Duy trì vận động vì sức khỏe khớp

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview¶

• The 2018 US physical activity guidelines recognized that any bouts of physical activity count for health [1].
• In children and adolescents aged 6-17, participating in moderate to vigorous physical activities led to multiple positive health outcomes [2].
• There is little evidence that physical activity is associated with significant harm, and the benefits, in general, outweigh the risks [3].
• The 2020 WHO guidelines on physical activity and sedentary behaviour update previous WHO recommendations released in 2010 [4].
• Maintenance interventions may help people continue to be physically active and improve physical function and health-related quality of life [5].
• About 15 times more physical activity of at least moderate intensity is needed to achieve similar results regarding the joint association of device-measured physical activity and abdominal obesity with incident cardiovascular disease [6].
• ISPAH's Eight Investments That Work for Physical Activity provides a summary of eight areas for action that are supported by scientific evidence and have worldwide applicability [7].
• Randomized controlled trials have failed to provide conclusive evidence that physical activity causes a reduced risk of death [11].
• Researchers need to come to agreement about how to collectively define physical activity, sedentary behaviour, and sleep through an inclusive and systematic consensus process [13].
• Patients may safely engage in activities to achieve important general health benefits and quality of life, as quality, but not quantity of physical activity is associated with metal ion concentrations in unilateral hip resurfacing [14].
• There may be no minimal or maximal threshold for the benefits of accelerometer-measured intensity-specific physical activity regarding incident type 2 diabetes [15].
• Policymakers should introduce physical activity promotion into the Quality and Outcomes Framework (QOF) as an individual indicator at a cost of approximately £1 million [18].
• Findings question whether total hip arthroplasty should be prioritized only for those patients who have severe hip osteoarthritis symptoms, but require confirmation in a trial [21].
• The Arthritis Committee recognizes the profound importance of arthritic disorders to the general population, not only as a health problem, but for their social and economic impact [25].
• Changes to physical activity guidelines, such as removal of a 10-min bout criterion, pose challenges for physical activity surveillance [26].
• An excellent outcome was considered 112% total active motion in the context of progressive force exercises to the injured flexor tendon [33].
• Individuals not achieving the WHO guideline for physical activity showed an elevated risk of cancer, even if they were abdominally lean (HR 1.04, 95% CI 1.01 to 1.07) [35].
• At follow-up, 65.0% of inactive participants were taking part in sport and 85.6% were meeting recommended moderate-to-vigorous physical activity guidelines in a Workplace Challenge intervention [36].
• Most differences in functional outcomes following a scapular exercise program for patients with hand, wrist, or elbow disorders did not reach the minimum threshold to be considered clinically important [82].
• Traditional Chinese medicine comprehensive therapy for exercise-related musculoskeletal injuries suggests potential benefits, though randomized controlled trials are needed for definitive efficacy assessment [83].
• There is widespread omission of basic teaching elements, such as the Chief Medical Officer recommendations and guidance on physical activity, in the undergraduate curricula of all UK medical schools [84].
• Consensus was reached in 46/49 (94%) statements regarding clinical and exercise professionals’ opinion of physical activity prescreening and contraindications for participating in postpartum physical activity [85].

How It Works¶

General Health and Mortality¶

• The 2018 US physical activity guidelines recognize that any bouts of physical activity count for health [1].
• In children and adolescents aged 6-17, participating in moderate to vigorous physical activities leads to multiple positive health outcomes [2].
• There is little evidence that physical activity is associated with significant harm, and the benefits generally outweigh the risks [3].
• Inverse non-linear dose–response associations suggest substantial protection against a range of chronic disease outcomes from small increases in non-occupational physical activity in inactive adults [8].
• Light-intensity physical activity accounts for the majority of physical activity energy expenditure (51–59%) and is an accessible public health target [9].
• Sustained physical activity in older age is associated with improved overall health [10].
• The proportion of participants meeting the health-enhancing physical activity recommendations increased from 33.1% to 42.3% between baseline and first follow-up in the Allez Hop programme [22].
• About 30-40 min of moderate-to-vigorous physical activity per day attenuate the association between sedentary time and risk of death [48].
• The highly interconnected role of cardiorespiratory fitness in the association between physical activity and cardiometabolic health suggests limited direct effects of physical activity on cardiometabolic health beyond its impact on cardiorespiratory fitness [49].

