¹Aarhus University, Department of Clinical Medicine, Aarhus, Denmark
²University of Southern Denmark, Center for Muscle and Joint Health, Odense, Denmark
³Aarhus University Hospital, Dept. Gynecology and Obstetrics, Aarhus, Denmark
⁴Mayo Clinic, Kern Center for the Science of Health Care Delivery, Rochester, United States
⁵University of Michigan, Dept. of Urology, Ann Arbor, United States
⁶Ann Arbor VA Healthcare System, Ann Arbor, United States

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Introduction: Surgeons have a high prevalence of musculoskeletal pain which is a significant threat to their career longevity and overall wellbeing. While improving intraoperative ergonomics and raising awareness are important preventive strategies, physical exercise remains a cornerstone in both the preventing and rehabilitation of musculoskeletal pain. Intelligent Physical Exercise Training (IPET) offers a tailored, evidence-based approach by designing targeted exercise programs based on the location of musculoskeletal pain, job-specific physical demands, individual physical capacity, and overall health. Incorporating IPET into the daily routines of surgeons has the potential to reduce pain, enhance physical resilience, and extend professional longevity—especially critical in the context of an aging population with growing surgical demands. The objective of this trial is to investigate the effectiveness of Intelligent Physical Exercise Training (IPET) in addition to ergonomic recommendations (Good Ergonomics) on musculoskeletal pain among abdominal and pelvic surgeons.

Methods: This protocol describes an international, pragmatic, multicenter, 20-week randomized controlled trial, in which surgeons are assigned to either IPET + Good Ergonomics (intervention) or Good Ergonomics only (control) in a 1:1 allocation ratio. The IPET program provides 50 minutes of individualized weekly exercise tailored to:

1. Job-specific physical demands (sedentary, walking/standing, or heavy work),
2. Physical capacity (cardiovascular fitness, strength, balance), and
3. Health risk indicators (BMI, blood pressure), including musculoskeletal pain.

The IPET program is delivered via a mobile application. Good Ergonomics consists of operating room ergonomics recommendations, displayed on posters in hospital departments and operation rooms with short informational videos. Eligible surgeons perform surgery (either open or minimally invasive) for at least four hours per week on average. The primary outcome is the mean change in musculoskeletal pain in the most painful body region reported at baseline to the 20-week follow-up.

Results: The trial is ongoing with continuous recruitment. In Denmark, three surgical departments have completed their participation, while three other departments across two hospitals are actively participating. Additionally, two more departments at separate Danish hospitals have signed up to join the trial. In the United States, three departments within a single hospital are participating.

Discussion: This trial addresses the research gap on effective interventions for musculoskeletal pain among surgeons. Its pragmatic design and inclusive eligibility criteria enhance external validity, though challenges like protocol adherence and retention may impact internal validity. The findings could provide valuable insights into the effectiveness of prescribing IPET to surgeons to prevent and rehabilitate musculoskeletal pain in surgeons. Additionally, the results may point to future musculoskeletal pain management strategies, ultimately contributing to efforts to prevent a future shortage of surgeons.

Registration no. NCT06112106.