Last Updated:February 24, 2026, 08:00 IST

Exercise for arthritis pain may be “minimal and short-lived,” claims a new umbrella study, but rheumatologists say the full story changes everything.

A new 2026 review suggests exercise may offer only modest relief for osteoarthritis, but experts say consistency and the right approach can still make a difference. (Image-iStock)

Exercise has long been considered essential for osteoarthritis care. Recently, a new umbrella study suggests that its pain-relief may be short-lived. However, experts argue that consistency and strategy may matter far more than the numbers alone indicate.

When it comes to osteoarthritis care, exercise has been positioned as the first-line recommendation. Doctors not only prescribe it, but clinical guidelines reinforce it as well.

Patients have been encouraged to exercise and move more to preserve mobility, but a February 2026 study published in RMD Open has prompted fresh debate, suggesting exercise may offer only small, temporary improvements in pain and function.

Dr Sandeep Nagar, Consultant – Rheumatology at Yatharth Super Speciality Hospitals, Omega-1, Greater Noida, stresses that the numbers need context. “Expectations should be reframed rather than lowered,” he explains.

“Modern pain management prioritises functional capacity over achieving a ‘zero pain’ score. A 7-15 point reduction on a 100-point scale is considered a clinical success because it often enables patients to do significantly more despite some remaining pain.”

What Is Osteoarthritis, And Why Exercise Matters

Osteoarthritis is one of the most common degenerative joint diseases globally. It involves cartilage breakdown, leading to pain, stiffness, swelling, and limited range of motion. Knees, hips, and hands are most frequently affected, though any joint can be involved.

Since the condition is progressive and incurable, treatment focuses on symptom control and preserving function. Exercise has traditionally been central to that strategy. It enhances circulation, improves joint alignment, strengthens surrounding muscles, and reduces stiffness.

Over time, it can also help patients maintain independence and delay invasive interventions. Yet, the new ‘umbrella review’ raises an important question: Are those benefits as substantial as long believed?

What The Study Says

The February 2026 study, titled “Effectiveness of exercise to ease osteoarthritis symptoms likely minimal and transient,” conducted what researchers describe as an umbrella systematic review, an overarching analysis of existing systematic reviews and randomised clinical trials.

Researchers searched medical databases for relevant studies published up to November 2025. They included:

• Five systematic reviews involving 8631 participants
• Twenty-eight randomised clinical trials involving 4360 participants

In total, nearly 13000 patients were represented. The analysis examined exercise in hip, hand, knee, and ankle osteoarthritis.

It compared exercise against multiple alternatives, including no treatment, placebo, patient education, manual therapy, NSAIDs, corticosteroid injections, hyaluronic acid injections, arthroscopy, osteotomy, and joint replacement. The experiment aimed to determine whether exercise truly stands out as a first-line intervention.

What The Study Found

Compared with placebo or no treatment, exercise reduced pain by between 6 and 12 points on a 100-point scale. For knee osteoarthritis, effects were small and short-lived, with very low certainty of evidence. Larger and longer-term trials showed even smaller benefits.

For hip osteoarthritis, effects were negligible. For hand osteoarthritis, they were small. Exercise did not significantly outperform patient education, NSAIDs, steroid injections, or arthroscopy in improving function. In certain trials, surgical options such as osteotomy and total joint replacement delivered stronger long-term outcomes.

The researchers concluded:

“We found largely inconclusive evidence on exercise for osteoarthritis, suggesting negligible or, at best, short-lasting small effects on pain and function across different types of osteoarthritis compared with placebo or no treatment.”

They added that the findings “question the universal promotion of exercise therapy as the sole focus in first-line treatment.”

How Should Patients Interpret A 6-12 Point Drop?

To many readers, a 6-12 point reduction may sound unimpressive. But Dr Nagar emphasises that clinical impact is not solely about numerical magnitude. “Goals should shift from complete pain relief to improved quality of life and movement,” he says.

“Even modest reductions can increase walking tolerance, improve sleep, and reduce fear of movement. Exercise also raises pain thresholds biologically by activating the body’s endogenous opioid systems.”

Medication Vs Movement: Risk And Cost

One of the review’s notable findings was that exercise alone reduces pain at levels comparable to NSAIDs and corticosteroid injections. Dr Nagar argues this comparison strengthens, rather than weakens, the case for exercise. “Relying on medication over several years carries higher systemic risks and rising long-term costs,” he explains.

“NSAIDs are associated with renal and gastric complications and cardiovascular events. Opioids can lead to dependency and increased pain sensitivity. Exercise, when supervised and individualised, has a superior safety profile.”

