Optimal modality and dose of exercise for relieving pain in patients with knee or hip osteoarthritis: Bayesian pairwise, network, and dose-response meta-analyses

Liang, Z; Wang, C; Zhang, M; Yu, Y; Hao, F; Tian, S

doi:10.1016/j.semarthrit.2025.152855

Optimal modality and dose of exercise for relieving pain in patients with knee or hip osteoarthritis: Bayesian pairwise, network, and dose-response meta-analyses

Semin Arthritis RheumPublished 21 Oct 2025Systematic review and Bayesian pairwise, network and dose-response meta-analyses of randomized controlled trials (RCTs)

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Authors' conclusion

Exercise effectively reduces pain in patients with knee or hip OA. Although no exercise type was found to be statistically superior to another, based on probabilistic ranking, aerobic training, strength combined with flexibility training, yoga, and strength training had the highest likelihood of being the most effective interventions.

Study context

Population: Patients with knee or hip osteoarthritis (OA) in RCTs of exercise interventions
Participants: 6,079 patients92 RCTs

Comparison: Different exercise modalities and doses for pain in knee or hip OA
Outcome: Pain

Methodological detailsrandom-effects model, six electronic databases searched, inception to December 2024, two reviewers independently assessed quality, Overall low to moderate certainty of evidence

Random-effects model
Six electronic databases searched, inception to December 2024
Two reviewers independently assessed quality
Overall low to moderate certainty of evidence

Pooled result

As reported in the abstract

Pain, network meta-analysis ranking (SUCRA) and SMD

Aerobic training

84.7%

SUCRA

Strength + flexibility training

73.0%

SUCRA

Yoga

63.7%

SUCRA

Strength training

55.9%

SUCRA

Flexibility training

39.8%

SUCRA

CrI

SMD (95% CrI)

Aerobic training

−1.00(−1.50 to −0.62)

Strength + flexibility training

−0.93(−1.40 to −0.50)

Yoga

−0.86(−1.50 to −0.24)

Strength training

−0.78(−1.00 to −0.55)

Flexibility training

−0.65(−1.10 to −0.22)

Further pooled results

Dose-response of overall exercise dose and pain (all modalities pooled)

	← Lower ←→ Higher →	SMD (95% CrI)
Optimal dose 620 METs-min/weekCrI	−1.5−1−0.500.5	−0.93 (−1.24 to −0.58)
	−1.5−1−0.500.5Difference (linear scale)

Dose-response of overall exercise dose and pain (all modalities pooled) — Optimal dose for maximising pain relief (metabolic equivalent of task (METs)-min/week): 620
Dose-response of overall exercise dose and pain (all modalities pooled) — Minimum dose for a clinically important difference (METs-min/week): 180

Dose-response of overall exercise dose and pain (all modalities pooled)

'U-shaped' dose-response relationship between overall exercise dose and pain

Original publication

Optimal modality and dose of exercise for relieving pain in patients with knee or hip osteoarthritis: Bayesian pairwise, network, and dose-response meta-analyses. Semin Arthritis Rheum. Published 21 October 2025. doi:10.1016/j.semarthrit.2025.152855

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