PeerJ · Nov 10, 2026
Network meta-analysis of the efficacy of different exercise therapies in patients with knee osteoarthritis
By Diao K, Zhang T, Wang H et al.
Background: Knee osteoarthritis (KOA) is a leading cause of disability in the elderly and a growing social burden due to aging and increasing obesity rates. This study aims to investigate the effects of different exercise modalities on pain, physical function, stiffness, and muscle strength in patients with KOA. Methods: A systematic search was conducted in PubMed, Embase, Web of Science, Cochrane Library, and EBSCO databases for randomized controlled trials evaluating the efficacy of exercise therapy for KOA from January 2000 to 16 August 2025, followed by an updated search through 28 March 2026. No additional eligible studies were identified in the updated search. In total, 51 studies involving 3,045 participants (71.7% female; study-group mean ages ranged from 50.3 to 74.4 years) were included. The studies were conducted in 14 countries across Asia, Europe, North America, South America, and Oceania. A network meta-analysis was performed using Stata 16.0. This systematic review was registered with PROSPERO (CRD420251177632). Results: The results showed that mind-body exercise was the most effective in reducing pain (standardized mean differences (SMD) = −1.13, 95% confidence interval (CI) [−1.47 to −0.79], P < 0.001, Surface Under the Cumulative Ranking Curve (SUCRA) = 83%) and improving joint stiffness (SMD = −1.15, 95% CI [−1.59 to −0.70], P < 0.001, SUCRA = 78.5%). Mixed exercise ranked highest in improving knee function (SMD = −1.43, 95% CI [−2.31 to −0.55], P < 0.001, SUCRA = 81.8%), followed by mind-body exercise (SMD = −1.28, 95% CI [−1.64 to −0.93], P < 0.001, SUCRA = 77.4%). Strength training was most effective in enhancing muscle strength (SMD = 0.79, 95% CI [0.470–1.12], P < 0.001, SUCRA = 79.1%). Conclusion: Mind-body exercise appeared to be the most favorable option for reducing pain and stiffness in patients with knee osteoarthritis, whereas strength training appeared to be the most beneficial for improving muscle strength. These findings may help inform individualized exercise prescription, but should be interpreted cautiously given the uncertainty and limitations of the available evidence.