing the duplicates, meta-analyses, bibliographic reviews, protocols, publications without accessible full texts, and case studies, 77 remained. Of the 77 full-text articles evaluated for eligibility, 58 were excluded. 19 studies met the inclusion criteria for the scoping review, as seen in Table 2.

Table 2.

Characteristics of the included cross-sectional survey studies

Referencenumber	Author and year	Country	Study population (n)	Mean age(years)	Outcome measures	Assessment tools	Key finding	Conclusion
[38]	Qi et al.,2023	China	Surgeons (145)	NR	Physical level	Stadiometer, digital scale, handgrip dynamometer, spirometer, second watch	Surgeons with high BMI, low lung capacity, poor grip strength, and standing were required to stand on one foot with closed eyes.	Surgeons have heavy tasks and a lack of enough time for physical exercise, which greatly limits the development of surgeons’ physical level.
[39]	Jeremy et al.,2023	USA	Orthopaedic surgeons(234)	52 ± 12	Personal health habits, burnout	PHHS, MBI	Most doctors do not follow exercise recommendations, personal health is impossible, and job burnout is relatively severe.	Enhanced exercise may improve personal health problems, improve quality of life, and avoid burnout.
[40]	Fatih et al.,2021	Turkey	Pediatric surgeons (82)	48.97 ± 8.90	musculoskeletal symptoms, levels of physical activity	CMDQ, IPAQ	The work causes back, shoulder, and neck pain in pediatric surgeons.	Physical activity should be appropriately increased to improve the physical health of surgeons.
[41]	Sang et al.,2014	Korea	Surgeons (621)	42.70 ± 9.52	Occupational stress level, career satisfaction	KOSS, CSA	Regular exercise can reduce the KOSS score, and long working hours and regular exercise are independent factors affecting the KOSS score.	Long hours at work are a major source of stress for surgeons, and regular exercise helps reduce it.
[42]	Sang et al.,2013	Korea	Surgeons (47)	NR	Occupational stress level, factors associated with KOSS score	KOSS, NSDSQS	Surgical doctors who exercised regularly had significantly lower KOSS scores.	Exercise may help reduce the stress of being a surgeon.
[43]	Johnson et al.,2025	Canada	Colorectal surgeon (48)	43	Body areas affected	WBS, RMS	The neck, shoulder, and back are the most common areas of discomfort, whether open or minimally invasive surgery.	Older age and a higher proportion of minimally invasive surgery can exacerbate discomfort, but postoperative exercise can be protective.
[44]	Alzayadneh et al.,2024	Jordan	Rhinoplasty surgeons (110)	48.4	Prevalence of back pain, severity of back pain, functional disability level, risk factors for musculoskeletal pain	SOQ, TDI	The severity of musculoskeletal pain was significantly associated with BMI, exercise, years of nasal plastic surgery practice, number of surgeries per week, and average duration of surgery.	Musculoskeletal problems related to the spine are common among nasal plastic surgeons. Awareness of this health problem needs to be raised, and ergonomic training and physical rehabilitation measures implemented.
[45]	Skinner et al.,2025	France	Surgeons(37)	47	Cardiac vagal tone, daily step count, daily sedentary time,	Accelerometers, RMSSD	The lnRMSSD of professor-level surgeons was significantly lower, as was the lnRMSSD of surgeons with less total operative time.	Exercise may help relieve surgeons’ stress during surgery, highlights the positive effects of physical activity on surgeons’ mental health.
[46]	Aldaheri et al.,2023	Saudi Arabia	Surgeons(208)	35.86 ± 9.45	Prevalence of lower back pain, characteristics, and associated risk factors of LBP	SAQ	Surgical back pain is linked to a lack of exercise.	Promote proper posture use and back health protection for surgeons through exercise.
[47]	Al-Mohrej et al.,2020	Saudi Arabia	Orthopedic surgeons(179 )	32.2(± 7.7)	Prevalence of musculoskeletal pain, types and locations of MSK pain, predictors of MSK pain	SNMQ	The most common sites of pain for surgeons are the lower back and neck, and doctors who exercise regularly have a lower incidence of pain.	Regular exercise can promote the physical health of plastic surgeons.
[48]	Garg et al.,2022	India	Surgeons(NR)	NR	Health and well-being	HLS, HQ	Surgeons had certain illnesses and were relatively less happy.	Surgical doctors should incorporate healthy eating and exercise habits into their daily work to improve overall health.
[49]	Zameer et al.,2016	India	Pediatric surgeons(173)	NR	Health condition	QS	41% of surgeons exercise more than three times a week.	Surgical doctors who exercise regularly are healthier and more mentally sound.
[50]	Uppada et al.,2020	India	Maxillofacial surgeons(156)	NR	Musculoskeletal pain	QS, VAS	Lower back pain is most common among surgeons because of the nature of their work.	Exercise helps prevent surgeon-related musculoskeletal diseases and improves physical health.
[51]	Wang et al.,2023	China	Surgeons(245)	NR	Musculoskeletal prevalence	NMQ	Musculoskeletal diseases are more common among surgeons.	Moderate physical exercise is beneficial in reducing the musculoskeletal diseases of surgeons.

