Can exercise snacks alleviate musculoskeletal discomfort in prolonged sitting? A systematic review of randomized controlled trials

Abstract

Background

Sedentary behavior constitutes a significant global public health issue and is strongly associated with musculoskeletal disorders, particularly neck and back pain. Exercise snacks, characterized by brief bouts of fragmented physical activity, provide a feasible intervention to interrupt prolonged sitting within occupational contexts. However, their efficacy in alleviating musculoskeletal discomfort has not been systematically evaluated. This systematic review aimed to evaluate the efficacy of exercise snacks in reducing musculoskeletal discomfort in sedentary populations.

Methods

A systematic search was conducted in Web of Science, PubMed, Scopus, Cochrane, EMBASE, and MEDLINE up to November 1, 2025, in accordance with PRISMA guidelines. Randomized controlled trials (RCTs) involving adults (aged ≥ 18 years) in sedentary occupations were included. Eligible studies compared interventions that interrupted prolonged sitting with exercise snacks against a control condition of uninterrupted sitting or passive rest. The primary outcome was musculoskeletal discomfort, and the risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool.

Results

Six RCTs involving 210 participants were included in the review. Interventions varied in modality (stretching, walking, stair climbing, dynamic contractions) and duration (2 to 10 min). Four studies demonstrated that exercise snacks significantly alleviated musculoskeletal discomfort compared to prolonged sitting or passive rest. Interventions incorporating targeted muscle stretching, strengthening, or moderate-intensity activities (e.g., stair climbing) demonstrated superior efficacy compared to low-intensity walking or passive controls. However, heterogeneity in study design was observed, and notably, five of the six studies were assessed as having a high risk of bias, limiting the strength of these findings.

Conclusions

Overall, interrupting prolonged sitting with exercise snacks may represent a feasible strategy to alleviate musculoskeletal discomfort in sedentary populations. Exercise snacks appear superior to passive rest; however, due to the substantial heterogeneity and high risk of bias across the majority of included studies, these findings should be interpreted with caution. Future high-quality, long-term RCTs in real-world settings are warranted to establish robust guidelines.

Background

The World Health Organization (WHO) reports that an estimated 60% to 85% of the global population, including individuals from both developed and developing countries, engage in a sedentary lifestyle. This constitutes a significant and ongoing public health issue [1]. This is exacerbated by the widespread adoption of electronic devices such as computers, mobile phones, and televisions, which has led to increased screen time and prolonged sedentary behavior [2, 3].

Prolonged sedentary behavior is associated with an increased risk of musculoskeletal disorders [4, 5]. Among these, neck and lower back pain constitute the most prevalent complaints in sedentary populations [6]. These conditions manifest as cervicodorsal pain and are associated with significantly reduced muscle endurance and an increased risk of lumbar stiffness [7–9]. Sedentary behavior may induce postural deviations, including excessive forward head tilt, a decreased cervical angle, and weakness in the deep cervical flexors and upper trapezius. In conjunction with prolonged static forward head posture, these factors contribute to fatigue in the trapezius and splenius capitis muscles, thereby exacerbating functional impairments such as work-related neck-shoulder dysfunction and myofascial pain syndrome [10, 11]. Surveys of office workers substantiate these observations; for instance, 31% of office workers in Thailand reported new-onset neck pain symptoms within the past year [12], and about 51% of office workers in Nigeria reported being affected by lower back pain annually [13]. Neck and lower back pain induced by sedentary behavior are significant contributors to physical and psychological health impairment, posing a public health issue that warrants urgent attention [14, 15].

Increasing physical activity is essential to mitigate musculoskeletal discomfort triggered by prolonged sitting. However, sedentary populations, particularly office workers, often lack dedicated time for exercise. In response to this challenge, physical activity guidelines in the United Kingdom and Australia have incorporated recommendations to reduce sedentary behavior, specifically by limiting prolonged sitting [16, 17], with Australian guidelines further advising regular breaks in sitting time [16]. In this context, performing “exercise snacks” during work breaks—defined as short bouts of sporadic exercise [18]—serves as a feasible strategy that aligns with the occupational characteristics and health maintenance needs of sedentary populations. It should be noted that the existing literature employs a wide variety of synonymous terms to describe this concept, including “active breaks,” “movement snacks,” “sedentary interruptions,” “physical activity break,” and “rest-break interventions”. To avoid confusion and ensure terminological consistency, the primary term “exercise snacks” will be explicitly and exclusively used throughout the remainder of this manuscript to refer to all such interventions. This approach can enhance physical activity levels without compromising work or academic tasks. In recent years, research on exercise snacks has increased, with several studies reporting the outcomes of such interventions among office workers and university students. Nevertheless, there remains a lack of consensus regarding the optimal type, intensity, and frequency of physical activity required to effectively alleviate sedentary-related musculoskeletal discomfort.