Tissue Healing and Remodeling¶

• Exercise has been shown to be necessary to support healthy joints and maintain cartilage remodeling and repair [37].
• Moderate treadmill exercise following an initial period of short-term immobilization has a positive impact on tendon-bone interface healing, whereas prolonged immobilization has a detrimental effect on physical recovery [38].
• After a short period of immobilization, increased activity is detrimental to both tendon mechanical properties and shoulder joint mechanics, presumably due to increased scar production [39].
• Physiological exercise applied after the initial biological response to injury has dampened can potentially promote remodeling of damaged tendons [40].
• Exercise accelerates bone defect healing and stimulates angiogenesis during bore repair [44].
• Delayed postoperative exercise with moderate strength appears to accelerate the early phase of bone-tendon healing, a process that may be linked to increased expression of periphery neuropeptides known to play a role in tissue healing [53].
• Physical activity speeds up tendon healing, which may prove to be linked to accelerated neuronal plasticity [55].
• Treadmill exercise engenders increased cyclic bone strain within a physiologic range and distribution, distinct from sedentary background activity, to investigate bone formation and modeling [56].

Clinical Outcomes and Interventions¶

• Interventions implemented at ≤12 weeks after total knee arthroplasty primarily improved functional performance, whereas those lasting >12 weeks resulted in greater gains in muscle strength and joint flexibility [19].
• Findings question whether total hip arthroplasty should be prioritized only for patients with severe hip osteoarthritis symptoms, but require confirmation in a trial [21].
• The addition of wearable activity tracker use did not have any effect on perceived joint function or health-related quality of life in people with hip and knee osteoarthritis [27].
• After 2 1/2 years of follow-up, both arthroscopic surgery and supervised exercises are better treatments than placebo for rotator cuff disease [28].
• Pain science education may act as a mechanism of action for exercise interventions and is less successful when delivered standalone [43].