PHHS Personal Health Habits Scale, MBI Maslach Burnout Inventory, CMDQ Cornell Musculoskeletal Discomfort Questionnaire, IPAQ International Physical Activity Questionnaire, KOSS Korean Occupational Stress Scale, CSA Career satisfaction assessment, WBS Web-based survey, RMS Risk-mitigating strategies, SAQ Self-administered questionnaire, SOQ Structured online questionnaire, NSDSQS National Study for Development and Standardization of Occupational Stress, TDI Total Disability Index, RMSSD The root mean square value of heart rate variability, HQ happiness quotient, QS Questionnaire survey, SNMQ Standardized Nordic Musculoskeletal Questionnaire, HLS Healthy Lifestyle Score, VAS Visual Analog Scale, NMQ Nordic Musculoskeletal Questionnaire

Study characteristics

This scoping review included 14 cross-sectional studies [38, 50–62], with detailed information presented in Table 2. These studies were conducted in various countries, including China, the United States, Turkey, South Korea, Canada, and Jordan. The sample sizes varied from 47 to 621 participants, analyzing 2,285 surgeons [38, 50–62]. However, the first study did not report the number of participants [48]. The included studies examined various surgical specialties such as general, orthopedic, pediatric, colorectal, and rhinoplasty. The average age of participants ranged from 32.2 to 52 years, although six studies did not report participant age [38, 42, 48, 50, 51, 62]. Some studies reported specific professional backgrounds, including resident physicians [38], fellows [45], and attending surgeons [40, 43, 44, 47, 49, 50]. In terms of PA and health outcomes, these studies examined various physical and mental health dimensions, including physical health status, musculoskeletal symptoms, burnout, occupational stress, and job satisfaction. A range of measurement tools were used, and most studies reported that insufficient PA negatively impacted surgeons’ health, including increased body mass index (BMI), musculoskeletal discomfort (such as back, neck, and shoulder pain), and elevated levels of occupational stress and burnout. Some studies emphasized the importance of regular PA in enhancing mental well-being, alleviating stress, and improving job satisfaction. The included studies provided valuable insights into the relationship between PA and surgeons’ physical and mental health, underscoring the need for interventions that promote healthy lifestyles within the surgical profession.

In this scoping review, a total of two qualitative studies were included that explored the relationship between PA and the physical or mental health of surgeons [52, 53]. The included studies were conducted in the United States and used survey-based methodologies to gather data. Participants consisted of plastic surgeons and cardiothoracic surgeons, and the research topics mainly focused on issues such as PA habits, exercise barriers, mental health, and occupational physical burden [52, 53]. As summarized in Table 3, the main findings indicate that insufficient PA among surgeons can lead to weight gain, poor mental health, and an increased risk of musculoskeletal injuries. Both studies highlighted the importance of regular exercise in improving surgeons’ mental well-being, quality of life, and professional longevity [52, 53]. Additionally, attention to ergonomics and the integration of physical training into medical education were recommended.

Table 3.

