BACKGROUND Fighter pilots endure significant physical stress due to elevated gravitational forces, leading to a high prevalence of neck pain. The biomechanical loads and operational demands of high-gravitational maneuvers highlight the need for targeted interventions. Exercise training has been proposed to mitigate neck pain and enhance musculoskeletal resilience. This review examines the effectiveness of exercise interventions and identifies research gaps requiring further exploration. METHODS A PRISMA-guided systematic review examined randomized controlled trials and longitudinal studies on fighter pilot neck pain exercise interventions. Databases searched included PubMed, Cochrane Library, Defense Technical Information Center, and Web of Science, with search terms such as "fighter pilot," "aircrew," "exercise," "neck pain," "cervical," "Gz," and "conditioning." Two independent reviewers selected studies based on population, intervention, outcomes, and design. There were 5 studies that met the inclusion criteria, involving 199 participants. RESULTS The findings were mixed regarding the effectiveness of exercise interventions in reducing neck pain. Three studies reported significant pain reduction, while two found no significant changes. Programs incorporating deep cervical muscle training and supervised sessions demonstrated more consistent positive outcomes. Improvements in neck muscle strength and endurance were observed across all studies. Training compliance was higher in supervised (58-77%) than unsupervised (28-41%) programs. CONCLUSIONS Exercise interventions, particularly strength and endurance training, show the potential to improve neck muscle function in fighter pilots. However, mixed results on pain reduction, small sample sizes, and varied methodologies limit generalizability. Future research should employ standardized definitions of flight-related neck pain and robust methods to develop tailored exercise protocols. Acevedo A, Zeigler Z. Exercise training and neck pain in fighter pilots. Aerosp Med Hum Perform. 2025; 96(5):425-430.