Exercise for OA no better than no treatment at all

The effectiveness of exercise therapy to ease the symptoms of osteoarthritis (OA) is likely minimal, short lived, and probably no better than no treatment at all, suggests a pooled data analysis of the available evidence, published in the BMJ journal RMD Open.

The findings question the universal promotion of exercise as a first line treatment to ease pain and improve physical function in all those living with OA.

Until now, there hasn’t 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.

To plug this gap, the researchers scoured research databases for relevant systematic reviews and randomised clinical trials published up to November 2025.

Pooled statistical analysis of all the study results indicated that exercise was associated with small, short lived effects in knee osteoarthritis pain, compared with placebo or no treatment, negligible effects for hip, and small effects for hand osteoarthritis.

And varying certainty evidence indicated comparable outcomes to patient education, manual therapy, use of painkillers, steroid or hyaluronic acid injections, and keyhole knee surgery (arthroscopy).

But exercise does have other health benefits, and some patients may prefer it, the researchers acknowledged.

‘Clinicians and patients should engage in shared decision-making, weighing the worth of exercise effects on pain and function alongside secondary health benefits, safety, low-cost profile, care stage, and alternative treatment options,’ they advised.

Schleimer T, et al. RMD Open. 2026;12:e006275. https://doi.org/10.1136/rmdopen-2025-006275