It is commonly believed among microsurgeons that over-exertion can impair microsurgical performance. The authors aimed to investigate if they could prove this theory and compared the performance of medical students, postgraduate trainees and expert controls who were microsurgery tutors. A total of 40 novice candidates (medical students and postgraduate trainees with no microsurgery experience) did a five-day microsurgery course and their performance was assessed on day 1 and day 5. The performance was assessed by performing end-to-end anastomosis of cryopreserved rat aortas. Hand motion analysis such as time, path length and number of hand movements were analysed. All candidates and expert controls completed the Baecke habitual physical activity questionnaire that is a validated tool evaluating physical activity of individuals within the last 12 months. The authors correlated the questionnaire score with hand motion analysis using Spearman’s rank correlation coefficient. They found that medical students had the highest physical activity scores followed by postgraduate trainees and finally expert controls. High physical activity scores in novice candidates were associated with slower completion of anastomosis on day 1 and day 5 (P<0.05). They also found novice candidates with high physical activity scores had an increased path length and total movements for day 1 which improved on day 5. The authors did not find any correlation between levels of activity and microsurgery performance in the expert controls. They concluded that higher physical activity impacts upon the microsurgical performance of trainees but not expert microsurgeons. This is probably due to the refined technique and consolidated fine motor movements by long-term potentiation of expert microsurgeons. Perhaps in the future this study could be repeated with microsurgery trainees and performance could be compared with different levels of training.