OBJECTIVE: To compare the efficacy of various exercise modalities for Rheumatoid arthritis (RA) employing a network meta-analysis. METHODS: A systematic search was conducted across eight databases-PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, VIP, and SinoMed-up to December 4, 2024, for randomized controlled trials on exercise for RA. The Cochrane Risk of Bias Assessment Tool (RoB (2) assessed study quality. A network meta-analysis was performed utilizing Stata 17.0. Our study measured outcomes through mean differences (MD) accompanied by 95% credible intervals (CIs) to quantify effect sizes, while interventions were ranked using surface under the cumulative ranking curve (SUCRA) probability scores, and the Confidence in Network Meta-Analysis (CINeMA) software to evaluate evidence certainty. RESULTS: A total of 34 trials included 2,435 RA patients and 10 exercise interventions: walking or jogging, relaxation training, resistance exercise, Pilates, aerobic exercise, aerobic exercise plus resistance exercise, yoga, traditional Chinese exercise, cycling, and Pilates plus walking or jogging. The NMA results indicated that Pilates was the most effective for pain relief (VAS: MD -2.17 cm, 95% CI -3.77 to -2.57, SUCRA 91.8%); aerobic exercise plus resistance exercise was most effective for reducing morning stiffness duration (MD -8.23 min, 95% CI -9.06 to -7.39, SUCRA 100.0%); and traditional Chinese exercise was most effective for improving disease activity (DAS28-ESR: MD -0.68 scores, 95% CI -1.04 to -0.32, SUCRA 95.5%). Risk assessment showed 4 studies low, 4 high, and 26 some concern regarding bias. The CINeMA assessment indicated that most comparisons provided low or very low-quality evidence. CONCLUSION: Exercise interventions are effective supplements for RA treatment, with specific exercises offering distinct benefits: Pilates for pain, aerobic exercise plus resistance exercise for morning stiffness, traditional Chinese exercise for disease activity. Further high-quality studies are needed for validation.

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