What the Evidence Shows¶

• Approximately 15 times more physical activity of at least moderate intensity is needed to achieve similar results regarding the joint association of device-measured physical activity and abdominal obesity with incident cardiovascular disease [6].
• Much of the evidence regarding physical activity and ageing is based on longitudinal associations from observational and randomised controlled intervention studies in relatively healthy community-dwelling older adults [12].
• Patients with unilateral hip resurfacing may safely engage in activities to achieve important general health benefits and quality of life, as quality but not quantity of physical activity is associated with metal ion concentrations [14].
• There may be no minimal or maximal threshold for the benefits of accelerometer-measured intensity-specific physical activity on incident type 2 diabetes [15].
• The consensus statement on precision exercise medicine outlines approaches that may identify determinants and modifiers of cardiorespiratory fitness exercise response [17].
• Exercise interventions implemented at ≤12 weeks after total knee arthroplasty primarily improved functional performance, whereas those lasting >12 weeks resulted in greater gains in muscle strength and joint flexibility [19].
• There is moderate certainty evidence that fall prevention exercise programmes are likely to be cost-effective [20].
• The joint association between daily time spent in physical activity, sedentary behaviour, and sleep and all-cause mortality was examined using compositional analysis [23].
• After 2 1/2 years of follow-up, both arthroscopic surgery and supervised exercises are better treatments than placebo for patients with rotator cuff disease (stage II impingement syndrome) [28].
• Compared with control players, those who participated in the NMC programme found it to be less physically challenging but more enjoyable and potentially of more benefit [29].
• Protocols using painful exercises offer a small but significant benefit over pain-free exercises in the short term for the management of chronic musculoskeletal pain [30].
• A regular program of relatively modest aerobic physical activity is associated with measurable improvement in health, including reduced all-cause and cardiovascular mortality [31].
• Brief interventions promoting physical activity in primary care and the community are likely to be inexpensive compared with usual care [32].
• An excellent outcome for the pyramid of progressive force exercises to the injured flexor tendon was considered 112% total active motion [33].
• Approximately 65 min per day of walking and 5 min of stair climbing were each linked to a more favourable cardiometabolic profile, while the adverse effects of sitting became pronounced above 12 hours per day [34].
• At follow-up, 65.0% of inactive participants in the Workplace Challenge were taking part in sport and 85.6% were meeting recommended MVPA guidelines [36].
• Exercise may improve pain and function in osteoarthritis of the knee with low to moderate certainty, but it is uncertain whether differences are clinically important [57].
• The 'Physical Activity 4 Everyone' school-based intervention resulted in a significant group-by-time interaction for mean minutes of MVPA per day in favour of the intervention group, equating to 27 min more MVPA per week [58].
• Aquatic exercise appears to provide meaningful pain relief for musculoskeletal disorders, with benefits that may persist during follow-up [59].
• There was no significant effect of the e-coachER intervention on weekly MVPA at 12 months between the groups recorded in ≥10 min bouts or without bouts [61].
• Compared with obesity-low physical activity, there was no survival benefit of being normal weight if physical activity levels were low [62].
• The absence of a control group in the trigger finger study means findings demonstrate feasibility and short-term clinical improvement but cannot establish superiority over other conservative treatments [63].
• Results from a formal 2-year cluster randomised-controlled trial confirmed the Y-PATH programme was effective in improving youth fundamental movement skills proficiency [64].
• A coaching intervention to enhance physical activity and prevent falls in community-dwelling people aged 60+ years improved daily steps, MVPA, hours per week of walking, overall well-being, quality of life, and disability [66].
• Home-based exercise is supported as a potentially scalable rehabilitation strategy for subacromial pain, although larger studies are needed to confirm long-term healthcare utilisation outcomes [67].
• Treatment groups in the WALK 2.0 trial differed significantly in trajectories of minutes/day of physical activity, with a greater change at 3 months for Web 2.0 than Web 1.0 (7.3 min/day, 95% CI 2.4 to 12.3) [68].
• Both exercise regimes are effective in improving cervical joint position sense and reducing symptoms in people with persistent neck pain [69].
• An educational handout is noninferior to hand therapy for achieving full ROM in composite flexion but not total active motion after plaster cast immobilization of simple phalangeal and metacarpal fractures in children [70].
• Exercise therapy is effective for some adolescents with patellofemoral pain but not all, and adherence to exercises is a challenge, with those doing home exercises three times per week or more being four times more likely to be recovered after 12 months [71].
• Physical activity interventions that combine self-monitoring with other components provide an additional modest yet sustained increase in step count compared with self-monitoring alone [72].
• Teachers at intervention schools recorded a greater increase in weekly minutes of physical activity implemented than teachers assigned to the control schools by approximately 44.2 min (95% CI 32.8 to 55.7) from baseline to 12-month follow-up [73].
• Exercise therapy was not associated with an increased risk of non-serious adverse events (risk ratio 0.96) and appeared to reduce the risk of serious adverse events such as hospitalisation and pneumonia (risk ratio 0.62) in people with multimorbidity [74].
• Many coaches are unaware of the benefits of exercise training programmes and do not deliver them, leading to low compliance and limited success in injury prevention [75].
• To realise the greatest effects of a pre-activity movement control exercise programme in schoolboy rugby players, players should complete the programme at least three times per week [76].
• Exercise is associated with improvements in physical and mental health in the maintenance of weight loss [77].
• Future research should focus on optimizing current exercise regimens for people with knee osteoarthritis and exploring how to improve adherence while minimizing symptom exacerbation by other exercise modalities [78].
• The PERSiST guidance attempts to address the problem of poor reporting of medical and healthcare systematic reviews in the sports and exercise medicine, musculoskeletal rehabilitation, and sports science fields [81].
• There is not strong research evidence for or against the value of hand exercise in the treatment of persons with rheumatoid arthritis, although results suggest that appropriate exercise might lead to long-term strength changes and very short-term changes in stiffness [86].
• More adequately powered and rigorous trials are needed to evaluate the effect of exercise interventions on sport-related concussion incidence, and on linear and rotational head accelerations [87].
• The modest volume of the prospective epidemiological evidence base and the moderate consistency between observational and laboratory evidence inhibits definitive conclusions regarding how light-intensity physical activity associates with adult cardiometabolic health and mortality [88].

