Purpose <p>This study aimed to evaluate the combined effects of a 12-week ergonomic training and exercise program on musculoskeletal pain and ergonomic risks in tea workers.</p> Methods <p>The study included 60 tea workers (aged 25–70) with musculoskeletal pain, randomly assigned to an intervention group (ergonomic training and exercise) or a control group (only ergonomic training). The assessments were done at baseline and 12&#xa0;weeks after the intervention. Outcomes included the Nordic Musculoskeletal Questionnaire (NMQ), Disabilities of the Arm, Shoulder and Hand QuestionnairIndex, kg: kilogram, m: metere (DASH), Visual Analog Scale (VAS), and Pittsburgh Sleep Quality Index (PSQI) assessment.</p> Results <p>In the intervention group, a significant difference was observed in the NMQ, DASH 1 and 2, PSQI, and VAS scores for all regions in the intra-group (pre-post intervention) comparison (<i>p</i> &lt; 0.05). In the control group, a significant difference was observed in the NMQ (shoulder and waist only), DASH 1, and PSQI scores (<i>p</i> &lt; 0.05). When comparing the post-treatment values of the two groups, significant differences in favor of the intervention group were found in all outcome measures (<i>p</i> &lt; 0.05).</p> Conclusion <p>An integrated approach of ergonomic training and exercise programs has the potential to alleviate musculoskeletal discomfort among tea workers. These interventions may be an effective strategy to improve the well-being of physically demanding tea workers.</p> Trial registration <p>NCT06407453.</p>