He adds that long-term medication costs often escalate. “Chronic opioid users frequently incur nearly double the annual healthcare costs. Structured exercise can potentially save hundreds per year in medication expenses and thousands over a lifetime by reducing the likelihood of surgery.”

However, he cautions that exercise is dose-dependent. “Unlike pills, its benefits require consistent participation.”

Limitations Of The Study

Several limitations may have diluted the exercises’ apparent effectiveness.

All Exercises Were Grouped Together

Strength training, aerobic workouts, stretching, aquatic exercise, and tai chi were analysed collectively. These interventions differ substantially in intensity and physiological impact.

Evidence suggests aerobic and resistance training often outperform stretching alone. By averaging all modalities, stronger effects may have been obscured.

Supervised Vs Unsupervised Was Not Distinguished

Supervised programs generally yield better outcomes than unsupervised routines. Professional oversight improves adherence, progression, and technique. Dr Nagar notes, “The best outcomes occur with tailored, supervised exercise combined with pain education. Active movement consistently outperforms inactivity.”

Short Study Durations

In the umbrella review, many trials lasted approximately 12 weeks. As osteoarthritis is lifelong, long-term adherence could produce cumulative benefits not captured in short trials.

Exercise Dose And Intensity

Research suggests optimal benefits occur at around 150 minutes of moderate intensity exercise weekly. If participants exercised below that threshold, the measured effect may reflect insufficient dosing rather than efficiency. In the study, the dose of exercise was not fully accounted for.

When Does Surgery Become More Effective?

The review also found that exercise is less effective than joint replacement in certain groups, but surgery is not an early solution. Dr Nagar explains that total joint arthroplasty is recommended for symptomatic moderate-to-severe osteoarthritis (stage 3 or 4) that does not respond to comprehensive nonoperative care.

“Persistent pain, significant functional limitation, and clear radiographic joint damage despite exhaustive conservative management justify surgical intervention,” he says. “Exercise remains essential before and after surgery to optimise outcomes.”

Why Exercise Still Matters Beyond Pain

The study focused on pain and function, but exercise delivers systemic benefits that extend far beyond the joint:

• Weight management
• Improved mood
• Cardiovascular protection
• Better sleep
• Reduced diabetes risk
• Lower cancer risk

“These secondary health benefits must be weighed in shared decision-making,” the review authors themselves noted. Exercise may not eliminate osteoarthritis pain entirely, but it strengthens overall resilience.

Should Exercise Remain First-Line Recommendation?

Dr Nagar believes that exercise should remain the first-line recommendation. “Yes,” he says. “Exercise delivers long-term functional and structural benefits that medication cannot. Corticosteroid injections may provide rapid relief, but effects often diminish within six months. Exercise builds strength, improves joint mechanics, and supports cartilage health.”

Unlike medication that masks symptoms, targeted movement addresses biomechanical dysfunction. Repeated injections, he notes, may even contribute to tissue degradation over time.

How To Protect The Joints?

For those concerned about aggravating pain, structured warm-up and cool-down routines are essential. Dr Nagar recommends:

Warm-up (5-10 minutes):

• Light cycling or brisk walking
• Dynamic movements like leg swings, arm circles, or walking lunges

Cool-down (5-10 minutes):

• Gradual slowing to normalise heart rate
• Static stretches, such as hamstring or quadriceps stretches, are held for 10-30 seconds

The February 2026 umbrella review in RMD Open suggests that exercise appears to produce modest, sometimes transient reductions in osteoarthritis pain when analysed broadly.

As Dr Nagar emphasises, “The goal is not zero pain; it is better living.” Exercise may not be a miracle cure or eliminate pain entirely, but when tailored, supervised, and sustained, it remains one of the safest and most empowering tools available to people living with osteoarthritis.

Patients have been encouraged to exercise and move more to preserve mobility, but a February 2026 study published in RMD Open has prompted fresh debate, suggesting exercise may offer only small, temporary improvements in pain and function.

Advertisement

Dr Sandeep Nagar, Consultant – Rheumatology at Yatharth Super Speciality Hospitals, Omega-1, Greater Noida, stresses that the numbers need context. “Expectations should be reframed rather than lowered,” he explains.

“Modern pain management prioritises functional capacity over achieving a ‘zero pain’ score. A 7-15 point reduction on a 100-point scale is considered a clinical success because it often enables patients to do significantly more despite some remaining pain.”

What Is Osteoarthritis, And Why Exercise Matters

Osteoarthritis is one of the most common degenerative joint diseases globally. It involves cartilage breakdown, leading to pain, stiffness, swelling, and limited range of motion. Knees, hips, and hands are most frequently affected, though any joint can be involved.

Since the condition is progressive and incurable, treatment focuses on symptom control and preserving function. Exercise has traditionally been central to that strategy. It enhances circulation, improves joint alignment, strengthens surrounding muscles, and reduces stiffness.

