Is exercise effective in relieving osteoarthritis symptoms?

The effectiveness of exercise therapy in relieving osteoarthritis symptoms is probably minimal, short-lived and probably no better than no treatment, a study suggests. general systematic review and a pooled data analysis of the available evidence, conducted by Bochum University of Applied Sciences (Germany) and Copenhagen University Hospital (Denmark).

The findings, available in the open access journal RMD Openquestion the universal promotion of exercise as a first-line treatment to relieve pain and improve physical function in all people living with degenerative joint disease, and highlight the need to review research priorities, the researchers conclude. Exercise is systematically recommended as initial treatment for various types of osteoarthritis. However, a growing body of evidence has questioned the extent and duration of its effects, the researchers say.

Although numerous systematic reviews have been published, there has not been a comprehensive review of the available evidence that compares exercise with a variety of different approaches, including placebo, usual care, nothing, medications, other therapies and surgery, they add.

To fill this gap, the researchers searched research databases for relevant systematic reviews and randomized clinical trials published through November 2025. They included 5 revisions, with a total of 8631 participants, and 28 randomized clinical trials on osteoarthritis of the knee/hip (23), hand (3) and ankle (2), with a total of 4360 participants, in the general review.

Pooled statistical analysis of the results from all studies indicated that exercise was associated with mild and short-lived effects on back pain. knee osteoarthritiscompared to placebo or no treatment. However, the certainty of the evidence was very low and the effects in larger or long-term trials were even smaller.

The evidence of moderate certainty suggested negligible effects for hip osteoarthritis and small effects for hand osteoarthritis. Furthermore, evidence of variable certainty indicated comparable results for patient education, manual therapy, use of analgesics, steroid or hyaluronic acid injections, and intracranial knee surgery (arthroscopy).

Likewise, individual trials in particular groups showed that exercise was less effective than surgery knee bone remodeling (osteotomy) and long-term joint replacement.

The researchers acknowledge that they prioritized the inclusion of certain reviews and therefore could have excluded other relevant ones. However, further analysis of the effect sizes of these other reviews indicated similar results. Furthermore, there were few direct comparisons between the included studies, considerable variation between participants in terms of severity of symptoms and some trials allowed other interventions alongside exercise.

However, they conclude: “We found largely inconclusive evidence on exercise for osteoarthritis, suggesting negligible or, at best, short-lived effects on pain and function in different types of osteoarthritis, compared with placebo or no treatment. These effects appear less pronounced in larger, long-term trials. Our findings question the universal promotion of exercise therapy as the sole focus of first-line treatment to improve pain and physical function in all patients with osteoarthritis.

But exercise has other health benefits, and some patients may prefer it, they acknowledge. “The importance of the effects of exercise on pain and function along with secondary health benefits, safety, low-cost profile, stage of care, and alternative treatment options,” the authors advise.