Practical Considerations¶

• The 2018 US physical activity guidelines recognise that any bouts of physical activity count for health [1].
• ISPAH's Eight Investments That Work for Physical Activity provides a summary of eight areas for action supported by scientific evidence and having worldwide applicability [7].
• Light-intensity physical activity (LPA) accounts for the majority of physical activity energy expenditure (51–59%) and is an accessible public health target [9].
• Much of the evidence regarding physical activity and ageing is based on longitudinal associations from observational and randomised controlled intervention studies, as well as quantitative and qualitative social studies in relatively healthy community-dwelling older adults [12].
• There may be no minimal or maximal threshold for the benefits of accelerometer-measured intensity-specific physical activity in relation to incident type 2 diabetes [15].
• Lessons learnt and recommendations for future research have been summarised as 'roadmaps' to encourage moving the field of physical activity towards achieving population-level impact globally [16].
• Policymakers are proposed to introduce physical activity promotion into the Quality and Outcomes Framework (QOF) as an individual indicator at a cost of approximately £1 million [18].
• The proportion of participants meeting the health-enhancing physical activity (HEPA) recommendations increased from 33.1% to 42.3% between baseline and first follow-up in the Allez Hop programme [22].
• The FIMS 2019 consensus statement on sport and exercise genomics should regularly be updated on the basis of new information emerging from sport and exercise medicine and genomics of health and disease [24].
• Changes to physical activity guidelines, such as the removal of a 10-min bout criterion, pose challenges for physical activity surveillance [26].
• Protocols using painful exercises offer a small but significant benefit over pain-free exercises in the short term, with moderate quality of evidence [30].
• Youth 12–24 months after a sport-related ACL injury exhibit themes of balancing physical activity, reframing perceptions of risk, and overcoming barriers to return to sport [45].
• Communication to raise awareness and knowledge of the physical activity guidelines must be supported by policies, environments and opportunities for physical activity [47].
• Broadbased application of the framework for driving physical activity policy will aid in moving from isolated interventions to sustainable, population-wide gains in physical activity [50].
• The costs and benefits of harmonising existing questionnaires, along with the potential introduction of device-based measures, are recommended for consideration in UK physical activity surveillance [52].
• Brief advice is a cost-effective way to improve physical activity among adults, provided short-term mental health gains are considered [60].
• Infographics aim to encourage patients to make exercising a regular habit by highlighting potential benefits and providing clear guidelines and safety messages for intermittent claudication [65].
• Hydroplasty and therapeutic exercise for frozen shoulder has the advantage of being performed in a clinic setting and is cost-effective [79].
• Adhering to physical activity guidelines (150–300 min per week) and surpassing them (≥300 min per week) were associated with 23% and 37% lower risk of incident cardiovascular disease, respectively, compared with those with the lowest physical activity duration (0–75 min per week) in cancer survivors [80].

