Effect of exercise given to factory workers with ergonomics training on pain and functionality: A randomized controlled trial

Abstract

BACKGROUND:

Exercise and manual therapy are used with pharmacological interventions to manage low back pain and prevent work-related musculoskeletal disorders. However, the potential benefits of incorporating exercise and ergonomics training for factory workers experiencing low back pain have not been definitively established.

OBJECTIVE:

The objective of this study was to assess the impact of ergonomics training with exercises on pain, functionality, sleep, and fatigue among factory employees experiencing low back pain.

METHODS

This research was conducted as a randomized controlled trial involving workers with back pain employed in a plastic molding factory in Gebze, Kocaeli. Both groups received ergonomics training, but only the experimental group was given exercise training inclusive of stretching and core stabilization exercises. The workers in the experimental group were instructed to perform the exercises regularly for three days a week over a period of eight weeks. The McGill Pain Questionnaire (MPQ), the Visual Analogue Scale (VAS), the Fatigue Severity Scale (FSS), the Pittsburgh Sleep Quality Index (PSQI), and the Oswestry Disability Index (ODI) were used for pre-and post-treatment assessment.

RESULTS:

The ODI, FSS, PSQI, and MPQ scores were significantly reduced in both groups. In the intergroup comparison, the exercise group showed a significantly greater decrease in all test scores compared to the control group.

CONCLUSION:

The exercise group showed a statistically significant decrease in ODI, FSS, MPQ, and PSQI scores compared to the control group. This study demonstrated that exercise is a more effective practice than ergonomic training for factory workers suffering from chronic low back pain.

Keywords

Employees exercise pain ergonomics rehabilitation sleep

1 Introduction

Work-related musculoskeletal disorders are the most common of all work-related diseases. These disorders are caused by poor posture, ergonomic inadequacies and the use of strenuous, repetitive movements [1]. Work-related musculoskeletal disorders are prevalent in many countries and result in significant economic losses. Low back pain, in particular, is one of the most common work-related musculoskeletal disorders in technologically advanced societies [2]. Low back pain is a significant musculoskeletal condition, leading to reduced productivity, workplace injuries, and loss of labor force. Activities such as carrying, pushing, pulling, holding, lowering, and lifting exacerbate the prevalence of low back pain [3]. Due to these risk factors, low back pain is common among factory workers who are exposed to physically demanding working conditions [4, 5]. Employees in the manufacturing, heavy industry, healthcare, cleaning, and service sectors are particularly susceptible to risks in the workplace [6]. Low back pain impacts fundamental activities like sitting, walking, dressing, and standing, thereby declining patients’ quality of life. It is also associated with psychological conditions such as sleep disturbance, depression and anxiety [7 –9].

In addition to pharmacological interventions, non-pharmacological alternatives, including exercise and manual therapy, are also employed for low back pain management [10]. Physical activity and exercise are recommended to prevent work-related musculoskeletal disorders and improve employee performance. These programs typically include stretching and strengthening exercises [11, 12]. Several studies have demonstrated that core stabilization exercises are a highly effective technique in rehabilitating low back pain. In addition, enhancing coordination and function in deep abdominal muscles through core stabilization exercises has been shown to lessen low back pain in patients [13, 14]. In addition to physical exercise, ergonomic training has been shown to be an effective approach to managing spinal conditions [15].

In this study, we hypothesized that physical activity combined with ergonomics training for factory workers with chronic low back pain may prevent pain and fatigue in employees. There is no study in the literature on this subject, especially on factory workers. Therefore, the present study analyzed the efficacy of an exercise program consisting of core stability and stretching exercises alongside ergonomics training in improving pain, functionality, sleep, and fatigue in factory workers experiencing low back pain.

2 Methods

2.1 Study design

This study was conducted between April and October 2023 after obtaining ethical approval from the Uskudar University Non-Interventional Research Ethics Committee (reference number 61351342/March 2023-39). The clinical trial number for this study is NCT06004284.