To date, few studies have systematically examined the impact of distinct exercise snacks protocols on musculoskeletal discomfort in sedentary populations. Therefore, the primary aim of this systematic review was to evaluate the efficacy of exercise snacks in alleviating musculoskeletal discomfort among sedentary individuals by synthesizing evidence from RCTs. Additionally, relevant training parameters were extracted to propose an optimal exercise protocol for improving musculoskeletal health in this population. Finally, this review sought to identify limitations in the current evidence and provide recommendations for future investigations.

Methods

The present systematic review was carried out following the PRISMA Statement for reporting systematic reviews [19, 20]. Although the protocol for this systematic review was not prospectively registered in databases such as PROSPERO prior to data extraction, all search strategies, inclusion/exclusion criteria, and analytical methods were rigorously pre-defined and documented by the research team prior to the initiation of the study selection process.

Search strategy

We searched Web of Science, PubMed, Scopus, Cochrane, EMBASE and MEDLINE, using the following keywords: (“exercise snack” OR “movement snack” OR snacktivity OR “movement break” OR “physical activity break” OR “active break” OR “vigorous intermittent lifestyle physical activity” OR VILPA OR “interrupting prolonged sitting” OR “sedentary interruptions” OR “accumulated exercise” OR “sedentary breaks” OR break OR “seated break”) AND (“prolonged sitting” OR sitting OR sedentary) AND (“muscle discomfort” OR “low back pain” OR “back pain” OR “neck pain” OR muscle OR Musculoskeletal). The search cutoff date was 1 November 2025. In addition to the systematic electronic database search, the reference lists of included studies and relevant reviews on exercise snacks were manually screened to identify further potentially eligible trials; however, no additional records met the inclusion criteria.

Inclusion criteria

Studies were included in this systematic review if they met all of the following criteria (the PICOS framework is indicated in parentheses):

1. Participants were required to be aged 18 years or older. The study population consisted of office workers or individuals utilizing computers, visual display units, or visual display terminals. (Population)

2. Studies must employ a defined form of physical activity to explicitly interrupt sedentary periods. (Intervention)

3. Studies clearly reported both a sedentary or passive rest condition (control group) and an exercise snack protocol (intervention group). The study design was required to include at least one condition involving a single bout of continuous prolonged sitting (or passive rest) as the control, and another condition in which physical activity was intermittently interspersed to interrupt the sedentary period as the intervention. (Comparison)

4. For crossover trials, different conditions were conducted on separate days with a distinct washout period. (Comparison)

5. The study included at least one measure of musculoskeletal discomfort as an outcome. (Outcome)

6. Only randomized controlled trials (parallel or crossover designs). (Study design)

7. English language articles.

Exclusion criteria

1. Different experimental conditions were conducted on the same day without a distinct washout period.

2. The specific protocol for exercise snacks was not explicitly described.

3. The study did not attempt to control the sedentary period; for example, participants were permitted to leave the laboratory during non-exercise intervals within the exercise condition, or the sedentary and rest protocols were not monitored to ensure adherence to the reported protocol.

4. Studies where standing was the sole intervention utilized to interrupt sedentary behavior were excluded. This exclusion criterion was established because the impact of standing on energy expenditure may be negligible compared to sitting. Furthermore, reported heterogeneity in energy expenditure during standing may originate from leg or body postural shifts, implying that variability in the effectiveness of standing interventions could stem from such differences [21, 22].

5. The study did not include any outcome measure related to musculoskeletal discomfort.

6. The publication type was a review, conference paper, conference abstract, research poster, guideline, study protocol, expert opinion, editorial, commentary, theses or dissertations.

