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ObjectiveTo provide an overview of the effects of exercise for osteoarthritis.DesignOverview.Data sourcesMedline, Embase, Epistemonikos, PEDro, Cochrane and registries from inception to 8 November 2025.Eligibility criteriaReviews comparing exercise with placebo, no intervention or other interventions on pain and function for osteoarthritis. Supplementary trials were included to update inconclusive areas.Data extraction and synthesisTwo independent reviewers extracted data and assessed bias. Data were standardised to a 0–100 scale and reanalysed using random-effects meta-analysis. Certainty was rated using Grading of Recommendations Assessment, Development and Evaluation.ResultsFive reviews (κ=100; n=8631) and 28 supplementary trials (knee/hip κ=23, hand κ=3, ankle κ=2; n=4360) were included. Evidence indicated small, short-term effects of exercise versus placebo (mean difference −10.8, 95% CI −19.1 to −2.6) and no-treatment (−12.4, 95% CI −15.6 to −9.2) for knee osteoarthritis pain, but certainty was very low and effects in larger or longer-term trials were smaller. Moderate evidence suggested negligible effects in hip (−6.7 95% CI −9.3 to −4.0) and small effects in hand (−10.0 95% CI −15.5 to −4.5) osteoarthritis. Varying certainty evidence indicated comparable outcomes to education, manual therapy, analgesics, injections and arthroscopy. Single trials in selected populations showed exercise was less effective than knee osteotomy (12.4 95% CI 4.7 to 20.2) and joint replacement (knee 17.1 95% CI 10.4 to 23.8; hip 24.2 95% CI 18.2 to 30.2) at longer term.Conclusion and relevanceEvidence on exercise for osteoarthritis remains largely inconclusive, suggesting negligible or short-lasting small effects comparable to, or less effective than, other treatments. These findings question its universal promotion and highlight the need to revisit research priorities and clinical discussions around its worthwhileness.RegistrationCRD42023446888.

Non-communicable diseases (NCDs) represent a high burden for the society and affected individuals. Conservative non-pharmacological interventions play a first-line role in the treatment and management of most NCDs. Systematic reviews (SRs) provide the highest level of evidence and significantly influence clinical decision-making. The primary aim of this study is to provide an overview of the evidence on the effectiveness of recommended conservative non-pharmacological interventions for highly burdensome NCDs. The secondary aim is to provide an overview of the evidence for guideline implementation. A literature search was performed in Medline (PubMed), EMBASE and Cochrane CENTRAL. Six reviewers will, in duplicate, independently screen and select studies following eligibility criteria. The population will include individuals with NCDs from disease categories chosen based on WHO burden of disease data and the importance of conservative rehabilitation for their management. Eligible interventions will encompass conservative non-pharmacological approaches recommended by clinical practice guidelines (ie, physical, psychological and education/advice). Eligible comparator will include no or minimal intervention and other competitive interventions. Outcomes will comprise proposed core outcomes for the respective diseases, including patient-reported (eg, pain) and performance-based (eg, physical functioning) outcomes. SRs published in the last 5 years as peer-reviewed journal article in the English language will be eligible. The overview will be reported in accordance with the Preferred Reporting Items for Overviews of reviews.