Characteristics of the included qualitative research studies

Number	Author and year	Country	Study population	Research method	Subject-oriented	Key finding	Conclusion
[52]	Rogoff et al.,2024	USA	Plastic surgeon	Surveys	Exercise habits, movement disorders, mental health experience, occupational injury, and physical burden	Surgeons are not getting enough exercise, and some people are gaining weight and losing mental health as a result. Regular exercise can improve doctors’ mental health, improve their quality of life, and reduce the incidence of occupational burnout.	Regular exercise is crucial to the career life of orthopedic surgeons, both for mental health and to reduce musculoskeletal injuries related to their profession.
[53]	Dairywala et al.,2021	USA	Cardiothoracic surgeon	Surveys	Ergonomics and strength training in cardiothoracic surgery	There are many physical discomforts for surgeons, and physical fitness can be improved through exercise.	Surgeons should pay attention to their physical fitness and ergonomics to avoid long-term cumulative damage that can affect their career lives. In the future, ergonomics should be incorporated into surgical education, and strength training should be promoted to improve doctors’ professional performance.

A total of 3 interventional studies were included in this scoping review (Table 4), conducted in the USA [54], Turkey [56], and Italy [55], with sample sizes ranging from 21 to 141 surgeons. All participants were surgical professionals. The interventions varied across studies, including resistance training, posture training, and specific or muscle-strengthening exercises. The interventions ranged from 2 weeks to 1 month, with different training frequencies and session lengths. The outcomes assessed included musculoskeletal pain (particularly in the neck and shoulders), physical condition, compliance, quality of life, and psychological well-being. Assessment tools commonly used were the Visual Analogue Scale (VAS), Likert Scales, Nordic Musculoskeletal Questionnaire (NMQ), Beck Depression Inventory (BDI), and the Short Form Health Survey (SF-36). Across all three studies, positive effects of PA were reported. These included reduced musculoskeletal pain, enhanced physical condition, improved quality of life, and better mental health, including lower levels of depression [54–56].

Table 4.

Characteristics of the included interventional studies

Number	Author and year	Country	Study population (N)	Intervention	Duration of intervention	Outcome measures	Assessment tools	Key finding	Conclusion
[54]	Rose et al.,2023	USA	Surgeons(21)	Resistance training	3 times a week for 2 weeks (6 training sessions). The median time for each exercise was 14 min (IQR: 11–17 min).	Difficulty, Inconvenience, Likelihood of continuation	Likert Scales	Surgeons have relatively poor physical fitness and are more likely to be unwell.	Exercise improves surgeons’ surgical posture, flexibility, and core stability, contributing to a longer career.
[56]	Külekçioğlu & Dilektaşlı,2024	Turkey	Surgeons(24)	Posture training and muscle strengthening exercises	1 month, Check the compliance once a week.	Pain, physical workload, physical state, and quality of life.	VAS, PWQ, BDI, SF-36	Surgeons generally have neck, back, and lower back pain. They have a high workload, high levels of depression, and a relatively poor quality of life.	Exercise can effectively reduce pain, improve quality of life, and improve surgeons’ mental health.
[55]	Giagio et al.,2019	Italy	Surgeons(141)	Specific exercise	NR	Musculoskeletal disease	NMQ, NRS, SF-36	Surgeons suffer from musculoskeletal diseases, and exercise can reduce musculoskeletal pain.	Proving the effectiveness of exercise in improving the health of surgeons.

VAS Visual Analogue Scale, PWQ Physical Workload Questionnaire, BDI Beck Depression Inventory, SF-36 Short Form Health Survey, NMQ Nordic Musculoskeletal Questionnaire, NRS Numerical Rating Scale, SF-36 Short Form 36 Health Survey

Physical health outcomes

Most included studies reported that surgeons commonly experience poor physical health, particularly issues related to musculoskeletal disorders (MSDs), as illustrated in Fig. 2. Cross-sectional studies have found a high prevalence of lower back, neck, and shoulder pain among surgeons. For example, Wang et al. (2023) [51] and Al-Mohrej et al. (2020) [47], using the Nordic Musculoskeletal Questionnaire, found that the prevalence of musculoskeletal issues in various surgical specialties could reach as high as 68%. Similar trends were also observed among pediatric and orthopedic surgeons [40, 44]. Multiple studies have identified prolonged static posture, high-intensity surgical tasks, and insufficient PA as the primary contributors to these issues [38, 43]. In addition, standardized assessment tools have revealed that surgeons generally exhibit low levels of physical fitness [38]. Qualitative studies further support these findings. Surgeons commonly reported persistent musculoskeletal discomfort resulting from prolonged surgical procedures and a lack of ergonomic awareness [52]. Interventional studies have shown that systematic physical activity programs, such as resistance and posture training, can effectively reduce pain and improve biomechanical function [54, 56]. For instance, Giagio et al. (2019) found that specific exercises significantly alleviated musculoskeletal pain and enhanced physical functioning in surgeons [55].

