Exercise for osteoarthritis: Effective or overstated?

Osteoarthritis is a degenerative joint condition that causes pain, stiffness, swelling and reduced mobility. It commonly affects the knees, hips and hands. Exercise has long been recommended as a standard part of treatment.

Researchers conducted an umbrella review, which analyses multiple systematic reviews to provide a broad overview of evidence. The study examined five major systematic reviews covering 100 studies involving 8,631 patients, along with 28 additional trials including 4,360 patients.

The review assessed the effects of exercise on knee, hip and hand osteoarthritis. It compared exercise with alternatives such as no treatment, placebo treatments, education, manual therapy, painkillers, injections and surgery.

What the findings showed

Compared with doing nothing or receiving placebo treatments, exercise reduced pain by 6 to 12 points on a 100-point scale in people with knee, hip and hand osteoarthritis.

However, the review found that exercise did not significantly improve function compared with these alternatives.

For knee and hip osteoarthritis, exercise appeared to reduce pain to a similar extent as medicines such as ibuprofen and corticosteroid injections. These treatments also reduced pain by around 5 to 10 per cent.

The researchers concluded that exercise was less effective than total joint replacement surgery in improving pain and function in severe knee and hip osteoarthritis.

Key limitations of the review

Experts highlighted several limitations that may have influenced the conclusions:

• All exercise types grouped together: Strength training, aerobic exercise, stretching, aquatic exercise and tai chi were analysed collectively. Previous research shows different forms of exercise produce different outcomes.
• Patient condition not differentiated: Evidence suggests patients with more severe symptoms often respond better to exercise than those with milder symptoms.
• Supervised vs unsupervised training combined: Supervised exercise programmes tend to produce better results.
• Short study duration: Most studies lasted around 12 weeks. Long-term exercise adherence may produce greater benefits.
• Exercise dose not considered: Research indicates optimal benefits may occur at around 150 minutes of moderate-intensity exercise per week.

These factors suggest the review may underestimate the potential long-term benefits of consistent and appropriately structured exercise.

Broader health benefits

Even modest pain reductions can improve daily life, mobility and independence. A 10 per cent reduction in pain may significantly enhance the ability to work, socialise and perform daily activities.

Exercise was found to reduce pain to a similar degree as non-steroidal anti-inflammatory drugs and corticosteroid injections, without associated medication side effects.

In addition, exercise improves cardiovascular health, supports weight management, enhances mood and reduces the risk of chronic diseases such as diabetes and certain cancers.

What patients should consider

Based on current evidence, exercise remains a recommended strategy for managing osteoarthritis symptoms.

The type of exercise that is most sustainable and enjoyable is likely to deliver the best long-term outcomes. Walking, gym-based strength training and moderate-intensity aerobic activity can all contribute to pain management and overall health improvement.

Experts advise consistency and gradual progression, as long-term commitment is more likely to produce meaningful benefits than short-term programmes.