7. The full text of the article was unavailable.

8. The article was not published in English.

Selection process

All identified citations were imported into EndNote (Version X9, Clarivate Analytics), and duplicates were removed. Two reviewers (MXG and YLL) independently screened the titles and abstracts, followed by a full-text assessment of potentially eligible articles. Any discrepancies between the independent reviewers were resolved through discussion; if consensus could not be reached, a third reviewer (JZ) was consulted [23]. The complete results of the search and selection process are detailed in the Results section and presented using a PRISMA flow diagram [24].

Risk of bias assessment

Risk of bias was assessed independently by two reviewers (MXG and YLL). Any disagreements were resolved through discussion or by consulting a third reviewer (JZ) to reach a consensus. Given the inclusion of different study designs in this systematic review, two specific risk of bias assessment tools were employed. The Cochrane risk-of-bias tool for randomized trials (RoB 2.0) for crossover designs (2021) was applied to included crossover trials, while the RoB 2.0 for parallel-group designs (2019) was utilized for included parallel-group trials [25]. In accordance with RoB 2.0 guidelines, the overall risk of bias was categorized as low risk, some concerns, and high risk.

Data extraction

Relevant data from each included study were extracted and recorded in a standardized Microsoft Excel spreadsheet. The extracted details included authors, year of publication, country, sample size, participant age, study design, intervention protocols, assessment methods, and outcomes. Data extraction was performed independently by two reviewers (MXG and YLL). Any discrepancies were resolved through discussion; if consensus could not be reached, a third reviewer (JZ) was consulted.

Results

Search results

A total of 1502 records were retrieved from electronic databases. Following the removal of 670 duplicates, 738 irrelevant records were excluded based on title and abstract screening. Of the remaining 94 articles assessed for eligibility by full-text review, 88 were excluded. The reasons for exclusion included: (i) intervention protocols did not meet the inclusion criteria (n = 18); (ii) outcome measures did not include musculoskeletal discomfort (n = 21); (iii) participants were not sedentary populations or there was insufficient information to verify their sedentary status (n = 8); and (iv) the study design was not a randomized controlled trial (n = 41). Ultimately, 6 studies were included in this review [11, 26–30]. The study selection process is illustrated in Fig. 1.

Fig. 1.

PRISMA flow diagram

Characteristics of the eligible studies

The six studies included in this systematic review were published between 2014 and 2024, comprising five parallel RCTs [26–30] and one randomized crossover RCT [11]. Sample sizes ranged from 24 to 52 participants per study. The cumulative sample size was 210 participants (range: 24–52 per study), consisting of habitually sedentary university students or office workers aged 18 to 40 years. Four studies recruited participants without musculoskeletal disorders [11, 28–30], while the other two explicitly enrolled participants presenting with symptoms of musculoskeletal discomfort [26, 27]. Geographically, four studies were conducted in Asian countries, specifically India [11], Thailand [26], Pakistan [27], and China [29], while two studies were implemented in Egypt [28] and Australia [30]. The main characteristics of the included studies are detailed in Table 1.

Table 1.