Fig. 2.

The nature of surgeons’ work and sources of occupational stress

Mental health outcomes

Studies have shown that surgeons face significant mental health burdens, including burnout, heightened stress, and reduced well-being. In a cross-sectional survey conducted by Jeremy et al. (2023) [39], participating surgeons commonly reported high levels of burnout and personal health issues, as measured by the Maslach Burnout Inventory (MBI) [54]. Garg et al. (2022) also found that surgeons had generally low scores in well-being indices and lifestyle assessments [48]. Multiple studies have indicated a significant association between low levels of PA and increased psychological distress. For instance, Skimmer et al. (2025) found that surgeons with prolonged sedentary time exhibited significantly lower heart rate variability (lnRMSSD), suggesting autonomic nervous system dysfunction and elevated stress levels. In contrast, those with higher PA levels demonstrated better autonomic nervous system function [45]. Qualitative studies have also revealed the widespread presence of psychological burdens. Respondents generally acknowledged the psychological benefits of exercise but reported difficulties in maintaining regular activity due to time constraints, fatigue, and insufficient institutional support [53]. Interventional studies further confirmed the psychological regulatory effects of PA. Thus, exercise not only contributes to physical recovery in high-pressure surgical environments but also plays a crucial role in emotional regulation.

Interventions and PA modalities

This study included three interventional studies involving resistance training, posture training, and specific exercise programs. Rose et al. (2023) conducted a two-month resistance training program with three weekly sessions, significantly improving surgeons’ core stability, physical endurance, and intraoperative posture while reducing pain [54]. Kulekcioglu et al. (2024) implemented a one-month posture training intervention effectively alleviated neck and shoulder pain and enhanced surgeons’ ergonomic awareness and daily posture control. Moreover, the study employed a training protocol focused on improving muscular strength and flexibility, and assessments using multiple scales (e.g., PWQ, SF-36) indicated significant improvements in quality of life and perceived workload [56]. The interventions were generally well accepted, with participants expressing satisfaction and reporting positive experiences. However, adherence to exercise was partially limited by factors such as work intensity and fatigue. Despite the short intervention duration, these systematic physical activity programs contributed positively to the prevention and rehabilitation of health issues among surgeons. Therefore, PA plays a vital role in addressing surgeons’ health challenges, and its importance should not be underestimated (Fig. 3).

Fig. 3.

The role of PA in surgeons’ well-being and performance

Summary of Gaps in the literature

Although existing studies have preliminarily confirmed the positive effects of PA on the physical and mental health of surgeons, several research gaps remain. First, most current literature comprises cross-sectional studies, lacking longitudinal follow-ups or randomized controlled trials, thereby limiting causal inference. Only a few studies have explored the long-term effects of PA interventions.

Second, inconsistencies in the definition, measurement methods of PA, and tools for assessing health outcomes hinder the synthesis and comparison across studies. In particular, measuring psychological health variables such as resilience and emotional regulation is often lacking, with most studies relying on self-report questionnaires without objective validation.

Third, current studies rarely examine differences across surgical specialties and lack systematic analysis of factors such as gender and cultural background, which limits the generalizability and practical applicability of findings. Moreover, the influence of structural barriers—such as irregular work schedules, lack of organizational support, and insufficient exercise facilities—on surgeons’ engagement in PA remains insufficiently explored.

To date, large-scale, multi-center systematic studies evaluating the long-term effects of integrated PA programs on surgeons’ health are still lacking. Future research should focus on the design of high-quality interventions and develop practical, effective, and scalable PA strategies that align with clinical realities.