2.2 Determination of sample size

The study’s required sample size was determined using the G*Power (v3.1) program. Under conditions where the effect level was 0.90 (large effect), the error level (a) was 0.05, and the test’s power (1-B) was 0.90, the minimum sample size necessary for a significant difference between the groups was 54. The study population consisted of factory workers in the plastics production department of Iraq Plastic Corporation Factory. The research was carried out as a single-blind, randomized controlled study, adhering to the ethical principles outlined in the Declaration of Helsinki and was approved by the ethics committee.

2.3 Randomization and blinding

The investigation was conducted as a single-blind randomized controlled trial following established principles of research design. The evaluator evaluated the study as single-blinded. Fifty-four employees from a factory participated in the study and were assigned at random to the experimental group (n:27) or control group (n:27) via a simple random method. Randomization was accomplished using a sealed envelope method.

First, a total of 60 participants underwent assessments by a medical specialist to be eligible for the trial. The trial was ultimately concluded with 54 participants. Figure 1 shows the flow of participants through the study. Inclusion criteria were defined as being between 18–65 years of age, having low back pain in the last 3 months, having a score above 4 on the Visual Pain Scale and not having undergone surgical intervention in the last 6 months. The study involved individuals who suffer from non-specific chronic low back pain. Desk work, having mental disorders, use of sleeping pills and medical conditions that prevent physical activity were the exclusion criteria for the study.

Fig. 1

CONSORT flow diagram of the participants.

2.4 Intervention and procedure

All participants provided written informed consent. The experimental group received ergonomics training and additional training involving stretching and core exercises, while the control group only received ergonomics training. Both types of training were explained to the employees individually and supported with a written brochure. Employees were asked to perform the exercises three times a week for 8 weeks. Exercise progress was tracked and monitored through the establishment of a group using an exercise tracking chart. The initial exercises were performed with the physiotherapist, and the subsequent exercises were assigned as an individual home program. Every week, the employees received reminder messages while the study was announced both verbally and in writing to ensure maximum participant reach.

2.4.1 Exercise training

The exercise training program implemented for the participants of the experimental group (n: 27) spanned 8 weeks, with 3 sessions per week, each lasting an average of 20–30 minutes. The exercise program did not involve the use of any equipment. Before the exercise training, all participants were instructed on the abdominal corseting technique. Following its teaching, the program consisted of 5-minute stretching exercises for warm-up and posture, and 25-minute core exercises, with their movements adjusted in accordance to the capacity of each participant. The set of stretching exercises included quadratus lumborum, hamstring, erector spina, and hip extensor exercises. A posterior pelvic tilt exercise was implemented as a control and smoothing exercise for the vertebrae of the lumbar and pelvic regions. The core stabilization exercises consisted of bridging, planking, side planking, abdominal strengthening, and cross-arm leg raising exercises in the crawling position (Fig. 2). Each exercise position was held for 8 seconds, and participants were instructed to complete 10–15 repetitions. Rest intervals of 30 seconds were implemented between each exercise. Participants were instructed not to engage in any physical activity other than the exercise provided.

Fig. 2

Exercise program applied to the participants. A: Abdominal bracing maneuver, B: Quadratus lumborum and erector spinae muscle stretching exercise, C: Hamstring muscle stretching exercise, D: Posterior pelvic tilt exercise, E: Bridging exercise, F: Plank exercise, G: Plank exercise in side lying, H: Abdominal strengthening exercise, I: Cross-arm leg raising exercise in crawling position.

2.4.2 Ergonomics training

Individual ergonomics training was given to both control group (n:27) and experimental group (n:27) participants. The training covered the definition and purpose of ergonomics, musculoskeletal diseases in employees, work-related musculoskeletal risk factors, ergonomic modifications in the work environment, and methods for preventing musculoskeletal diseases. At the start of the study, each participant received individual face-to-face ergonomics training that lasted approximately two hours. The training was presented through a combination of video, visual aids, and practical applications. Additionally, informative booklets were distributed.

2.5 Outcome measurements

Data on age, sex, marital status, education, smoking, and alcohol consumption were collected using a demographic questionnaire. In addition, functionality, pain, sleep quality, and fatigue severity were assessed at baseline and the end of the study.