Summary table of studies included in the systematic review of the literature

Author	Country	Sample (n)	Mean age (age range)	Study Design	Arms	Outcome measures	Musculoskeletal Discomfort Results
Nakphet et al. (2014) [26]	Thailand	0 male, 30 female	NR (18–40)	Parallel RCT	1. Reference group: Passive break (relax sitting) for 3 min every 20 min 2. Stretching group: Active break (static stretching) for 3 min every 20 min 3. Dynamic contractions group: Active break (shoulder elevation, flexion, and neck extension exercises) for 3 min every 20 min	EMG; Borg CR-10 scale	There were no significant differences between active breaks (stretching or dynamic) and passive breaks in muscle activity, muscle discomfort. However, muscle discomfort significantly decreased immediately after breaks compared to before breaks in all conditions.
Osama et al. (2015) [27]	Pakistan	26 male, 6 female	NR (NR)	Parallel RCT	1. Rest Breaks group: Supplemental micro breaks (30 s every 15 min) + conventional breaks (15 min twice daily) 2. Exercise Breaks group: Stretching (10 min twice daily) + conventional breaks (15 min twice daily) Both groups received ergonomic training	VNRS; CMDQ	The Exercise Break group showed significantly greater improvement compared to the Rest Break group in both VNRS and CMDQ scores post-intervention.
Battecha et al. (2019) [28]	Egypt	0 male, 24 female	NR (21–35)	Parallel RCT	1. Group A (Control): Education on posture and workstation modification/ergonomics 2. Group B (Study): Education and workstation modification plus CCFT and supplementary daily rest breaks for 6 weeks	VAS; NDI; CCFT; Cervical angles	The intervention group showed significantly greater improvements in neck pain, deep cervical flexor performance, Head Flexion angle, and Cranio-cervical flexion angle.
Ding et al. (2020) [29]	China	24 male, 24 female	22.8 ± 1.1 (19–24)	Parallel RCT	1. PB5: Passive break (sitting) for 5 min 2. PB10: Passive break (sitting) for 10 min 3. AB5: Active break (change posture/walk) for 5 min 4. AB10: Active break (change posture/walk) for 10 min 5. SS5: Stand and stretch for 5 min 6. SS10: Stand and stretch for 10 min	EMG; Borg CR-10 scale	Compared to the reference (no break), all break types were effective for muscle recovery. SS5 (5-min stand & stretch) was the most effective.
Craige et al. (2024) [30]	Australia	28 male, 24 female	NR (18–35)	Parallel RCT	1. Sit9: Prolonged sitting during five consecutive 8.5-h nightshifts 2. Break9: Sitting interrupted by 3 min of light-intensity treadmill walking every 30 min during nightshifts	VAS; SF-MPQ	Compared to prolonged sitting, breaking up sitting did not reduce musculoskeletal pain intensity; pain intensity increased within-nights for both groups.
Raj et al. (2024) [11]	India	17 male, 7 female	24.92 ± 1.06 (20–30)	Randomized crossover RCT	1. Prolonged Sitting (PS): Sitting for 2 h 2. Breaking up sitting with 3-min light-intensity walking every 30 min (Break9) 3. Incremental (IS): Sitting for 2 h interrupted by 2 min of externally paced stair climbing (metronome) every 30 min	Craniocervical angles, cervical flexor endurance, agility; Borg CR-10 scale	Compared to prolonged sitting, incremental stair climbing significantly improved agility and reduced shoulder discomfort.

NR not reported, RCT Randomized controlled trial, VAS Visual Analogue Scale, EMG electromyography, VNRS Visual Numeric Rating Scale, Borg CR-10 scale Borg Category-Ratio 10 Scale, CMDQ Cornell Musculoskeletal Discomfort Questionnaire, SF-MPQ Short-Form McGill Pain Questionnaire, NDI Neck Disability Index, DIPA Digital Imaging for Postural Assessment, CCFT Craniocervical Flexion Training

Musculoskeletal discomfort outcomes

Musculoskeletal discomfort was the primary outcome assessed in this review. The assessment instruments used across the six included studies varied. Borg CR-10 scale was the most frequently used tool, appearing in three studies [11, 26, 29]. Two studies employed the Visual Analogue Scale (VAS) [28, 30], and two evaluated muscle activity using electromyography (EMG) [26, 29]. Other assessment methods included the Visual Numeric Rating Scale (VNRS) [27], the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) [27], the Short-Form McGill Pain Questionnaire (SF-MPQ) [30], the Neck Disability Index (NDI) [28], the Digital Imaging for Postural Assessment (DIPA) method, and the Craniocervical Flexion Test (CCFT) [28].

Interventions

In all included studies, the experimental groups employed interventions involving exercise snacks to interrupt prolonged sitting. However, the included studies exhibited substantial heterogeneity in intervention modality, duration, and frequency. Exercise modalities varied widely, encompassing stretching [26, 27, 29], dynamic contractions [26], low-intensity walking [29, 30], moderate-to-vigorous stair climbing [11], and specific neuromuscular training (i.e., CCFT) [28]. The duration of individual exercise snacks ranged from brief 30-second bouts [27] to 2–3 min of activity [11, 26, 30], and up to 5–10 min of stretching or walking [27, 29]. Furthermore, intervention frequencies and study periods differed markedly: acute experimental designs required exercise snacks every 15 to 30 min during a single 1- to 2-hour task or simulated nightshift [11, 26, 29, 30], whereas longitudinal interventions incorporated daily exercise snacks over extended periods of 5 to 6 weeks [27, 28]. This pronounced methodological variability underscores the diverse approaches to exercise snacks. Detailed protocols and characteristics of the intervention and control groups are presented in Table 1.

