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, researchers have said.
However, the new study published in the journal RMD Open acknowledged that some patients may consider exercise ‘worthwhile’ even if expected effects are small or absent, for example, to prevent the worsening of symptoms.
Exercise is consistently recommended as an initial treatment for various types of osteoarthritis, but researchers have now questioned the extent and durability of its effects in a review and pooled data analysis of the available evidence.
The researchers noted that systematic reviews have previously been published, but there has not 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.
Aiming to plug this gap, they looked at research databases for relevant systematic reviews and randomised clinical trials published up to November 2025.
This included five reviews, involving a total of 8,631 participants, and 28 randomised clinical trials on knee/hip, hand, and ankle osteoarthritis, involving a total of 4,360 participants.
‘Largely inconclusive’ evidence on exercise for osteoarthritis
The researchers said they 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, and that these effects appear less pronounced in larger and longer-term trials.
Comparing exercise with no intervention for knee osteoarthritis, they said: ‘When compared with no intervention, exercise therapy may result in a small effect in pain and physical function in the short term but the evidence is very uncertain.
‘Exercise may result in little to no difference in pain (low certainty) and function (moderate certainty) in the long term.’
They added that their 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.
They concluded: ‘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.’
New evidence for NICE?
NICE guidance updated in 2022 said all osteoarthritis patients should be offered therapeutic exercise, such as local muscle strengthening, general aerobic fitness, tailored to their needs to help manage and reduce symptoms.
And it said that supervised exercise was likely to have greater benefits for people with osteoarthritis because it may increase adherence and social support.
‘Advise people with osteoarthritis that joint pain may increase when they start therapeutic exercise,’ the guidance added. ‘Explain that doing regular and consistent exercise, even though this may initially cause pain or discomfort, will be beneficial for their joints [and] long-term adherence to an exercise plan increases its benefits by reducing pain and increasing functioning and quality of life.’
However, the authors of the recent study concluded that clinicians and patients should weigh the worthwhileness of exercise effects on pain and function alongside secondary health benefits, safety, low-cost profile, care stage and alternative treatment options.
‘Given that exercise seemingly yields comparable outcomes to many other treatments, doctors and physiotherapists could decide based on the preferences of patients, the possible harms of the treatment and their own expertise,’ they said. ‘In this context, exercise may be preferable due to its safety, secondary health benefits and lower costs.
‘Further, we acknowledge that some patients may consider exercise worthwhile even if expected effects are small or absent, for example, to prevent worsening of symptoms.
But they added that exercise may not be suitable for all patients with osteoarthritis as they may face barriers such as comorbidity or lack of access that prevent them from adhering to regular exercise.
A version of this article was originally published by our sister publication Pulse.