Key Evidence¶

• [L5] The 2018 US PA guidelines opened new horizons for PA and exercise medicine practice by recognising that any bouts of PA count for health. [1] (10.1136/bjsports-2018-100397)
• [Paper] The panel agreed on 10 major themes with strong scientific evidence that, in children and adolescents aged 6-17, participating in moderate to vigorous physical activities led to multiple positive health outcomes. [2] (10.1136/bjsports-2020-102261)
• [L5] There is little evidence that physical activity is associated with significant harm, and the benefits, in general, outweigh the risks. [3] (10.1136/bjsports-2021-104634)
• [Paper] These 2020 WHO guidelines update previous WHO recommendations released in 2010. [4] (10.1136/bjsports-2020-102955)
• [L1] Maintenance interventions may help people continue to be physically active and improve physical function and health-related quality of life. [5] (10.1136/bjsports-2025-110444)
• [L3] About 15 times more physical activity of at least moderate intensity is needed to achieve similar results. [6] (10.1136/bjsports-2023-107252)
• [Paper] ISPAH's Eight Investments That Work for Physical Activity provides a summary of eight areas for action that are supported by scientific evidence and have worldwide applicability. [7] (10.1136/bjsports-2020-103635)
• [L1] Inverse non-linear dose–response associations suggest substantial protection against a range of chronic disease outcomes from small increases in non-occupational physical activity in inactive adults. [8] (10.1136/bjsports-2022-105669)
• [L5] LPA is an accessible public health target and a potentially valuable complement to existing PA guidelines, as it accounts for the majority of PA energy expenditure (51–59%). [9] (10.1136/bjsports-2025-111179)
• [L3] Sustained physical activity in older age is associated with improved overall health. [10] (10.1136/bjsports-2013-092993)
• [L5] RCTs have failed to provide conclusive evidence that physical activity causes a reduced risk of death. [11] (10.1136/bjsports-2017-098995)
• [Paper] Much of the evidence presented in the statements is based on longitudinal associations from observational and randomised controlled intervention studies, as well as quantitative and qualitative social studies in relatively healthy community-dwelling older adults. [12] (10.1136/bjsports-2018-100451)
• [L5] Researchers need to prevent this looming ‘24-hour Babel’ by coming to agreement about how to collectively define PA, SB and sleep through an inclusive and systematic consensus process. [13] (10.1136/bjsports-2021-104487)
• [L3] This suggests that patients may safely engage in such activities to achieve important general health benefits and quality of life. [14] (10.1002/jor.24637)
• [L2] There may be no minimal or maximal threshold for the benefits. [15] (10.1136/bjsports-2022-106653)
• [Paper] We have summarised lessons learnt and recommendations for future research as 'roadmaps' in progress to encourage moving the field of physical activity towards achieving population-level impact globally. [16] (10.1136/bjsports-2019-101001)
• [Paper] The consensus statement outlines approaches that may identify determinants and modifiers of CRF exercise response and recommends future research to better understand exercise response variability. [17] (10.1136/bjsports-2018-100328)
• [L5] The authors propose that policymakers should introduce physical activity promotion into the Quality and Outcomes Framework (QOF) as an individual indicator at a cost of approximately £1 million. [18] (10.1136/bjsm.2010.073726)
• [L1] The interventions implemented at ≤12 weeks primarily improved the functional performance, whereas those lasting >12 weeks resulted in greater gains in the muscle strength and joint flexibility. [19] (10.1186/s13018-025-06430-7)
• [L1] There is moderate certainty evidence that fall prevention exercise programmes are likely to be cost-effective. [20] (10.1136/bjsports-2022-105747)
• [L3] These findings question whether THA should be prioritized only for those patients who have severe hip OA symptoms, but require confirmation in a trial. [21] (10.1016/j.arth.2025.04.032)
• [L4] The proportion of participants meeting the health-enhancing physical activity (HEPA) recommendations increased from 33.1% to 42.3% between baseline and first follow-up. [22] (10.1136/bjsm.2009.070201)