2.5.1 McGill Pain Questionnaire (MPQ)

The short form of the McGill pain questionnaire, developed by Melzack and validated in Turkish by Yakut et al., is employed for evaluating the sensory and affective pain experienced by patients. Pain intensity is expressed using 15 words, comprised of 11 sensory and 4 affective descriptors. From these descriptions, the patient is asked to select the response that best describes their symptoms, ranging from none (0) to mild (1), moderate (2) or severe (3). Furthermore, pain experienced during the survey is evaluated using the Visual Analogue Scale (VAS) method, while the overall intensity of pain is assessed using a 6-point Likert scale. On the Likert scale, zero and five are defined as the endpoints of the intensity of the pain. The pain is rated between 0 and 45, where 0 indicates no pain and 45 denotes severe pain [12, 16].

2.5.2 The Oswestry Disability Index (ODI)

The ODI was designed to assess the functionality of individuals affected by low back pain. Yakut et al. carried out the Turkish validation of the scale, which was initially developed by Fairbanks and later modified by Husdoon-Cook [16].

The ODI assesses functional impairment in activities including sitting, walking, personal hygiene, lifting, socializing, traveling, and sleeping. The scale comprises 10 questions, each offering six response options, from which participants choose the one that most accurately describes their condition. A score between 0 and 5 points is assigned to each sentence, yielding a maximum score of 50 points. A score of 1 to 10 is considered mild, 11 to 30 is considered moderate and 31 to 50 is considered severe.

2.5.3 Fatigue Severity Scale (FSS)

Participants were evaluated for fatigue using the FSS, which comprises 9 questions where each option is given a score ranging from 0 to 7. A score of 0 indicates ‘strongly disagree’ and a score of 7 indicates ‘agree’. The maximum score is 7, and scores of 4 and above indicate a considerable level of fatigue [17].

2.5.4 Pittsburgh Sleep Quality Index (PSQI)

PSQI was utilized to evaluate participants’ sleep quality. PSQI measures sleep duration, disturbance, efficiency, subjective quality, medication use, daytime work disruption, and latency. It includes 24 questions in total, with 19 self-report scales and 5 queries to be completed by a friend or partner. The scale consists of 7 components with 18 questions, and each component is scored from 0 to 3 points. The total score ranges from 0 to 21, with a score of 5 or more indicating a poor quality of sleep [18].

2.6 Data analysis

The data analysis was conducted using SPSS 22. Initially, demographic variables in the experimental and control groups were presented as frequency and percentage distributions. Chi-square was used to compare the relation between groups and demographic variables. Bonferroni correction method was used to compare the column proportion for the significant Chi-square results. To compare the scale scores, parametric methods were employed. Normality was assessed using the Shapiro-Wilk normality test. Independent t-tests were carried out for normally distributed measurements, while paired t-tests were used to compare pre- and post-treatment measurements within each group. For measurements that displayed non-normal distribution (e.g. sleep characteristics) in both groups, the Mann-Whitney U test was used as a nonparametric alternative to the independent group t-test, and the Wilcoxon signed-rank test was used as an alternative to the dependent group t-test. Despite the normal distribution of pain scores, the Mann-Whitney U analysis method was used for comparing pain-related scores among demographics due to limited data for various demographic variables in each group. A significance level of p < 0.05 was implemented for all statistical analyses.

3 Results

A total of fifty-four factory workers participated in the study. Demographic characteristics of the participants are presented in Table 1.

Table 1
Demographic characteristics of the participants

Variable Groups Exercise Control p*

n (%) n (%)

Age 20–30 14 (51.9) 11 (40.7) 0.813

31–40 5 (18.5) 6 (22.2)

41–50 5 (18.5) 5 (18.5)

51–60 3 (11.1) 5 (18.5)

Gender Female 4 (14.8) 8 (29.6) 0.19

Male 23 (85.2) 19 (70.4)

Place of residence Big city 23 (85.2)a 10 (37)b 0.002

City 0 (0)a 3 (11.1)a

District 3 (11.1)a 13 (48.1)b

Village 1 (3.7)a 1 (3.7)a

Health insurance Private insurance 1 (3.7) 1 (3.7) 1

SSI 26 (96.3) 26 (96.3)