Effects of exercise snacks on musculoskeletal discomfort

The included studies generally demonstrated that exercise snacks could alleviate musculoskeletal discomfort, though the efficacy varied substantially. To better identify broader patterns within the heterogeneous evidence, the findings can be synthesized according to three underlying themes: the duration of the intervention, the exercise modality, and the intensity of the activity.

Regarding the duration of the intervention, longitudinal studies spanning several weeks consistently demonstrated the superiority of exercise snacks over passive rest. Osama et al. [27] found that a 5-week regimen of exercise snacks (stretching and strengthening) yielded significantly greater improvements in general and self-perceived discomfort compared to 30-second supplemental passive micro-breaks. Similarly, Battecha et al. [28] observed that a 6-week intervention incorporating CCFT significantly reduced neck pain compared to ergonomic modifications alone. In contrast, acute experimental studies within a single 1- to 2-hour window showed mixed comparative results. Nakphet et al. [26] reported that while any break (active stretching, dynamic contractions, or passive rest) reduced discomfort immediately after the break during a 60-minute typing task, there were no significant differences between exercise snacks and passive rest. This suggests that while acute interruptions provide immediate subjective relief, sustained exercise snack interventions are necessary to manifest distinct long-term benefits.

Beyond intervention duration, the modality of the exercise snack appears to strongly influence its effectiveness. Interventions incorporating targeted stretching or specific neuromuscular control demonstrated pronounced benefits. Ding et al. [29] compared multiple break types and found that standing and stretching for 5 min was the most effective modality for alleviating subjective discomfort, outperforming simply changing posture, walking, or passive rest. As previously noted, Battecha et al. [28] successfully utilized CCFT to target deep cervical flexors, effectively mitigating neck pain. Conversely, generic walking yielded less consistent benefits.

Finally, the intensity of the activity emerged as a critical differentiating factor. Raj et al. [11] demonstrated that stair climbing—a moderate-to-vigorous activity—effectively mitigated neck, shoulder, and upper back discomfort induced by 2 h of prolonged sitting. In contrast, Craige et al. [30] utilized a low-intensity stimulus (light treadmill walking at 3.2 km/h for 3 min) during simulated night shifts. This low-intensity activity failed to reduce musculoskeletal pain compared to uninterrupted sitting, with pain intensity increasing over time in both groups.

In summary, the overall balance of the current evidence leans toward a positive effect. Specifically, four of the six included studies (66.7%) demonstrated explicit positive findings favoring exercise snacks over uninterrupted sitting or passive rest. Conversely, two studies (33.3%) reported null findings regarding the between-group superiority of exercise snacks. In these cases, exercise snacks either did not statistically outperform passive rest despite showing within-group relief [26], or failed to reduce pain intensity under specific high-stress conditions like simulated night shifts [30].

Quality assessment

The risk of bias for the six RCTs was assessed using the Cochrane RoB 2.0 tool. The included studies comprised five parallel-design trials [26–30] and one crossover trial [11]. Among the six included studies, five parallel-design RCTs (83.3%) were assessed as having a high risk of bias [26–30], whereas the remaining crossover RCT (16.7%) was rated as low risk [11]. The high risk of bias in these five studies primarily stemmed from Domain 4 (“Measurement of the outcome”) due to inadequate reporting. Specifically, outcome assessors were aware (or potentially aware) of the allocated intervention, which potentially influenced the outcome measurement. Additionally, four studies were rated as having some concerns in Domain 1 (“Randomisation process”) [26–29] due to inadequate description or non-reporting regarding allocation sequence concealment. The overall risk of bias assessment is illustrated in Fig. 2.

Fig. 2.

