BACKGROUND: Rheumatologic and geriatric scholarly organisations recommendations for the management of hip and knee osteoarthritis, which emphasise the usefulness of non-pharmacological therapies, are not scaled according to patient's age and physical condition. We conducted a systematic review of clinical trials on exercise and weight loss in hip and knee osteoarthritis in very old patients. METHODS: Electronic search in Medline, Embase, PASCAL database, systematic search of the Cochrane reviews, manual search in guidelines, meta-analyses and identified relevant articles. RESULTS: We identified 83 trials, with only 2 on patients aged > 75 years; we therefore lowered the mean age threshold to 70 years and found 15 trials, mainly performed in knee osteoarthritis and outpatients. Physical exercise (8 trials): was effective on pain and function (4 controlled trials), with a persistent effect only in case of self-rehabilitation. Aquatic exercise (5 trials): was as effective as land-based exercise. Weight loss (2 trials): only patients under diet+exercise had significant improvement on symptoms. CONCLUSION: Our systematic review confirms that international recommendations on exercise for knee osteoarthritis also apply to subjects aged 70 to 80 years. Long-term effectiveness requires a maintenance strategy. Specific trials on very old patients with various comorbidities are mandatory, given that these subjects are more exposed to drug-related iatrogenesis.

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