The “Most Effective” Treatment for Osteoarthritis May Be Less Helpful Than Thought

By Admin

20 Feb, 2026

For decades, exercise therapy has been widely promoted as the go-to first-line treatment for osteoarthritis. From clinic visits to rehabilitation centers, patients are almost automatically advised to stay active and strengthen their joints.

However, a major new analysis published in the open-access journal RMD Open suggests that the benefits of exercise for osteoarthritis may be smaller and shorter-lived than many people expect.

A Long-Standing Recommendation Under Review

Osteoarthritis affects millions of people worldwide, particularly older adults. It commonly impacts the knees, hips, hands, and ankles, leading to chronic pain, stiffness, and reduced mobility.

Exercise has long been encouraged as an early intervention because it is non-invasive, low-cost, and generally safe. But researchers note that a growing number of studies have raised doubts about how strong and lasting its effects truly are.

The new research challenges the widespread belief that exercise should automatically be the first-line treatment for everyone with osteoarthritis.

Scope and Methods of the Review

To provide a clearer picture, researchers conducted an umbrella systematic review combined with pooled data analysis.

They examined:

• 5 systematic reviews including 8,631 participants
  
  

• 28 randomized clinical trials involving 4,360 participants
  
  

• Studies published up to November 2025
  
  

Most trials focused on knee (23) and hip osteoarthritis, with a smaller number examining hand (3) and ankle (2) osteoarthritis.

This approach allowed researchers to compare exercise against a broad range of alternatives, including:

• Placebo
  
  

• No treatment
  
  

• Usual care
  
  

• Medications
  
  

• Manual therapy
  
  

• Injections (steroids or hyaluronic acid)
  
  

• Arthroscopic knee surgery
  
  

What the Study Found

When all results were pooled together, exercise therapy was linked to:

Small, Short-Lived Benefits for Knee Osteoarthritis

Exercise showed minor reductions in knee pain compared to placebo or no treatment. However:

• The certainty of this evidence was rated as very low.
  
  

• In larger studies and longer follow-ups, the benefits were even smaller.
  
  

Little to No Effect for Hip Osteoarthritis

Evidence of moderate certainty indicated that exercise had little or no meaningful impact on hip osteoarthritis symptoms.

Small Effects for Hand Osteoarthritis

Only small improvements were observed for hand osteoarthritis.

Comparable Results to Other Treatments

Exercise often performed similarly to:

• Patient education
  
  

• Manual therapy
  
  

• Painkillers
  
  

• Steroid or hyaluronic acid injections
  
  

• Arthroscopic knee surgery
  
  

In certain subgroups, exercise was less effective long term than:

• Knee bone remodeling surgery (osteotomy)
  
  

• Joint replacement surgery
  
  

Limitations of the Analysis

The researchers acknowledged several limitations:

• Some relevant reviews may not have been included due to selective prioritization.
  
  

• Few studies directly compared exercise head-to-head with other treatments.
  
  

• Participants varied widely in symptom severity.
  
  

• Some trials allowed additional therapies alongside exercise, which may have influenced results.
  
  

Despite these limitations, additional analysis of excluded studies showed similar effect patterns.

What This Means for Patients

The authors conclude that the overall evidence for exercise in osteoarthritis is largely inconclusive. On average, the benefits appear negligible or short-lasting, especially in larger and long-term trials.

Importantly, the findings question the universal promotion of exercise as the sole focus of first-line treatment for all osteoarthritis patients.

However, this does not mean exercise should be abandoned.

Beyond Joint Pain: The Broader Benefits of Exercise

Osteoarthritis care is not only about reducing joint symptoms. Exercise still offers significant advantages:

• Improved heart health
  
  

• Better mood and mental well-being
  
  

• Enhanced sleep quality
  
  

• Improved balance
  
  

• Greater independence
  
  

Many patients also prefer exercise over medications or surgical procedures due to its safety profile and low cost.

A Call for Personalized Care

Rather than eliminating exercise from treatment plans, researchers recommend a more individualized approach.

Clinicians and patients should engage in shared decision-making, considering:

• The expected size and duration of pain relief
  
  

• Secondary health benefits
  
  

• Safety and affordability
  
  

• Disease stage
  
  

• Alternative treatment options
  
  

The key message is balance. Exercise may not be the powerful pain-reliever once assumed, but it still plays a valuable role when tailored to the right patient at the right time.

Reference

Schleimer T, Teichert F, Henriksen M, Doeding R, Innocenti T, Brisby H, Klotz MC, Korinth M, Owen PJ, Pieper D, Belavy DL. “Effectiveness of exercise therapy for osteoarthritis: an overview of systematic reviews and randomised controlled trials.” Published 17 February 2026 in RMD Open.