BACKGROUND: Osteoarthritis (OA) is a complex disease that causes pain, stiffness and swelling, limiting function and mobility, thus interfering with daily life and affecting personal, social, and psychological aspects of life. OBJECTIVE: To evidence the role of exercise on pain reduction and the effectiveness of one type of training over another in terms of pain, functional capacity, and inflammatory biomarkers in OA. METHODS: Studies retrieved from Web of Science, PubMed and Scopus databases were systematically reviewed. RCTs involving physical exercise interventions in participants with OA were included. The 3 main outcomes considered in the systematic review were pain, functional capacity and inflammatory biomarkers. The effects of different types of interventions (aerobic, resistance, combined, neuromuscular and others) were analysed for each outcome. Systematic review and meta-analysis were conducted following the PRISMA Statement. RESULTS: 21 studies were included in the systematic review and 11 in the meta-analysis. The meta-analysis was conducted on pain in training intervention subgroups, showing a larger effect size for neuromuscular training -2.26 (95% CI -4.37 to -0.14). Functional capacity and inflammatory biomarkers were analysed only with a systematic review because it was not possible to estimate the efficacy of the different training protocols with a meta-analysis. CONCLUSION: Neuromuscular training protocols seem to be the most effective in reducing pain in OA. Direct comparison of different training treatment options on functional capacity and inflammatory biomarkers for OA is not currently feasible in practice, due to the heterogeneity of the test and the small number of studies. High-quality physical exercise intervention studies are warranted to estimate their effectiveness more accurately on pain, functional capacity, and inflammatory status in OA. PROSPERO REGISTRATION: NUMBERCRD42023481061.

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