BACKGROUND: The aim of this systematic review was to identify principles of exercise interventions associated with improved physical function, weight management or musculoskeletal pain relief among young and middle-aged adults with obesity and propose an evidence-based exercise prescription that could assist in secondary prevention of osteoarthritis. METHODS: A structured electronic review was conducted using Medline, PubMed, and SPORTDiscus. The search string included (1) "obes*" AND "exercise" AND "interven*" AND "musculoskeletal pain OR knee pain OR hip pain". Studies (1) were randomized controlled trials of humans, with a non-exercise control, (2) included participants aged 18 to 50 years, and (3) had outcomes that included physical function, musculoskeletal pain, and/or body composition. Studies were excluded if participants had peri-menopausal status, cancer, or obesity-related co-morbidities. A recommended exercise prescription was developed based on common principles used in the included exercise interventions with greatest change in function or pain. RESULTS: Seven studies were included. Similarities in exercise intensity (40 to 80% VO2max), frequency (three times per week), duration (30 to 60 min), and exercise mode (treadmill, cross-trainer, stationary bike, aquatic exercise) were observed in exercise interventions that resulted in improved physical function and/or pain, compared to non-exercise control groups. CONCLUSION: Common principles in exercise prescription for improvements in weight management, physical function and pain relief among otherwise healthy people with obesity. Exercise prescription including moderate intensity exercise for 30 to 60 min, three times per week can be considered an effective treatment for weight management and obesity-related musculoskeletal symptoms. Exercise should be recommended to at-risk individuals as part of secondary prevention of osteoarthritis.

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