Study Finds Minimal Immediate Gains From Exercise in Osteoarthritis - Video

An umbrella review published in RMD Open suggests that exercise therapy may provide only minimal and short-lived relief for people with osteoarthritis, raising questions about its universal recommendation as a first-line treatment.

Exercise is widely advised to reduce pain and improve physical function in individuals with knee, hip, and hand osteoarthritis. However, growing evidence has cast doubt on how strong and long-lasting these benefits truly are. To better understand the overall picture, researchers conducted an overarching systematic review and pooled analysis of existing data.

They analyzed five systematic reviews involving 8,631 participants and 28 randomized clinical trials including 4,360 participants with knee, hip, hand, or ankle osteoarthritis. The studies compared exercise with placebo, usual care, no treatment, medications, injections, manual therapy, and surgery.

The pooled results showed that for knee osteoarthritis, exercise was associated with small and short-term pain relief compared to placebo or no treatment. However, the certainty of the evidence was very low, and the effects were even smaller in larger and longer-term trials. For hip osteoarthritis, moderate-certainty evidence suggested negligible benefit, while small effects were observed for hand osteoarthritis.

Outcomes were generally comparable to patient education, manual therapy, painkillers, steroid or hyaluronic acid injections, and arthroscopic knee surgery. In some trials, surgical options such as osteotomy and joint replacement provided greater long-term improvements than exercise alone.

The authors conclude that evidence supporting exercise as a standalone first-line treatment is largely inconclusive. Still, they acknowledge that exercise has broader health benefits and may be preferred by some patients.

They recommend shared decision-making between clinicians and patients, weighing modest symptom relief against safety, cost, overall health benefits, and alternative treatment options.

REFERENCE: Schleimer, T., et al. (2026). Effectiveness of exercise therapy for osteoarthritis: an overview of systematic reviews and randomised controlled trials. RMD Open. https://doi.org/10.1136/rmdopen-2025-006275. DOI: 10.1136/rmdopen-2025-006275. https://rmdopen.bmj.com/content/12/1/e006275