Overview
- Researchers synthesized 217 randomized trials from 1990–2024 involving 15,684 participants to compare aerobic, flexibility, strengthening, mind–body, neuromotor, and mixed exercise against controls.
- Aerobic activities such as walking, cycling and swimming had the highest probability of improving pain, function, gait performance and short‑ to mid‑term quality of life.
- Mind–body exercise probably boosts short‑term function, neuromotor training likely improves short‑term gait, and strengthening or mixed programs probably enhance mid‑term function.
- Outcomes were assessed at 4, 12 and 24 weeks, with aerobic exercise improving function across short, mid and long‑term follow‑up.
- No exercise modality increased adverse events versus controls; authors recommend an aerobic‑first plan, suggest alternatives for those unable to perform aerobic activity, and call for larger, longer, severity‑specific trials.