• [L2] The joint association between daily time spent in physical activity, sedentary behaviour and sleep and all-cause mortality was examined using compositional analysis. [23] (10.1136/bjsports-2020-102345)
• [L5] This guiding reference should regularly be updated on the basis of new information emerging from the area of sport and exercise medicine as well as from the developments and challenges in genomics of health and disease in general in order to best protect the athletes, patients and all other relevant stakeholders. [24] (10.1136/bjsports-2019-101532)
• [Paper] The Arthritis Committee recognizes the profound importance of arthritic disorders to the general population, not only as a health problem, but for their social and economic impact. [25] (10.1016/s0363-5023(83)80245-7)
• [Paper] Changes to the PA guidelines, such as removal of a 10-min bout criterion, pose challenges for PA surveillance. [26] (10.1136/bjsports-2020-102621)
• [L1] The addition of WAT-use did not have any effect on perceived joint function or HRQoL. [27] (10.1186/s12891-024-08238-8)
• [L1] We conclude that after 2 1/2 years of follow-up, both arthroscopic surgery and supervised exercises are better treatments than placebo. [28] (10.1016/s1058-2746(99)90001-0)
• [L1] Compared with control players, those who participated in the NMC programme found it to be less physically challenging but more enjoyable and potentially of more benefit. [29] (10.1136/bjsports-2013-092816)
• [L1] Protocols using painful exercises offer a small but significant benefit over pain-free exercises in the short term, with moderate quality of evidence. [30] (10.1136/bjsports-2016-097383)
• [Paper] A regular program of relatively modest aerobic physical activity is associated with measurable improvement in health, including reduced all-cause and cardiovascular mortality. [31] (10.1016/s0278-5919(05)70197-6)
• [L1] Brief interventions promoting physical activity in primary care and the community are likely to be inexpensive compared with usual care. [32] (10.1136/bjsports-2015-094655)
• [L5] An excellent outcome was considered 112% total active motion. [33] (10.1197/j.jht.2003.10.005)
• [L5] The resource also delivered the first pooled analysis exploring physical activity type in relation to cardiometabolic health, showing that approximately 65 min per day of walking and 5 min of stair climbing were each linked to a more favourable cardiometabolic profile, while the adverse effects of sitting became pronounced above 12 hours per day. [34] (10.1136/bjsports-2025-111283)
• [L2] Similarly, individuals not achieving the WHO guideline for physical activity showed an elevated risk, even if they were abdominally lean (HR 1.04, 95% CI 1.01 to 1.07). [35] (10.1136/bjsports-2024-108708)
• [Paper] At follow-up, 65.0% of inactive participants were taking part in sport and 85.6% were meeting recommended MVPA guidelines. [36] (10.1136/bjsports-2017-097716)
• [L5] Exercise has been shown to be not only “not harmful” but necessary to support healthy joints and maintain cartilage remodeling and repair. [37] (10.1016/s0894-1130(00)80040-x)
• [L5] Moderate treadmill exercise following an initial period of short-term immobilization has a positive impact on tendon-bone interface healing, whereas prolonged immobilization has a detrimental effect on physical recovery. [38] (10.1177/2325967125s00320)
• [Paper] Therefore, we conclude that after a short period of immobilization, increased activity is detrimental to both tendon mechanical properties and shoulder joint mechanics, presumably due to increased scar production. [39] (10.1002/jor.21059)
• [Paper] Physiological exercise applied after the initial biological response to injury has dampened can potentially promote remodeling of damaged tendons. [40] (10.1002/jor.22856)
• [L1] PSE may act as a mechanism of action for exercise interventions, and is less successful delivered standalone. [43] (10.1186/s12891-025-09313-4)
• [Paper] We conclude that exercise accelerates bone defect healing and stimulates angiogenesis during bore repair. [44] (10.1002/jor.21352)
• [L4] It highlights themes of balancing physical activity, reframing perceptions of risk, and overcoming barriers to return to sport. [45] (10.1002/jor.25064)
• [Paper] Communication to raise awareness and knowledge of the physical activity guidelines must be supported by policies, environments and opportunities for physical activity. [47] (10.1136/bjsports-2020-102324)