Marital Status Married 14 (51.9) 12 (44.4) 0.685

Single 12 (44.4) 12 (44.4)

Widow 0 (0) 1 (3.7)

Divorced 1 (3.7) 2 (7.4)

Alcohol use No 19 (70.4) 25 (92.6) 0.100

Rarely 7 (25.9) 2 (7.4)

Once a week 1 (3.7) 0 (0)

Cigarette use No 13 (48.1) 11 (40.7) 0.679

Dropped out 1 (3.7) 0 (0)

Sometimes 3 (11.1) 4 (14.8)

1 packet a week 1 (3.7) 3 (11.1)

1 packet a day 9 (33.3) 9 (33.3)

Type of residence Apartment 22 (81.5) 19 (70.4) 0.386

Detached house 4 (14.8) 7 (25.9)

Guest House-Hotel 1 (3.7) 0 (0)

Care home 0 (0) 1 (3.7)

House of residence Owned by 12 (44.4) 6 (22.2) 0.223

Belongs to his family 8 (29.6) 11 (40.7)

Rent 7 (25.9) 10 (37)

Living environment Single 14 (51.9) 14 (51.9) 0.884

With his wife 3 (11.1) 2 (7.4)

Spouse and child 10 (37) 11 (40.7)

Education level Primary School 6 (22.2)a 4 (14.8)a 0.025

Middle School 1 (3.7)a 10 (37)b

High School 13 (48.1)a 9 (33.3)a

Bachelor 7 (25.9)a 4 (14.8)a

Income level Below minimum wage 1 (3.7)a 1 (3.7)a 0.034

Minimum wage 20 (74.1)a 26 (96.3)b

2 times the minimum wage 6 (22.2)a 0 (0)b

Variable	Groups	Exercise	Control	p*
Age	20–30	14 (51.9)	11 (40.7)	0.813
	31–40	5 (18.5)	6 (22.2)
	41–50	5 (18.5)	5 (18.5)
	51–60	3 (11.1)	5 (18.5)
Gender	Female	4 (14.8)	8 (29.6)	0.19
	Male	23 (85.2)	19 (70.4)
Place of residence	Big city	23 (85.2)a	10 (37)b	0.002
	City	0 (0)a	3 (11.1)a
	District	3 (11.1)a	13 (48.1)b
	Village	1 (3.7)a	1 (3.7)a
Health insurance	Private insurance	1 (3.7)	1 (3.7)	1
	SSI	26 (96.3)	26 (96.3)
Marital Status	Married	14 (51.9)	12 (44.4)	0.685
	Single	12 (44.4)	12 (44.4)
	Widow	0 (0)	1 (3.7)
	Divorced	1 (3.7)	2 (7.4)
Alcohol use	No	19 (70.4)	25 (92.6)	0.100
	Rarely	7 (25.9)	2 (7.4)
	Once a week	1 (3.7)	0 (0)
Cigarette use	No	13 (48.1)	11 (40.7)	0.679
	Dropped out	1 (3.7)	0 (0)
	Sometimes	3 (11.1)	4 (14.8)
	1 packet a week	1 (3.7)	3 (11.1)
	1 packet a day	9 (33.3)	9 (33.3)
Type of residence	Apartment	22 (81.5)	19 (70.4)	0.386
	Detached house	4 (14.8)	7 (25.9)
	Guest House-Hotel	1 (3.7)	0 (0)
	Care home	0 (0)	1 (3.7)
House of residence	Owned by	12 (44.4)	6 (22.2)	0.223
	Belongs to his family	8 (29.6)	11 (40.7)
	Rent	7 (25.9)	10 (37)
Living environment	Single	14 (51.9)	14 (51.9)	0.884
	With his wife	3 (11.1)	2 (7.4)
	Spouse and child	10 (37)	11 (40.7)
Education level	Primary School	6 (22.2)a	4 (14.8)a	0.025
	Middle School	1 (3.7)a	10 (37)b
	High School	13 (48.1)a	9 (33.3)a
	Bachelor	7 (25.9)a	4 (14.8)a
Income level	Below minimum wage	1 (3.7)a	1 (3.7)a	0.034
	Minimum wage	20 (74.1)a	26 (96.3)b
	2 times the minimum wage	6 (22.2)a	0 (0)b

*Chi-square analysis method was used. a, b; Small letters indicates the significant difference between column proportions and different small letters shows the difference between columns.

