Comparative efficacy and safety of exercise modalities in knee osteoarthritis: systematic review and network meta-analysis
Authors' conclusion
In patients with knee osteoarthritis, aerobic exercise is likely the most beneficial exercise modality for improving pain, function, gait performance, and quality of life, with moderate certainty.
Study context
- Population
- Patients with knee OA
- Participants
- 15,684 patients217 RCTs
- Comparison
- Exercise modalities vs control
- Outcome
- Pain, function, gait performance and quality of life
- Follow-up
- Short term (four weeks), mid-term (12 weeks), long term (24 weeks)
Pooled result
As reported in the abstract
Each group vs controlSMD (95% CI)
Aerobic exercisepain, short term; moderate certainty
−1.10(−1.68 to −0.52)
Aerobic exercisepain, mid-term; moderate certainty
−1.19(−1.59 to −0.79)
Aerobic exercisefunction, mid-term; moderate certainty
1.78(1.05–2.51)
Aerobic exercisegait performance, mid-term; moderate certainty
0.85(0.55–1.14)
Aerobic exercisequality of life, short term; moderate certainty
1.53(0.47–2.59)
Mind-body exercisefunction, short term; moderate certainty
0.88(0.03–1.73)
Neuromotor exercisegait performance, short term; moderate certainty
1.04(0.51–1.57)
Strengthening exercisefunction, mid-term; moderate certainty
0.86(0.53–1.18)
Mixed exercisefunction, mid-term; moderate certainty
1.07(0.68–1.46)
Flexibility exercisepain, long term; low certainty
−0.99(−1.63 to −0.36)
Aerobic exercisefunction, long term; low certainty
0.87(0.02–1.72)
Mixed exercisefunction, long term; low certainty
0.56(0.26–0.86)
Mixed exercisegait performance, long term; moderate certainty
0.57(0.21–0.92)
- Aerobic exercise highest probability of being the best treatment, SUCRA mean across outcomes
- 0.72
Safety
Safety outcome
- Reported in 40 studies (18%); no clear differences between exercise interventions and control
Original publication
Comparative efficacy and safety of exercise modalities in knee osteoarthritis: systematic review and network meta-analysis. BMJ. Published 15 October 2025. doi:10.
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