An umbrella systematic review and pooled data analysis suggests that exercise therapy for osteoarthritis may offer minimal and short-lived benefits, potentially comparable to no treatment.
This finding challenges the widespread recommendation of exercise as a primary treatment for pain and improved physical function in individuals with degenerative joint disease. Published in the journal RMD Open, the research suggests a necessity for reevaluation of current research priorities.
Study Details
The review incorporated a substantial body of evidence:
- It included 5 existing systematic reviews, encompassing 8,631 participants, and 28 randomized clinical trials with 4,360 participants.
- These trials specifically focused on osteoarthritis in the knee, hip, hand, and ankle.
- Pooled statistical analysis indicated small, short-lived effects on knee osteoarthritis pain when compared to placebo or no treatment. The certainty of this evidence was very low, and effects were observed to be smaller in larger or longer-term trials.
- Moderate certainty evidence suggested negligible effects for hip osteoarthritis and small effects for hand osteoarthritis.
- Outcomes for exercise were found to be comparable to various other interventions, including patient education, manual therapy, pain medication use, steroid or hyaluronic acid injections, and arthroscopic knee surgery.
- Specific trials showed exercise to be less effective over the longer term than knee bone remodeling surgery (osteotomy) and joint replacement.
Researcher Conclusions
Researchers acknowledged limitations such as the prioritization of certain reviews and variability among participants. Despite these, they concluded that the evidence for exercise in osteoarthritis is largely inconclusive, pointing to negligible or, at best, short-lasting small effects on pain and function across different osteoarthritis types.
They emphasize that these effects appear less pronounced in larger and longer-term studies. While questioning the universal promotion of exercise as the sole focus in first-line treatment, the researchers also noted that exercise provides other health benefits and patient preferences should be considered.
Clinicians and patients are advised to engage in shared decision-making, considering the effects of exercise on pain and function alongside its secondary health benefits, safety profile, low cost, and alternative treatment options.