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In spite of large changes in working life during the last three decades work-related musculoskeletal disorders (WMSDs) are still highly prevalent. This has significant implications for quality of life for the individual employer but also impacts the workplace with significant economic losses from sickness absence and reduced productivity as well as society with increased healthcare costs.

Development of WMSD is associated with physically demanding work as well as with repetitive-monotonous, or highly sedentary jobs. Well documented risk factors are high physical or psychosocial work demands such as prolonged static or awkward postures, sustained muscle contractions, repetitive forceful or fine motor movements, lifting, carrying, pushing and pulling heavy burdens, exposure to vibration as well as high work demands, low job control, and insufficient recovery time.

Physically heavy jobs have been automized introducing assistive devices and the sedentary jobs have become digital. Overall work demands have to a large extent changed from dynamic profiles with peak loads to long lasting low static loadings. Correspondingly, there has been an extensive focus on the mechanisms behind static work as risk factor with a clear aim to provide safe guidelines for the exposure. However, neuromuscular studies clearly documents that it is not possible to find a safe limit for static muscle activity that would not result in WMSD if sustained or repeated for long time. This fully supports the most important ergonomic advice of as much variation into the workday as possible.

Work ability defines the relation between work demand and capacity and is a key factor in prevention. It can be improved both by decreasing demands and by improving capacity of the employee. An ergonomic approach focusing on work demands of the whole workday to provide a health enhancing variation are demanding to implement at most workplaces. In contrast over the last two decades a large number of RCT studies with short breaks of structured, individualized physical exercise programs, strongly based on work physiological principles and tailored to job type and individual health, have emerged as effective strategies for preventing and alleviating WMSD. Based on these studies the concept of Intelligent Physical Exercise Training (IPET) has emerged, and it has become evident that workplace-delivered IPET interventions consistently show reductions in WMSD, enhanced work ability, lowered sickness absence, and improved productivity across diverse occupational groups. This dual nature of physical activity – as both a cause and a cure for WMSD – argues for a shift in occupational health paradigms. Prevention strategies should move beyond fitting the task to the man and aim to provide the possible variation in terms of ergonomics and the big variation in terms of context specific exercise programs.

WMSD is multifactorial and in the last decade research shows that it is not only a peripheral but also a central phenomenon. Pain perception is important for prevention strategies and cognitive training must be integrated in prevention. Dialogs about WMSD at the workplace and feeling support as well as having influence and control over own workday are also supporting factors. IPET only has an effect if practised and three future fields remain to be explored. First, integrating IPET into the everyday routines at the workplace, calling for a participatory approach acknowledging that the worker is the expert. Secondly, motivating factors beyond the health argument are needed, to make health just a positive side effect. Lastly, the economic benefit for workplace and society needs to be clearly shown as the productivity paradox, that in spite of IPET shortening weekly work time with 1hour, productivity stays the same or even increase.