Effectiveness of exercise therapy for osteoarthritis: an overview of systematic reviews and randomised controlled trials

Abstract

Objective To provide an overview of the effects of exercise for osteoarthritis. Design Overview. Data sources Medline, Embase, Epistemonikos, PEDro, Cochrane and registries from inception to 8 November 2025. Eligibility criteria Reviews comparing exercise with placebo, no intervention or other interventions on pain and function for osteoarthritis. Supplementary trials were included to update inconclusive areas. Data extraction and synthesis Two independent reviewers extracted data and assessed bias. Data were standardised to a 0–100 scale and reanalysed using random-effects meta-analysis. Certainty was rated using Grading of Recommendations Assessment, Development and Evaluation. Results Five reviews (κ=100; n=8631) and 28 supplementary trials (knee/hip κ=23, hand κ=3, ankle κ=2; n=4360) were included. Evidence indicated small, short-term effects of exercise versus placebo (mean difference −10.8, 95%CI −19.1 to −2.6) and no-treatment (−12.4, 95%CI −15.6 to −9.2) for knee osteoarthritis pain, but certainty was very low and effects in larger or longer-term trials were smaller. Moderate evidence suggested negligible effects in hip (−6.7 95%CI −9.3 to −4.0) and small effects in hand (−10.0 95%CI −15.5 to −4.5) osteoarthritis. Varying certainty evidence indicated comparable outcomes to education, manual therapy, analgesics, injections and arthroscopy. Single trials in selected populations showed exercise was less effective than knee osteotomy (12.4 95%CI 4.7 to 20.2) and joint replacement (knee 17.1 95%CI 10.4 to 23.8; hip 24.2 95%CI 18.2 to 30.2) at longer term. Conclusion and relevance Evidence on exercise for osteoarthritis remains largely inconclusive, suggesting negligible or short-lasting small effects comparable to, or less effective than, other treatments. These findings question its universal promotion and highlight the need to revisit research priorities and clinical discussions around its worthwhileness. Registration CRD42023446888.