The researchers say these findings challenge the routine practice of recommending exercise as the first line treatment for reducing pain and improving mobility in people with this degenerative joint disease. They also argue that it may be time to rethink research priorities in this area.

Exercise is widely promoted as an initial treatment for many forms of osteoarthritis. However, growing evidence has raised concerns about how meaningful and long lasting those benefits really are.

Although many systematic reviews have examined exercise, no single analysis had pulled together all the available evidence comparing it directly with placebo, usual care, no treatment, medications, other therapies, or surgery.

Large Scale Analysis Across Thousands of Patients

To address that gap, the team searched research databases for systematic reviews and randomized clinical trials published through November 2025. Their final analysis included 5 reviews covering 8631 participants and 28 randomized clinical trials involving 4360 participants with knee or hip (23), hand (3), and ankle (2) osteoarthritis.

When the results were combined, exercise was linked to only small and short lived reductions in knee osteoarthritis pain compared with placebo or no treatment. The researchers note that the overall certainty of this evidence was very low. In larger studies and those that followed patients for longer periods, the benefits appeared even smaller.

For hip osteoarthritis, evidence of moderate certainty pointed to negligible improvement. For hand osteoarthritis, the data suggested small effects.

How Exercise Compares With Other Treatments

The review also found that exercise generally performed about the same as patient education, manual therapy, pain medications, steroid or hyaluronic acid injections, and keyhole knee surgery (arthroscopy), though the certainty of evidence varied.

In some individual trials focused on specific patient groups, exercise was less effective over the long term than knee bone remodeling surgery (osteotomy) or joint replacement.

The authors acknowledge certain limitations. They prioritized specific reviews for inclusion, which means some relevant studies may not have been part of the main analysis. However, when they examined effect sizes from those other reviews, the findings were similar.

They also point out that many studies lacked direct head to head comparisons, participants differed widely in symptom severity, and some trials allowed additional treatments alongside exercise.

Rethinking First Line Treatment for Joint Pain

Despite these caveats, the researchers conclude: “We found largely inconclusive evidence on exercise for osteoarthritis, suggesting negligible or, at best, short-lasting small effects on pain and function across different types of osteoarthritis compared with placebo or no treatment. These effects appear less pronounced in larger and longer-term trials.

“Our findings question the universal promotion of exercise therapy as the sole focus in first- line treatment to improve pain and physical function in all patients with osteoarthritis.”

At the same time, they stress that exercise offers other health benefits beyond joint pain relief, and some patients may still prefer it.

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