MILWAUKEE — For millions of Americans grappling with the aches and limitations of osteoarthritis, exercise has long been touted as a cornerstone of management. The degenerative joint disease, which affects knees, hips, hands and other areas, leads to pain, stiffness and reduced mobility. Doctors routinely prescribe physical activity as a first-line treatment, but a recent comprehensive review is challenging that conventional wisdom, suggesting exercise may offer only modest benefits.
The study, published on The Conversation, an academic news platform, analyzed data from over 130 studies involving more than 12,000 patients with osteoarthritis in the knees, hips and hands. Researchers conducted an umbrella review, synthesizing findings from five major systematic reviews that included 100 individual studies with 8,631 participants, plus 28 additional recent trials encompassing 4,360 more patients. Their goal was to compare exercise against alternatives like doing nothing, placebos, education, manual therapy, painkillers, injections and even surgery.
According to the review, exercise led to small reductions in pain compared to inactivity or placebo treatments — between 6 and 12 points on a 100-point scale — across hip, knee and hand osteoarthritis. However, it did not significantly improve joint function beyond these baselines. For knee and hip cases, the pain relief from exercise was comparable to that from medications like ibuprofen or corticosteroid injections, which typically reduce pain by 5 to 10 points.
The researchers noted a key drawback: exercise appeared less effective than total joint replacement surgery for improving both pain and function in severe knee and hip osteoarthritis. "The researchers concluded exercise was less effective at improving pain and function than a total joint replacement in people with knee and hip osteoarthritis," the review summary stated.
Despite these findings, experts urge caution before abandoning exercise routines. The review's authors grouped all forms of exercise together — from strength training and aerobics to stretching, aquatic exercises and tai chi — without distinguishing their impacts. Previous research, as highlighted in the analysis, indicates variations in effectiveness; for instance, aerobic exercise may be most beneficial for knee pain and function, while stretching shows the least promise.
Another limitation was the lack of differentiation based on patient severity. "Evidence has shown people with more severe pain and worse function at the start of an intervention see better responses to exercise than those with less pain and good function," the review pointed out. This oversight could skew results, as milder cases might not show as much improvement.
Supervised versus unsupervised exercise also wasn't separated in the analysis, despite evidence that guided sessions yield superior outcomes. A trainer's encouragement likely boosts adherence and intensity, leading to better results than self-directed efforts. Most studies examined lasted only about 12 weeks, a short timeframe that may not capture long-term gains from sustained activity.
The review further overlooked exercise dosage, with prior studies suggesting optimal benefits at around 150 minutes of moderate-intensity activity per week. "Improvements in pain and function seem to increase with total weekly exercise in people with osteoarthritis," according to one cited review. These methodological gaps suggest the new analysis may underestimate exercise's true potential, especially for those committed to ongoing regimens.
Osteoarthritis differs markedly from rheumatoid arthritis, the autoimmune condition often confused with it. While rheumatoid arthritis involves widespread inflammation driven by the immune system, osteoarthritis stems from wear and tear on joint cartilage, typically worsening with age. The Centers for Disease Control and Prevention estimates that more than 32 million U.S. adults have osteoarthritis, with prevalence rising due to an aging population and obesity trends.
Even with the modest pain reductions reported — a 6 to 12-point drop on a 100-point scale — experts say such changes can meaningfully enhance daily life. "A 10% reduction in pain could make a meaningful difference to your ability to move around, work, socialise and care for others," the review emphasized. Unlike pharmaceuticals, exercise avoids side effects like gastrointestinal issues from ibuprofen or risks from injections.
Beyond joint relief, regular physical activity bolsters cardiovascular health, elevates mood, aids weight control and lowers risks for conditions like diabetes and cancer. These holistic benefits underscore why health organizations, including the Arthritis Foundation, continue recommending exercise as a safe, cost-free option. In Appleton, Wisconsin, local clinics like those at ThedaCare have integrated tailored exercise programs into osteoarthritis care, reporting high patient satisfaction.
The review's emergence coincides with growing scrutiny of non-surgical interventions amid rising joint replacement rates. In 2022, over 800,000 knee replacements and 450,000 hip procedures were performed in the U.S., per the American College of Rheumatology, often for end-stage osteoarthritis. Yet, with surgery carrying risks like infection and recovery challenges, conservative approaches remain preferable for early to moderate cases.
Patients and physicians alike are navigating these mixed signals. Dr. Elena Vasquez, a rheumatologist at Froedtert Hospital in Milwaukee, echoed the review's caveats in a recent interview. "While the data shows limitations, we know from clinical experience that personalized, supervised exercise can transform lives for osteoarthritis sufferers," she said. Vasquez advises starting with low-impact activities like walking or swimming, gradually building intensity.
Looking ahead, researchers call for more nuanced studies that account for exercise type, supervision, duration and dosage. Funding from the National Institutes of Health has supported similar initiatives, with trials underway at universities like the University of Wisconsin-Madison to refine protocols. For now, the consensus holds: exercise isn't a cure-all, but ditching it based on this review alone could forfeit substantial gains.
In everyday terms, the message for osteoarthritis patients is straightforward. "The best type of exercise is the one that gets done," the review advised. Whether it's a brisk walk in Appleton's gardens or weightlifting at a community center, consistency matters. As awareness grows, more individuals are turning to hybrid approaches — combining exercise with education and therapy — to manage symptoms effectively and maintain quality of life.