Table 2 shows the results of the pre and post-treatment assessments that were used in this study. Before treatment, there were no significant differences between the FSS, ODI, PSQI, VAS, and MPQ scores of patients in the control and experimental groups (p > 0.05). However, after treatment, a significant decrease was observed in the FSS (p < 0.001), ODI (p < 0.001), PSQI (p < 0.05), and MPQ (p < 0.001) measurements of the patients in the experimental and control groups. A substantial difference was observed between the patients in the experimental and control groups after treatment in the measures sub-parameters of PSQI. Subjective sleep quality, sleep latency, sleep time, daytime dysfunction, sleeping disorder, sleeping medicine use and PSQI total scores were significantly lower in the exercise group compared to the control group (p < 0.05). However, there was no difference between the mean measurements of habitual sleep activity and daytime dysfunction in the experimental and control groups (p > 0.05).

Table 2

Pre and post-treatment scores by groups

Variables	Control group			Exercise group			p1/p2
	Pretreatment	Posttreatment	Mean Dif.^a	Pretreatment	Posttreatment	Mean Dif.
	X±SD	X±SD	(% 95-CI)	X±SD	X±SD	(% 95-CI)
ODI	27.09±9.35	22.45±6.76	(2.57–6.7)**	26.15±7.85	16.54±7.17	(7.37–11.86)**	<0.001/<0.001
MPQ	23.33±8.21	19.93±6.66	(1.71–5.1)**	23.41±5.59	13.93±5.25	(7.5–11.46)**	<0.001/<0.001
FSS	4.15±1.05	3.66±0.99	(0.28–0.69)**	3.91±0.99	2.87±0.9	(0.78–1.31)**	<0.001/<0.001
PSQI (Total Score)	8±3.4	7.3±3.6	(1.2–2.88)*	6.8±2.8	4.7±2.3	(1.2–2.88)**	0.045/<0.001
	Median [Min-Max]	Median [Min-Max]	Z^b	Median [Min-Max]	Median [Min-Max]	Z	p1/p2
Subjective Sleep Quality	2 [1–3]	1 [0–3]	–1.890	1 [0–3]	1 [0–2]	–2.714*	0.059/0.007
Sleep Latency	1 [0–2]	1 [0–2]	–1.667	1 [0–2]	1 [0–2]	–3.606*	0.096/<0.001
Sleep Time	1 [0–2]	1 [0–2]	–2*	1 [0–2]	1 [0–2]	–2.121*	0.046/0.034
Habitual Sleep Activity	1 [0–3]	1 [0–2]	–0.447	0 [0–2]	0 [0–1]	–0.333	0.655/0.739
Sleeping disorder	1 [1–3]	1 [0–2]	–2.121*	1 [1–3]	1 [0–2]	–2.968*	0.034/0.003
Sleeping Medicine Use	0 [0–2]	0 [0–2]	–1	0 [0–1]	0 [0–1]	–1	0.317/0.317
Daytime Dysfunction	1 [0–2]	1 [0–2]	–0.816	1 [0–3]	0 [0–2>]	–3.234*	0.414/0.001

*: p < 0.05; **: p < 0.01; p1: significant value for control group; p2: significant value for exercise group; a: Mean difference between pre and post treatmend for measures and Dependent sample t test was used; b: Wilcoxon signed rank test Z statistics.

Table 3 represents the inter-group differences in evaluations. The exercise and control groups showed a significant decrease in the ODI, FSS, PSQI, and MPQ scores at the end of the study (p < 0.05). Also, the exercise group depicted a significantly greater decrease in ODI, FSS, PSQI, and MPQ scores than the control group in the between-group comparison (p < 0.05) (Tables 2, 3). Also, a significant difference was obtained between sleep latency and daytime dysfunction difference measurements and PSQI total score difference scores of the patients in the exercise and control groups (p < 0.05) (Tables 2, 3). There was no significant difference between the subjective sleep quality, sleep duration, habitual sleep activity, sleeping disorder and sleep medication use of the patients in the exercise and control groups.

