Daijiworld Media Network - London
London, Feb 18: The effectiveness of exercise therapy in easing symptoms of osteoarthritis may be minimal and short lived, and possibly no better than no treatment at all, according to a major umbrella review and pooled data analysis published in the open-access journal RMD Open.
The findings challenge the widespread recommendation of exercise as a first-line treatment to reduce pain and improve physical function in people living with the degenerative joint condition. Researchers suggest that current treatment guidelines and research priorities may need to be revisited.
Exercise is routinely advised as an initial therapy for different types of osteoarthritis. However, emerging evidence has raised concerns about the magnitude and durability of its benefits.
To provide a comprehensive overview, researchers analysed systematic reviews and randomised clinical trials published up to November 2025. The umbrella review included five systematic reviews involving 8,631 participants and 28 randomised clinical trials covering knee and hip (23 trials), hand (3 trials), and ankle (2 trials) osteoarthritis, with a combined total of 4,360 participants.
The pooled analysis showed that exercise was linked to small, short-term reductions in knee osteoarthritis pain compared with placebo or no treatment. However, the certainty of the evidence was rated as very low, and the effects appeared even smaller in larger and longer-term studies.
For hip osteoarthritis, moderate-certainty evidence suggested negligible benefits, while small improvements were observed for hand osteoarthritis. Outcomes were broadly comparable to those achieved through patient education, manual therapy, painkillers, steroid or hyaluronic acid injections, and arthroscopic knee surgery.
Some individual trials indicated that exercise was less effective than knee bone realignment surgery (osteotomy) or joint replacement over the longer term.
The researchers acknowledged limitations, including selective inclusion of certain reviews, limited head-to-head comparisons, variation in symptom severity among participants, and the allowance of additional treatments alongside exercise in some trials.
Despite these caveats, the authors concluded that evidence supporting exercise as a standalone first-line therapy remains largely inconclusive.
They noted that while exercise may not substantially reduce pain or improve function for all patients, it offers broader health benefits and may still be preferred by some individuals.
The researchers emphasised the importance of shared decision-making between clinicians and patients, considering potential pain relief, overall health benefits, safety, cost, stage of disease, and alternative treatment options before deciding on therapy.