Advertisement

Over time, it can also help patients maintain independence and delay invasive interventions. Yet, the new ‘umbrella review’ raises an important question: Are those benefits as substantial as long believed?

What The Study Says

The February 2026 study, titled “Effectiveness of exercise to ease osteoarthritis symptoms likely minimal and transient,” conducted what researchers describe as an umbrella systematic review, an overarching analysis of existing systematic reviews and randomised clinical trials.

Researchers searched medical databases for relevant studies published up to November 2025. They included:

• Five systematic reviews involving 8631 participants
• Twenty-eight randomised clinical trials involving 4360 participants

In total, nearly 13000 patients were represented. The analysis examined exercise in hip, hand, knee, and ankle osteoarthritis.

It compared exercise against multiple alternatives, including no treatment, placebo, patient education, manual therapy, NSAIDs, corticosteroid injections, hyaluronic acid injections, arthroscopy, osteotomy, and joint replacement. The experiment aimed to determine whether exercise truly stands out as a first-line intervention.

Advertisement

What The Study Found

Compared with placebo or no treatment, exercise reduced pain by between 6 and 12 points on a 100-point scale. For knee osteoarthritis, effects were small and short-lived, with very low certainty of evidence. Larger and longer-term trials showed even smaller benefits.

For hip osteoarthritis, effects were negligible. For hand osteoarthritis, they were small. Exercise did not significantly outperform patient education, NSAIDs, steroid injections, or arthroscopy in improving function. In certain trials, surgical options such as osteotomy and total joint replacement delivered stronger long-term outcomes.

The researchers concluded:

“We found largely inconclusive evidence on exercise for osteoarthritis, suggesting negligible or, at best, short-lasting small effects on pain and function across different types of osteoarthritis compared with placebo or no treatment.”

They added that the findings “question the universal promotion of exercise therapy as the sole focus in first-line treatment.”

Advertisement

How Should Patients Interpret A 6-12 Point Drop?

To many readers, a 6-12 point reduction may sound unimpressive. But Dr Nagar emphasises that clinical impact is not solely about numerical magnitude. “Goals should shift from complete pain relief to improved quality of life and movement,” he says.

“Even modest reductions can increase walking tolerance, improve sleep, and reduce fear of movement. Exercise also raises pain thresholds biologically by activating the body’s endogenous opioid systems.”

Medication Vs Movement: Risk And Cost

One of the review’s notable findings was that exercise alone reduces pain at levels comparable to NSAIDs and corticosteroid injections. Dr Nagar argues this comparison strengthens, rather than weakens, the case for exercise. “Relying on medication over several years carries higher systemic risks and rising long-term costs,” he explains.

Advertisement

“NSAIDs are associated with renal and gastric complications and cardiovascular events. Opioids can lead to dependency and increased pain sensitivity. Exercise, when supervised and individualised, has a superior safety profile.”

He adds that long-term medication costs often escalate. “Chronic opioid users frequently incur nearly double the annual healthcare costs. Structured exercise can potentially save hundreds per year in medication expenses and thousands over a lifetime by reducing the likelihood of surgery.”

However, he cautions that exercise is dose-dependent. “Unlike pills, its benefits require consistent participation.”

Limitations Of The Study

Several limitations may have diluted the exercises’ apparent effectiveness.

Advertisement

All Exercises Were Grouped Together

Strength training, aerobic workouts, stretching, aquatic exercise, and tai chi were analysed collectively. These interventions differ substantially in intensity and physiological impact.
Evidence suggests aerobic and resistance training often outperform stretching alone. By averaging all modalities, stronger effects may have been obscured.

Supervised Vs Unsupervised Was Not Distinguished

Supervised programs generally yield better outcomes than unsupervised routines. Professional oversight improves adherence, progression, and technique. Dr Nagar notes, “The best outcomes occur with tailored, supervised exercise combined with pain education. Active movement consistently outperforms inactivity.”

Short Study Durations

Advertisement

In the umbrella review, many trials lasted approximately 12 weeks. As osteoarthritis is lifelong, long-term adherence could produce cumulative benefits not captured in short trials.

Exercise Dose And Intensity

Research suggests optimal benefits occur at around 150 minutes of moderate intensity exercise weekly. If participants exercised below that threshold, the measured effect may reflect insufficient dosing rather than efficiency. In the study, the dose of exercise was not fully accounted for.

When Does Surgery Become More Effective?

The review also found that exercise is less effective than joint replacement in certain groups, but surgery is not an early solution. Dr Nagar explains that total joint arthroplasty is recommended for symptomatic moderate-to-severe osteoarthritis (stage 3 or 4) that does not respond to comprehensive nonoperative care.

