ABSTRACT Aim: The aim of this study was to determine the most effective exercise program for the management of occupational lower back pain. Background: Occupational lower back pain accounts for 25% of workdays lost. The annual occurrence of occupational related lower back pain among blue collar workers in South Africa has shown to be between 55,7% and 63,9%. Methodology: Primary studies were searched with the use of the Entrez-cross-database search tool. Methodologies were assessed and critiqued. Data which included exercise detail, outcome measures of lower back pain intensity, painful episodes, sick leave and physical measures with statistical p-values was then extracted. Results: Nine primary studies, which included 11 exercise groups, complied to the inclusion and exclusion criteria. These studies proved to be of high methodology quality with quality scoring 70% on the quality assessment checklist. Exercise regimes, which included stretching, strengthening, endurance exercises and the combination use of stretching, strengthening and endurance exercises were identified and grouped according to the corresponding outcome measures. No meta-analysis could be done as no similar exercises with similar outcome measures could be found. Discussion: The limitations in the nine selected studies methodological quality were the lack of blinding of the assessors and subjects, and in six of the nine studies the lack of adequate participation rate among the intervention subjects. The validation process is acknowledged as a weakness within this study. Stretching, dynamic strengthening and endurance exercises were not statistically significant. Isometric exercise was statistically significant for lower back pain relief when the control group (p<0,0001) was compared to the experimental group. Isometric exercise however had no significant effect on abdominal strength at 9 months follow up period. Functionalexercises were statistically significant when the exercise group was compared to the control group with lower back pain intensity relief (p<0,018), painful episodes (p<0,018), sick leave (p< 0,0044). Functional exercises also had a long-term statistically significant effect on back muscle strength. A meta analysis could not be done due to insufficient similar studies. Conclusion: Although the methodology quality of the nine primary studies showed to be of high quality the validation process was a weakness within this study. Functional strengthening exercises were the most effective type of exercise for the management of occupational lower back pain among blue-collar workers. Future similar randomized control trials on exercise as an intervention to occupational lower back pain are needed to conduct a meta analysis. A meta analysis will be able to provide more evidence to establish which exercise regime is most effective for the management of occupational lower back pain.