Summary of risk of bias with ROB 2 tool (a) randomized controlled trials (b) crossover studies

Discussion

To the best of our knowledge, this is the first systematic review of RCTs to investigate the effects of exercise snacks on musculoskeletal discomfort in sedentary populations. The synthesized findings suggest that regularly interrupting prolonged sitting with exercise snacks may serve as a potentially feasible and exploratory strategy for alleviating discomfort in the neck, shoulder, and lower back. However, because five of the six included studies were assessed as having a high risk of bias, these results are based on limited high-quality evidence and must be interpreted cautiously. Furthermore, the observed heterogeneity across studies suggests that the efficacy of these interventions is highly contingent upon the influence of factors such as exercise modality, duration, and environmental context.

Several included studies demonstrated that exercise snacks were significantly more effective than prolonged sitting or passive rest in alleviating musculoskeletal discomfort. Osama et al. [27] found that after a 5-week intervention, office workers in the exercise snack group exhibited significant reductions in both CMDQ and VNRS scores compared to a passive rest group, suggesting that active interruptions yield superior outcomes to rest alone. Raj et al. [11] reported that 2 min of stair climbing every 30 min effectively attenuated shoulder, neck, and upper back discomfort in healthy young adults. Similarly, Battecha et al. [28] demonstrated that combining CCFT with workstation adjustments over 6 weeks produced significantly greater improvements in pain intensity and neck disability compared to workstation modification alone, highlighting the value of exercises that specifically target the deep cervical flexors to correct biomechanical imbalances. Furthermore, Ding et al. [29] provided an empirical physiological basis for intervention timing: using EMG analysis, they identified the onset of muscle fatigue in the trapezius and latissimus dorsi at approximately 40 to 50 min of continuous sitting, supporting the recommendation to schedule exercise snacks within this timeframe.

However, not all studies reported favorable outcomes. Nakphet et al. [26] found no significant differences in EMG activity or discomfort among groups performing stretching, dynamic contractions, or passive rest during a 60-minute typing task, although all groups reported reduced discomfort following each interruption compared to continuous work. Craige et al. [30] similarly found that 3 min of low-intensity walking every 30 min during simulated night shifts did not improve musculoskeletal pain compared to prolonged sitting; pain intensity increased within nights in both groups. A plausible explanation for these null findings is that within short acute experimental windows, any form of interruption—including passive rest—may suffice to temporarily disrupt static loading and allow overloaded motor units to relax [26, 31–33]. In contrast, the longer-term studies by Osama et al. [27] and Battecha et al. [28] suggest that achieving sustained neuromuscular adaptations likely requires cumulative, targeted physiological stimuli [27, 28, 34]. The failure of the intervention in the Craige et al. [30] study may additionally reflect the unique physiological stressors of night-shift work, particularly considering that shift workers are exposed to elevated risks of musculoskeletal disorders [35–38]. Craige et al. [30] themselves noted that the dose of the exercise snack may have been insufficient to influence pain in healthy populations. From a theoretical perspective, night-shift-induced circadian misalignment can heighten central pain sensitivity and impair pain recovery [37, 39–41], potentially raising the physiological threshold required for an exercise snack to produce meaningful effects.

A comparative analysis across the included studies further suggests that both exercise intensity and modality specificity influence the effectiveness of exercise snacks. Regarding intensity, Raj et al. [11] employed moderate-to-vigorous stair climbing and reported significant reductions in shoulder discomfort, noting that stair climbing increases muscle recruitment more effectively than level walking. By contrast, Craige et al. [30] used low-intensity treadmill walking (3.2 km/h) and observed no between-group benefit. Regarding modality, Ding et al. [29] found that 5-minute standing-and-stretching exercise snacks were significantly more effective than passive rest or those involving simple posture changes and walking, and could maintain muscles in a non-fatigue state for 30 to 45 min—compared to only 20 to 28 min for other exercise snack modalities. Battecha et al. [28] further reinforced this pattern: their CCFT, which specifically targeted deep cervical neuromuscular control, produced significant improvements in neck pain and cervical angles. Collectively, these empirical findings suggest that generic low-intensity exercise snacks may provide only minimal relief, whereas those that reach a moderate-to-vigorous intensity threshold or incorporate targeted biomechanical corrective elements are more likely to produce meaningful reductions in musculoskeletal discomfort.