Table 3

Comparison of the difference values regarding pre- and post-treatment among groups

Variables	Exercise	Control	t**	p value
	X±SD	X±SD
ODI	9.61±5.66	4.63±5.22	3.35	<0.001*
MPQ	9.48±5	3.41±4.28	4.79	<0.001*
FSS	1.05±0.66	0.49±0.52	3.45	<0.001*
PSQI (Total Score)	2.04±2.12	0.74±1.83		0.020*
	Median	Median	U***	p value
	[Min-Max]	[Min-Max]
Subjective Sleep Quality	0 [0–2]	0 [0–2]	–1.24	0.21
Sleep Latency	0 [0–1]	0 [–1–2]	–2.24	0.020*
Sleep Time	0 [–1–1]	0 [0–1]	–0.69	0.48
Habitual Sleep Activity	0 [–1–1]	0 [–1–1]	–0.02	0.98
Sleeping disorder	0 [–1–2]	0 [–1–1]	–1.44	0.14
Sleeping Medicine Use	0 [–1–0]	0 [–1–1]	–0.48	0.63
Daytime Dysfunction	1 [–1–2]	0 [–1–1]	–2.84	<0.001*

ODI: Oswestry Disability Index, MPQ: McGill Pain Questionnaire, FSS: Fatigue Severity Scale, PSQI: Pittsburgh Sleep Quality Index, *p < 0.05; **Independent sample t-test statistics; ***Mann-Whitney U Test Statistics.

4 Discussion

Physical activity has been studied extensively and has been found to have a positive impact on both physiological and psychological health [19]. One of the most notable benefits of physical activity is the reduction of fatigue. Fatigue results in a reduction of problem-solving skills, a lack of focus, and decreased concentration. It therefore increases the risk of work-related accidents due to fatigue, particularly for industrial workers [20]. Biman and colleagues investigated how a 3-month yoga program affected musculoskeletal pain, fatigue, and stress in employees. Their research revealed that yoga is an effective intervention for improving fatigue levels [21]. Ramos et al. assessed the effects of transcutaneous electrical nerve stimulation (TENS) and stabilization exercises on pain, fatigue, transversus abdominis activation and functionality in patients suffering from lumbar disc herniation. The study revealed that stabilization exercises yielded favorable outcomes in all assessment criteria, including fatigue levels [22]. Stretching and stabilization exercises have been shown to reduce muscle fatigue in healthy university students [23]. In line with existing literature, our study revealed a statistically more significant reduction in pain severity (FSS) among participants who received an exercise program with ergonomics training. These findings provide evidence for the crucial role of exercise in alleviating pain among factory workers.

The decline in physical capacity, spasms, and posture among individuals experiencing low back pain results in reduced muscle strength and a decrease in their overall quality of life [24]. Multidisciplinary treatment is becoming increasingly important due to the impact of low back pain on the workforce, the high cost of treatment and the long recovery times. Complementary methods, such as massage, physiotherapy, exercises, and traction, play a significant role alongside medical interventions. Exercise has been identified as a particularly effective modality for reducing the severity of low back pain [25]. In this study, the level of functional impairment (ODI) was observed among participants who received an exercise program with ergonomics training, as well as those who received only ergonomics training. Employees who underwent an exercise program in addition to ergonomics training showed a greater decrease in functional impairment compared to the group receiving only ergonomics training. This demonstrates the positive effect of exercise on worker functionality.