Discussion

This review included 19 studies on PA among surgeons, comprising 14 cross-sectional studies [38, 50–62], 2 qualitative studies [52, 53], and 3 interventional studies [54–56], systematically presenting the current status, influencing factors, and preliminary intervention attempts related to surgeons’ PA behavior. The results indicated that overall PA levels among surgeons were low, with most not meeting the World Health Organization’s recommended standards (≥ 150 min/week of moderate-intensity PA or ≥ 75 min/week of vigorous-intensity PA) [57]. Several cross-sectional studies revealed that even among this highly health-literate professional group, many surgeons lacked regular exercise habits, with less than 50% engaging in any form of PA weekly in some studies. This suggests that although surgeons possess substantial health knowledge, they struggle to translate such awareness into sustained behavioral practice under high-pressure professional environments. Qualitative studies further revealed deeper reasons for low PA participation among surgeons, such as uncontrollable time schedules, suppressive workplace culture, and a professional attitude that relegates exercise to a low priority. These structural and cultural barriers, such as residency, are especially prominent during the early career stages, indicating that surgeons’ PA behavior is constrained by multiple systemic factors rather than individual willingness or motivation alone. Interventional studies showed that while specific strategies, such as wearable devices [58], team competitions [59], or multidimensional health programs [60], may temporarily increase PA participation, their sustainability and scalability remain to be verified. Moreover, most interventions remain at the individual level and lack systemic reform of organizational structures and professional culture [61]. In summary, these 19 studies complement each other and collectively construct a comprehensive picture, showing that insufficient PA among surgeons results from intertwined factors, including personal time constraints, motivational barriers, and deeper cultural and institutional influences. To improve PA behavior in this group, it is necessary to move beyond traditional “advocacy-based” health education and adopt integrated interventions addressing structural, cultural, and institutional levels.

This review is the first to integrate multiple types of studies to systematically summarize the current state, influencing factors, and intervention recommendations for PA behaviors among surgeons, particularly addressing gaps in prior research at the level of occupational sub-specialization. Existing research has focused mainly on general clinicians or medical students, overlooking surgeons—a group with the highest workload and psychological stress [62–65]. Moreover, a key innovation of this review lies in integrating “surface-level” issues identified in quantitative studies—such as low PA participation rates and limited exercise types—with “deeper” mechanisms uncovered in qualitative research, including cultural barriers, structural constraints, and psychological stress, thereby offering a more comprehensive understanding. This integration enhances the relevance and feasibility of intervention design and policy recommendations.

The findings of this study indicate that time constraints are one of the primary barriers to participation in PA. Surgeons commonly face prolonged surgeries, frequent night shifts, and unexpected emergencies, leading PA to be perceived as an optional add-on rather than an integral part of daily life. Moreover, PA is often deprioritized in favor of professional obligations, making it challenging to develop a consistent exercise routine [66]. Influenced by promotion pressure and a hierarchical mentorship culture, residents and junior surgeons tend to prioritize work and regard exercise as a “non-productive activity” [67]. This cultural climate subtly undermines surgeons’ attention to their health.

Interventions should be based on structural integration rather than individual advocacy. Enhancing awareness and motivation is insufficient to address systemic time constraints and cultural resistance. Therefore, feasible strategies, such as embedding “restorative exercise” windows within shift schedules, like brief PA before or after surgery, are essential [68]. Offering flexible and personalized exercise programs, such as app-based modular training or walking challenges, is also recommended [69]. Hospitals can establish visual health prompts to foster a culture that supports PA. A top-down approach should be employed to engage mentors and department heads in PA demonstrations, thereby conveying the “health-first” philosophy [70]. In addition, PA interventions should be incorporated into the broader framework of occupational health, integrating with sleep, nutrition, and psychological regulation to enhance intervention acceptance and sustainability [71].

This study integrates various types of research evidence, highlighting the complementary value of different research methodologies in understanding PA issues among surgeons. For example, although some studies report that approximately 30% of surgeons engage in regular weekly PA, qualitative research reveals considerable instability behind this figure, with exercise routines frequently disrupted by emergencies or shift work [72]. This suggests that single-source data are insufficient to reflect real-life conditions, and mixed-methods approaches are necessary to deepen the understanding of underlying mechanisms [73]. Therefore, future research and intervention assessments should adopt mixed-methods designs that balance the breadth of data with contextual depth.

