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)…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 8,631 participants or records.
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