Based on the synthesized findings, exercise snacks hold potential practical value for workplace health promotion. Physiologically, muscle fatigue typically onsets after 40 to 50 min of continuous sitting. Therefore, to effectively manage sedentary behavior and prevent muscle fatigue, sedentary office workers are advised to schedule structured 2 to 10 min “exercise snacks” every 30 to 50 min. Furthermore, the type of exercise snack is crucial. To effectively counteract the static load imposed by prolonged sitting, targeted exercises (e.g., stretching specific tight muscles) or moderate-to-vigorous activities (e.g., stair climbing) are significantly more effective than passive rest or general low-intensity walking. It should be noted, however, that the included studies primarily measured subjective discomfort and surface electromyography; the physiological and biomechanical mechanisms discussed above remain theoretical explanations that require further empirical validation using direct biomarkers.

Limitations

Several limitations should be acknowledged. First, the included studies featured small sample sizes (20 to 50 participants) and considerable heterogeneity, which may limit the statistical power of the analyses. Second, the ecological validity of the study environments warrants consideration. Three studies [26, 29, 30] used controlled laboratory settings with standardized simulated tasks (e.g., typing). While this controlled for confounding factors, it cannot fully replicate the multitasking demands and autonomous break behaviors of real-world work environments, thereby restricting generalizability. Third, the outcome measures relied on inherently subjective tools, such as the VAS, CMDQ, and Borg’s CR-10. Because pain and discomfort are subjective experiences, these measures remain susceptible to participants’ psychological expectations and individual variations in pain thresholds. Finally, a notable methodological limitation of this review is the lack of prior protocol registration in a public database. Although our review protocol was internally pre-defined, the absence of prospective public registration limits the external verifiability of our pre-specified endpoints against the final reported outcomes, which is a recognized standard for modern systematic reviews.

Conclusion

Based on a synthesis of six randomized controlled trials, this systematic review evaluated the impact of exercise snacks on musculoskeletal discomfort in sedentary populations. Exploratory evidence suggests that regularly interrupting sedentary behavior with exercise snacks may represent a potentially feasible occupational health strategy for alleviating discomfort in the neck, shoulder, and lower back. However, due to the limited high-quality evidence among the included studies, these findings remain preliminary and should be interpreted with caution.

However, given that five of the six included studies were assessed as having a high risk of bias, combined with the observed heterogeneity in sample size and intervention parameters, the overall quality of evidence is limited. Consequently, current evidence is insufficient to establish a universal “optimal dose” standard. Future research should prioritize large-scale, long-term RCTs within real-world office settings to validate the sustained benefits of exercise snacks on musculoskeletal discomfort. Concurrently, emphasis should shift toward exploring personalized intervention protocols for specific occupational populations, including night shift employees and high-stress knowledge workers, alongside the integration of smart monitoring technologies to optimize intervention timing and intensity. These efforts will provide a more robust scientific basis for fostering healthier modern work environments.

Abbreviations

RCTs

Randomized Controlled Trials

WHO

World Health Organization

PRISMA

Preferred Reporting Items for Systematic Reviews and Meta Analyses

RoB

The Cochrane risk-of-bias tool for randomized trials

VAS

Visual Analogue Scale

EMG

Electromyography

VNRS

Visual Numeric Rating Scale

CMDQ

Cornell Musculoskeletal Discomfort Questionnaire

SF-MPQ

Short-Form McGill Pain Questionnaire

NDI

Neck Disability Index

DIPA

Digital Imaging for Postural Assessment

CCFT

Craniocervical Flexion Test/Training

Authors’ contributions

JZ: Conceptualization, Data curation, Investigation, Literature Screening, Methodology, Writing-original draft, Writing-review & editing. DYL: Conceptualization, Writing-original draft, Visualization. MXG: Literature Screening, Extract data, Methodology, Supervision. YLL: Literature Screening, Extract data, Methodology, Supervision. SA: Writing-Review & Editing, Supervision. WJZ: Conceptualization, Supervision, Validation, Writing-review & editing. All authors read and approved the final manuscript.

Funding

This review was not supported by any external funding.

Data availability

The datasets used and analyzed during the current study are available from the corresponding author on request.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.