In addition, this study has several limitations. First, we did not conduct a systematic quality assessment of the included studies, which may affect the robustness of some conclusions. Second, substantial heterogeneity in the inclusion criteria, participant populations, and assessment tools among the included studies limited data synthesis and rendered meta-analysis unfeasible. Third, cultural differences across countries and healthcare systems may affect the comparability of surgeons’ PA behaviors, and such factors were not fully controlled. Moreover, most existing studies employed cross-sectional designs, making assessing long-term trends in PA behavior or the sustainability of intervention effects difficult.

Future research should delve deeper across multiple dimensions to promote PA behavior among surgeons more effectively. Methodologically, there is an urgent need for high-quality longitudinal studies and intervention studies embedded in randomized controlled trials (RCTs) to verify the feasibility and effectiveness of various strategies in real clinical settings. Regarding the study population, attention should be paid to the distinct needs of female surgeons, residents, and different surgical specialties to avoid a one-size-fits-all intervention approach. At the theoretical level, future research should further explore the complex interaction mechanisms among departmental culture, professional identity, and health behaviors to provide a culturally embedded perspective for interventions. Meanwhile, intervention modules should be designed with greater individual adaptability based on behavioral science frameworks such as Social Cognitive Theory and Self-Determination Theory, and efforts should be made to integrate them into routine clinical systems to enhance sustainability and practical applicability. Finally, it is also essential to systematically evaluate how hospital policies and organizational structures support surgeons’ health behaviors to provide an evidence base and guidance for structural reform.

Conclusion

This scoping review, aiming to map the existing evidence on PA and its impact on surgeons’ physical and mental health, highlights the need to consider PA as a critical yet underutilized component of occupational health strategies for surgical professionals. Although the included studies varied in design (interventional, cross-sectional, qualitative) and measurement approaches, they consistently suggested that regular PA is associated with reduced stress, improved cardiovascular health, and better musculoskeletal outcomes among surgeons. However, it is important to note that surgeons are not immune to the detrimental effects of unrelenting high stress, and the investigation of tailored physical exercise regimens should be incorporated into their professional training. For current surgeons, developing an effective and acceptable routine physical exercise regime is essential. We propose that healthcare institutions adapt evidence-based PA guidelines tailored to surgical workloads and implement structured PA programs with institutional support. Crucially, this requires addressing systemic barriers, such as time constraints and cultural norms in surgical practice, through policy-level changes to improve surgeons’ physical and mental health and professional performance. Therefore, the inclusion of guidance on physical exercise in surgeons’ training programs could be pivotal in supporting their long-term health and professional efficacy.

Abbreviations

PA

Physical activity

PRISMA-ScR

Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews

OSF

Open Science Framework

PHHS

Personal Health Habits Scale

MBI

Maslach Burnout Inventory

CMDQ

Cornell Musculoskeletal Discomfort Questionnaire

IPAQ

International Physical Activity Questionnaire

KOSS

Korean Occupational Stress Scale

CSA

career satisfaction assessment

WBS

Web-based survey

RMS

risk-mitigating strategies

SAQ

Self-administered questionnaire

SOQ

Structured online questionnaire

NSDSQS

National Study for Development and Standardization of Occupational Stress

TDI

Total Disability Index

RMSSD

The root mean square value of heart rate variability

HQ

happiness quotient

QS

Questionnaire survey

SNMQ

Standardized Nordic Musculoskeletal Questionnaire

HLS

Healthy Lifestyle Score

VAS

Visual Analog Scale

NMQ

Nordic Musculoskeletal Questionnaire

VAS

Visual Analogue Scale

PWQ

Physical Workload Questionnaire

BDI

Beck Depression Inventory

SF-36

Short Form Health Survey

NMQ

Nordic Musculoskeletal Questionnaire

NRS

Numerical Rating Scale

SF-36

Short Form 36 Health Survey

Authors’ contributions

All authors contributed to the paper conception and design. Manual literature search and review of articles for inclusion in the review was done by Kai Qi and Zuopeng Wang. The first draft of the manuscript was written by Kai Qi, and all authors commented on previous versions of the manuscript. One authors (Aleksandra Bojarczuk read and approved the final manuscript.

Funding

The authors did not receive support from any organization for the submitted work.

Data availability

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.