Osteoarthritis (OA) is a prevalent condition among older adults that causes joint degradation and inflammation, leading to pain and disability. While nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol are commonly used to manage OA pain, their long-term use is hindered by gastrointestinal and cardiovascular side effects. Exercise is also recommended as part of OA treatment but is underutilized due to concerns about joint safety and a lack of standardized protocols. This study compared the effectiveness of exercise therapy to NSAIDs and/or paracetamol for knee and hip OA treatment. The analysis included 152 randomized controlled studies with 17,431 participants, and exercise was found to be more effective than usual care and just as effective as oral NSAIDs and paracetamol in relieving pain and improving function at 4, 8, and 24 weeks.
A network meta-analysis allows for quantitative comparisons of multiple interventions, including those sourced from different studies, making it a valuable tool to evaluate treatment options. A previous meta-analysis found comparable effects for pain reduction between exercise and analgesics, while a more recent network meta-analysis ranked exercise as the "best" intervention for pain reduction, followed by NSAIDs, opioids, and placebo/control interventions. The current study supports these findings and adds to the literature by including participants with hip OA and knee OA, as well as examining the effects of interventions on function. Exercise and analgesics were similarly effective for improving function in OA patients, providing clinicians with valuable treatment options. While the mechanisms underlying the effectiveness of exercise and analgesics are not fully understood, exercise has been shown to improve muscle strength, range of motion, balance, cardiovascular health, and may lead to weight loss, all of which contribute to reduced OA symptoms. Exercise prescriptions should be tailored to individual needs and consider factors like age and comorbidities. While analgesics may provide short-term pain relief, exercise is preferred for long-term pain management due to its lack of side effects and added health benefits. However, future research should explore which types of exercise are most effective for OA. Overall, getting active is important for OA patients, regardless of the form of exercise.