Advertisement

“Persistent pain, significant functional limitation, and clear radiographic joint damage despite exhaustive conservative management justify surgical intervention,” he says. “Exercise remains essential before and after surgery to optimise outcomes.”

Why Exercise Still Matters Beyond Pain

The study focused on pain and function, but exercise delivers systemic benefits that extend far beyond the joint:

• Weight management
• Improved mood
• Cardiovascular protection
• Better sleep
• Reduced diabetes risk
• Lower cancer risk

“These secondary health benefits must be weighed in shared decision-making,” the review authors themselves noted. Exercise may not eliminate osteoarthritis pain entirely, but it strengthens overall resilience.

Should Exercise Remain First-Line Recommendation?

Dr Nagar believes that exercise should remain the first-line recommendation. “Yes,” he says. “Exercise delivers long-term functional and structural benefits that medication cannot. Corticosteroid injections may provide rapid relief, but effects often diminish within six months. Exercise builds strength, improves joint mechanics, and supports cartilage health.”

Advertisement

Unlike medication that masks symptoms, targeted movement addresses biomechanical dysfunction. Repeated injections, he notes, may even contribute to tissue degradation over time.

How To Protect The Joints?

For those concerned about aggravating pain, structured warm-up and cool-down routines are essential. Dr Nagar recommends:

Warm-up (5-10 minutes):

• Light cycling or brisk walking
• Dynamic movements like leg swings, arm circles, or walking lunges

Cool-down (5-10 minutes):

• Gradual slowing to normalise heart rate
• Static stretches, such as hamstring or quadriceps stretches, are held for 10-30 seconds

The February 2026 umbrella review in RMD Open suggests that exercise appears to produce modest, sometimes transient reductions in osteoarthritis pain when analysed broadly.

As Dr Nagar emphasises, “The goal is not zero pain; it is better living.” Exercise may not be a miracle cure or eliminate pain entirely, but when tailored, supervised, and sustained, it remains one of the safest and most empowering tools available to people living with osteoarthritis.

Advertisement

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Denver — The evidence is clear: Exercise has mental health benefits, although studies have come to different conclusions about how large it might be.

And yet, when February rolls around again, the gyms suddenly aren’t so crowded as New Year’s resolutions lose their shine. Nationwide, only about 30% of people meet the federal guidelines for physical activity, and even in famously outdoorsy Colorado, just 35% do.

So if exercise gets the endorphins flowing and gives a quick mood boost, why do many people find it hard to stick with?

The popular perception that exercise produces endorphins, which then raise mood, isn’t wrong, but it oversimplifies complex interactions between brain chemistry and mental states, said Katrina Oselinsky, a post-doctoral researcher at the Health and Wellness Center on the University of Colorado’s Anschutz Medical Campus.

If you’re venturing into the world of lifting, there are more than a few ways to go about curating a workout split that supports your fitness goals.

Whether you’re interested in Olympic lifting or powerlifting, the activity offers immense benefits for developing muscle, improving mobility, boosting energy levels and relieving stress. 

For the unfamiliar, a workout split simply refers to how you curate your exercise routine and how to divide which exercises you’ll complete over a week’s worth of time, says Dr. Robert Trasolini, an orthopedic surgeon and sports medicine specialist at Northwell Health. 

Is there one split for lifting that prevails above the rest? Here’s what fitness experts say. 

Is there an ideal workout split for lifting?

“No, there really isn’t a perfect split,” says Alex Milton, a certified strength and conditioning specialist and the director of sports performance at MedStar Health. How you vary your upper and lower body workouts over the course of a week will ultimately depend on how much time you can dedicate to going to the gym. 

If you’re able to commit four to five days at the gym, one gym session could be dedicated to an upper body workout that concentrates on building strength in your chest, shoulders or arms, and the following session could focus on the lower body to work your legs, lower back and posterior chain.

If you’re heading to the gym closer to two to three times a week, it may be more beneficial to complete full-body lifts to stay more consistent with your workouts, Milton recommends.

What muscles do squats work? How to correctly do a squat and the benefits for your body

The push-pull-legs split is one type of lifting framework that prioritizes strength building and muscle development, says Trasolini. “Push” exercises primarily work your body’s anterior front structure, and could look like a mix of chest, shoulder and tricep workouts. “Pull” exercises consist of pulling weights toward your body, such as back or bicep workouts. The third and final portion of the split centers around leg workouts, which could include squats or dead lifts. 

Incorporating recovery into your split is essential, says Dr. Trasolini. From a physiological standpoint, exercising works to break down the muscle with the intention of rebuilding it. “You need that recovery time for your body to see the damage, reassess and then repair,” he says.