A groundbreaking comprehensive review published in the journal RMD Open challenges the long-held assumption that exercise therapy is an unequivocally beneficial intervention for osteoarthritis symptom management. This umbrella systematic review, which synthesizes data from an extensive collection of systematic reviews and randomized controlled trials, reveals that the therapeutic value of exercise in alleviating pain and enhancing physical function may be minimal, transient, and comparable to placebo or no treatment at all. The study’s findings raise critical questions about the prevalent clinical practice of universally recommending exercise as a first-line treatment for all osteoarthritis patients.
Osteoarthritis, characterized by the progressive degeneration of joint cartilage and underlying bone, afflicts millions worldwide, prompting significant disability and morbidity. Over the decades, exercise regimens have been widely endorsed across clinical guidelines for varying osteoarthritis presentations, including those targeting knees, hips, hands, and ankles. Despite this, growing skepticism regarding the magnitude and sustainability of exercise’s therapeutic effects has emerged from recent evidence, pointing to a need for a rigorous reevaluation of the data underpinning these recommendations.
Prior to this review, numerous individual systematic reviews assessed exercise’s efficacy, but none had exhaustively compared it to a diverse spectrum of intervention alternatives, ranging from placebos and standard care to pharmacological treatments and surgical procedures. This gap in the literature motivated the researchers to conduct a meta-analysis that integrated and critically appraised findings from both aggregated and participant-level randomized trials to derive a more conclusive understanding.
The investigative team conducted a meticulous search for relevant studies published up to November 2025, ultimately including five systematic reviews encompassing 8,631 participants, as well as 28 randomized controlled trials involving 4,360 patients with osteoarthritis affecting different joints—primarily knee and hip. The analytical framework focused on key outcome metrics such as pain reduction and functional improvement, while also evaluating the quality and certainty of the evidence.
Upon performing pooled statistical analyses, the results revealed that exercise interventions yielded only slight, short-lived benefits in knee osteoarthritis pain compared with placebo or no intervention. Of considerable note, the certainty of this evidence was rated very low, undermining confidence in the robustness of these findings. Furthermore, studies with larger sample sizes and extended follow-up periods tended to demonstrate even smaller therapeutic effects, suggesting that initial improvements might dissipate over time.
In osteoarthritis impacting the hip, evidence of exercise’s effectiveness was even less convincing, classified with moderate certainty as negligible. Conversely, for hand osteoarthritis, the effects were small but inconsistent. Interestingly, the review also found that exercise often produced outcomes comparable to those observed with patient education, manual therapy, analgesic use, corticosteroid or hyaluronic acid injections, and minimally invasive arthroscopic knee surgeries. These insights challenge the hierarchy of treatment efficacy often implied in clinical protocols.
In specific subgroups, singular trials indicated that more invasive surgical interventions, such as knee osteotomy aimed at bone remodeling, and total joint replacement, delivered superior long-term outcomes compared to exercise therapy. This suggests a nuanced therapeutic landscape where the invasiveness and nature of intervention must be balanced against patient preferences and expected benefits, particularly for individuals with advanced osteoarthritis.
The researchers acknowledged certain methodological constraints, notably their prioritization criteria for including reviews, which may have omitted some relevant studies. Yet, supplementary analyses that incorporated effect sizes from excluded reviews validated the overarching conclusions. Additional limitations involved heterogeneity in patient characteristics, notably symptom severity variability, as well as the allowance of concomitant therapies alongside exercise in various trials, complicating direct causal interpretations.
Despite these caveats, the investigators concluded that prevailing evidence offers limited and largely inconclusive support for recommending exercise as the solitary first-line treatment to mitigate pain and improve function across osteoarthritis subtypes. The temporal brevity and minimal magnitude of benefits underscore the imperative to reevaluate clinical guidelines and research agendas, emphasizing the pursuit of innovative and more effective therapeutic modalities.
Notwithstanding limited efficacy for osteoarthritis symptoms, the study authors recognize and emphasize that exercise confers myriad systemic health benefits—improving cardiovascular fitness, metabolic health, mood, and overall well-being. They advocate for nuanced, patient-centered care models employing shared decision-making approaches in which clinicians and patients collaboratively weigh the modest joint-specific benefits of exercise therapy against its broader health advantages, safety, cost-effectiveness, and available alternative treatments.
This paradigm shift calls for clinicians to move beyond blanket prescriptions of exercise and instead tailor interventions to individual patient profiles, disease stages, and preferences. Moreover, it highlights an urgent research imperative to explore novel therapeutic strategies capable of delivering durable symptom relief in osteoarthritis, potentially integrating multimodal approaches that address both joint pathology and systemic health.
As osteoarthritis continues to impose a substantial public health burden, the insights from this synthesis urge a critical reassessment of entrenched treatment dogmas. By aligning clinical practices with high-certainty evidence and fostering personalized treatment plans, healthcare providers can better navigate the complexities of osteoarthritis management, ultimately improving patient outcomes and quality of life.
Subject of Research: People
Article Title: Effectiveness of exercise therapy for osteoarthritis: an overview of systematic reviews and randomised controlled trials
News Publication Date: 17-Feb-2026
Web References: http://dx.doi.org/10.1136/rmdopen-2025-006275
Keywords: Osteoarthritis, Physical exercise
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