OBJECTIVE: To evaluate the efficacy of exercise interventions with differing frequency, intensity, type and time (FITT) on shoulder pain and disability in people with rotator cuff related shoulder pain (RCRSP). DESIGN: Intervention systematic review with meta-analyses. LITERATURE SEARCH: Electronic searches were conducted up to May 2023. STUDY SELECTION CRITERIA: Randomized controlled trials (RCTs) comparing the effects of exercise interventions differing in prescription according to the FITT principle, in people with RCRSP. DATA SYNTHESIS: Separate meta-analyses comparing exercise type (specific versus non-specific exercise) and intensity (high versus low) were conducted. GRADE was used to evaluate the certainty of evidence. RESULTS: Twenty-two RCTs (n = 1281) were included. There was moderate certainty evidence that motor control exercise programs, when compared to non-specific exercise programs, significantly reduced disability in the short- (SMD -0.29; 95% CI -0.51 to -0.07; n = 323; 7 RCTs) and medium-term (SMD -0.33; 95% CI -0.57 to -0.09; n = 286; 5 RCTs), but not pain in the short-term (SMD -0.19; 95% CI -0.41 to 0.03; n = 323; 7 RCTs). Uncertainties remained regarding other exercise types (eccentric and scapula-focused exercise programs) versus non-specific exercise programs, and exercise intensity due to low to very low certainty evidence. No trials were identified that compared different frequencies or times. CONCLUSION: For adults with RCRSP, motor control exercise programs were probably slightly superior to non-specific exercise programs. However, it is unclear if the effects were due to motor control exercise or to other program characteristics such as progression and tailoring.

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