Findings of evidence overview question its universal promotion as first line treatment
The effectiveness of exercise therapy to ease the symptoms of osteoarthritis is likely minimal, short lived, and probably no better than no treatment at all, suggests an overarching (umbrella) systematic review and pooled data analysis of the available evidence, published in the open access journal RMD Open.
The findings question the universal promotion of exercise as a first line treatment to ease pain and improve physical function in all those living with the degenerative joint disease, and highlight the need to revisit research priorities, conclude the researchers.
Exercise is consistently recommended as an initial treatment for various types of osteoarthritis. But an emerging body of evidence has questioned the extent and durability of its effects, note the researchers.
While numerous systematic reviews have been published, there hasn’t been a comprehensive review of the available evidence comparing exercise with a range of different approaches, including placebo, usual care, nothing, drugs, other therapies, and surgery, they add.
To plug this gap, the researchers scoured research databases for relevant systematic reviews and randomised clinical trials published up to November 2025. They included 5 reviews, involving a total of 8631 participants, and 28 randomised clinical trials on knee/hip (23), hand (3), and ankle (2) osteoarthritis, involving a total of 4360 participants, in the overarching review.
Pooled statistical analysis of all the study results indicated that exercise was associated with small, short lived effects in knee osteoarthritis pain, compared with placebo or no treatment. But the certainty of the evidence was very low and the effects in larger or longer term trials were smaller still.
Moderate certainty evidence suggested negligible effects for hip, and small effects for hand, osteoarthritis.
And varying certainty evidence indicated comparable outcomes to patient education, manual therapy, use of painkillers, steroid or hyaluronic acid injections, and keyhole knee surgery (arthroscopy).
Single trials in particular groups showed that exercise was less effective than knee bone remodelling surgery (osteotomy) and joint replacement over the longer term.
The researchers acknowledge that they prioritised the inclusion of certain reviews, and so may have excluded others that were relevant. But additional analysis of the effect sizes from these other reviews indicated similar results.
And there were few direct head to head comparisons in most of the included studies, considerable variation among participants in terms of symptom severity, and some trials allowed other interventions alongside exercise.
Nevertheless, they conclude: “We found largely inconclusive evidence on exercise for osteoarthritis, suggesting negligible or, at best, short-lasting small effects on pain and function across different types of osteoarthritis compared with placebo or no treatment. These effects appear less pronounced in larger and longer-term trials.
“Our findings question the universal promotion of exercise therapy as the sole focus in first- line treatment to improve pain and physical function in all patients with osteoarthritis.”
But exercise does have other health benefits, and some patients may prefer it, they acknowledge.
“Clinicians and patients should engage in shared decision-making, weighing the worthwhileness of exercise effects on pain and function alongside secondary health benefits, safety, low-cost profile, care stage, and alternative treatment options,” they advise.
17/02/2026
Notes for editors
Research: Effectiveness of exercise therapy for osteoarthritis: an overview of systematic reviews and randomised controlled trials Doi: 10.1136/rmdopen-2025-006275
Journal: RMD Open
About the journal
RMD Open is one of 70 journals published by BMJ Group.
https://rmdopen.bmj.com
Externally peer reviewed? Yes
Evidence type: Umbrella systematic review + meta analysis
Subjects: People
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