Low back pain is the most prevalent musculoskeletal disorder associated with work, impacting around 45% of employees in Europe [26]. In the study, both groups exhibited high pain levels as measured by VAS and MPQ pain scores. The literature reveals numerous studies examining the impact of exercise and ergonomics training on pain among individuals employed in different industries. Several studies have highlighted the effectiveness of exercise programs in reducing pain levels among employees with chronic low back pain or neck and back pain across different occupational groups [27 –30]. The study evaluated the effects of an exercise program combined with an ergonomics brochure for low back and neck pain on pain and functionality parameters among teachers. Results demonstrated that the group receiving ergonomics training along with exercise exhibited noticeable enhancements compared to those only receiving ergonomics training [27]. A study investigated the impact of ergonomics and exercise training on reducing musculoskeletal pain in automobile factory employees. The results showed a significant decrease in pain values among the employees [31]. The significance of exercise intervention in low back pain treatment is well-established, and research has focused on identifying the most effective exercise type. Recent studies have shown that core stabilization exercises are more efficacious in treating low back pain and were utilized for the experimental group’s exercise program in our study [32, 33]. In a study examining the impact of health education and stabilization exercises on low back pain among nurses, it was observed that the intervention group, which included stabilization exercises, had more significant improvements [34]. In line with the available literature, we found that the inclusion of both an ergonomics training and exercise program was effective in reducing VAS and MPQ scores among participants in our study. Another study, focusing solely on ergonomics training for operating theatre nurses, investigated the impact of a 3-month training program on musculoskeletal pain, particularly low back pain. The authors reported a decrease in the prevalence of such pain following the training program [35]. Similarly, we observed a noteworthy alleviation of pain scores in both the control and exercise groups. However, a combination of exercise programs and ergonomics training was found to be more effective in controlling functionality and pain intensity. Therefore, based on the literature and the findings of this study, an ergonomics training and physical exercise program tailored to the characteristics of the workplace for factory workers suffering from chronic low back pain may be an effective treatment to reduce pain interference and improve functionality.

In general, 50–59% of individuals suffering from chronic low back pain also encounter sleep disturbance [7, 36]. A meta-analysis of research exploring sleep quality and sleep-related issues in the industrial workforce revealed a significant incidence of sleep-related problems [37]. The current study, conducted with factory workers suffering from low back pain, indicates that both the experimental and control groups had poor sleep quality before any intervention, in line with the literature findings. Among female teachers with chronic musculoskeletal pain, Metri et al. found a positive effect of occupational yoga on sleep quality [38]. A study examining the impact of stabilization exercises on sleep disturbance in chronic low back pain patients found that these exercises led to a significant improvement in sleep disturbance scores [39]. Yoga and physiotherapy have been discovered to result in slight enhancement in sleep quality in adult individuals experiencing persistent low back pain [40]. In a systematic literature review investigating the impact of resistance or aerobic exercises on sleep quality among middle-aged and elderly individuals experiencing sleep difficulties, the evidence demonstrated a moderate improvement in sleep quality following exercise training [41]. Our study found that sleep quality improved when the exercise program was coupled with ergonomics training, which is consistent with previous literature. Furthermore, it was observed that the degree of low sleep quality vastly improved in the control group, which only received ergonomics training, comparable to the exercise group. In line with this, ergonomic training was found to be effective in improving sleep quality, pain, and quality of life in office employees [42]. Therefore, it is crucial not to underestimate the significance of ergonomics training in improving the quality of sleep and, indirectly, the quality of life for factory workers.

The study had some limitations. Firstly, the gender distribution is imbalanced, with men outnumbering women by approximately four to one. Secondly, the study did not examine the long-term impact of the intervention, which raises questions about whether the effects can be sustained over time. Finally, frequent job changes among the factory employees prevented an assessment of long-term effects.

5 Conclusion

In this study, although ergonomics training effectively alleviated high pain levels among factory workers with low back pain, the success of the intervention was further increased by adding an exercise program to the training.The results demonstrate that exercises in combination with ergonomics training effectively enhance moderately affected functionality and reduce moderate fatigue levels among workers. It has been also shown that physical activity and ergonomic training could enhance the sleep quality of employees facing sleep difficulties. Further research is required to substantiate the effectiveness of core stabilization exercises, which are more efficacious in reducing low back pain than various other exercise methods, particularly in factory workers. To enhance employee well-being, maximize work productivity, and reduce work absence caused by health problems, it is advised to undertake preventive physiotherapy services and consult experts at the institutional level for ongoing support.

Ethical approval

Ethical approval was obtained from the Uskudar University Non-Interventional Research Ethics Committee (reference number 61351342/March 2023–39).

Informed consent

All participants provided written informed consent.

Conflict of interest

None to report.

Footnotes

Acknowledgments

None to report.

Funding

None to report.

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