Effectiveness of exercise therapy for osteoarthritis: an overview of systematic reviews and randomised controlled trials

Tim Schleimer; Florian Teichert; Marius Henriksen; Rebekka Doeding; Tiziano Innocenti; Helena Brisby; Matthias C Klotz; Marianne Korinth; Patrick J Owen; Dawid Pieper; Daniel L Belavy

doi:10.1136/rmdopen-2025-006275

Effectiveness of exercise therapy for osteoarthritis: an overview of systematic reviews and randomised controlled trials

Tim Schleimer
, Florian Teichert
, Marius Henriksen
, Rebekka Doeding
, Tiziano Innocenti
, Helena Brisby
, Matthias C Klotz
, Marianne Korinth
, Patrick J Owen
, Dawid Pieper
, Daniel L Belavy

Research output: Contribution to Journal › Article › Academic › peer-review

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) and joint replacement (knee 17.1 95% CI 10.4 to 23.8; hip 24.2 95% CI 18.2 to 30.2) at longer term.

CONCLUSION AND RELEVANCE: 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.

REGISTRATION: CRD42023446888.

Original language	English
Article number	e006275
Journal	RMD Open
Volume	12
Issue number	1
DOIs	https://doi.org/10.1136/rmdopen-2025-006275
Publication status	Published - 17 Feb 2026

Bibliographical note

Funding

The authors would like to thank Dr. Carolien Teirlinck (PhD student; Department General Practice, Erasmus MC University Medical Center Rotterdam, the Netherlands) for providing feedback to the protocol and sharingtheir dataset.

Funders
Erasmus Universitair Medisch Centrum Rotterdam

Keywords

Humans
Exercise Therapy/methods
Randomized Controlled Trials as Topic
Osteoarthritis/therapy
Treatment Outcome
Systematic Reviews as Topic
Osteoarthritis, Knee/therapy

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10.1136/rmdopen-2025-006275

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Cite this

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title = "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) and joint replacement (knee 17.1 95\% CI 10.4 to 23.8; hip 24.2 95\% CI 18.2 to 30.2) at longer term.CONCLUSION AND RELEVANCE: 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.REGISTRATION: CRD42023446888.",

keywords = "Humans, Exercise Therapy/methods, Randomized Controlled Trials as Topic, Osteoarthritis/therapy, Treatment Outcome, Systematic Reviews as Topic, Osteoarthritis, Knee/therapy",

author = "Tim Schleimer and Florian Teichert and Marius Henriksen and Rebekka Doeding and Tiziano Innocenti and Helena Brisby and Klotz, \{Matthias C\} and Marianne Korinth and Owen, \{Patrick J\} and Dawid Pieper and Belavy, \{Daniel L\}",

note = "{\textcopyright} Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.",

year = "2026",

month = feb,

day = "17",

doi = "10.1136/rmdopen-2025-006275",

language = "English",

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T1 - Effectiveness of exercise therapy for osteoarthritis

T2 - an overview of systematic reviews and randomised controlled trials

AU - Schleimer, Tim

AU - Teichert, Florian

AU - Henriksen, Marius

AU - Doeding, Rebekka

AU - Innocenti, Tiziano

AU - Brisby, Helena

AU - Klotz, Matthias C

AU - Korinth, Marianne

AU - Owen, Patrick J

AU - Pieper, Dawid

AU - Belavy, Daniel L

PY - 2026/2/17

Y1 - 2026/2/17

N2 - 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) and joint replacement (knee 17.1 95% CI 10.4 to 23.8; hip 24.2 95% CI 18.2 to 30.2) at longer term.CONCLUSION AND RELEVANCE: 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.REGISTRATION: CRD42023446888.

AB - 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) and joint replacement (knee 17.1 95% CI 10.4 to 23.8; hip 24.2 95% CI 18.2 to 30.2) at longer term.CONCLUSION AND RELEVANCE: 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.REGISTRATION: CRD42023446888.

KW - Humans

KW - Exercise Therapy/methods

KW - Randomized Controlled Trials as Topic

KW - Osteoarthritis/therapy

KW - Treatment Outcome

KW - Systematic Reviews as Topic

KW - Osteoarthritis, Knee/therapy

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DO - 10.1136/rmdopen-2025-006275

M3 - Article

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SN - 2056-5933

VL - 12

JO - RMD Open

JF - RMD Open

IS - 1

M1 - e006275

ER -

Effectiveness of exercise therapy for osteoarthritis: an overview of systematic reviews and randomised controlled trials

Abstract

Bibliographical note

Funding

Keywords

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