• [L1] About 30-40 min of MVPA per day attenuate the association between sedentary time and risk of death, which is lower than previous estimates from self- reported data. [48] (10.1136/bjsports-2020-103270)
• [L4] The highly interconnected role of CRF in the association between PA and cardiometabolic health suggests limited direct effects of PA on cardiometabolic health beyond its impact on CRF. [49] (10.1136/bjsports-2023-107451)
• [Paper] Broadbased application of this framework will aid in moving from isolated interventions to sustainable, population-wide gains in PA. [50] (10.1136/bjsports-2025-110686)
• [Paper] We recommend that the costs and benefits of harmonising the existing questionnaires are considered, along with the potential introduction of device-based measures. [52] (10.1136/bjsports-2018-100355)
• [Paper] In conclusion, delayed postoperative exercise with moderate strength appears to accelerate the early phase of B‐T healing, a process that may prove to be linked to increased expression of periphery neuropeptides known to play a role in tissue healing. [53] (10.1002/jor.24678)
• [Paper] Physical activity speeds up tendon healing, which may prove to be linked to accelerated neuronal plasticity. [55] (10.1002/jor.20257)
• [L3] The study supports the use of treadmill exercise to engender increased cyclic bone strain within a physiologic range and distribution, distinct from sedentary background activity, to investigate bone formation and modeling. [56] (10.1002/jor.1100160106)
• [L1] Exercise may improve pain and function with low to moderate certainty, but it is uncertain whether differences are clinically important. [57] (10.1097/corr.0000000000003476)
• [L1] There was a significant group-by-time interaction for mean minutes of MVPA per day in favour of the intervention group (adjusted difference between groups at follow-up=3.85 min, 95% CI (0.79 to 6.91), p≤0.01), including significantly more vigorous physical activity (2.45 min, p≤0.01), equating to 27 min more MVPA per week. [58] (10.1136/bjsports-2014-094523)
• [L1] AQE appears to provide meaningful pain relief for musculoskeletal disorders, with benefits that may persist during follow-up. [59] (10.1186/s12891-026-09953-0)
• [Paper] BA is a cost-effective way to improve PA among adults, provided short-term mental health gains are considered. [60] (10.1136/bjsports-2013-092897)
• [L1] There was no significant effect of the intervention on weekly MVPA at 12 months between the groups recorded in ≥10 min bouts (mean difference 11.8 min of MVPA, 95% CI: −2.1 to 26.0; p=0.10) or without bouts (mean difference 13.7 min of MVPA, 95% CI: −26.8 to 54.2; p=0.51). [61] (10.1136/bjsports-2020-103121)
• [L2] Compared with obesity-low physical activity, there was no survival benefit of being normal weight if physical activity levels were low. [62] (10.1136/bjsports-2021-104827)
• [L4] Because of the absence of a control group, these findings demonstrate feasibility and short-term clinical improvement but cannot establish superiority over other conservative treatments. [63] (10.1016/j.jhsg.2026.101038)
• [Paper] Results from a formal 2-year cluster randomised-controlled trial confirmed the programme was effective in improving youth FMS proficiency. [64] (10.1136/bjsports-2018-099745)
• [Paper] The infographic aims to encourage patients to make exercising a regular habit by highlighting potential benefits and providing clear guidelines and safety messages. [65] (10.1136/bjsports-2019-101930)
• [L1] However, this programme improved other physical activity measures (ie, daily steps, MVPA, hours per week of walking), overall well-being, quality of life and disability. [66] (10.1136/bjsports-2023-107027)
• [L2] These findings support home-based exercise as a potentially scalable rehabilitation strategy, although larger studies are needed to confirm long-term healthcare utilisation outcomes. [67] (10.1016/j.jseint.2026.101779)
• [L1] Treatment groups differed significantly in trajectories of minutes/day of physical activity (p=0.0198), through a greater change at 3 months for Web 2.0 than Web 1.0 (7.3 min/day, 95% CI 2.4 to 12.3). [68] (10.1136/bjsports-2016-096890)
• [L1] The results suggest that both exercise regimes are effective in improving cervical joint position sense and reducing symptoms in people with persistent neck pain. [69] (10.1002/jor.20220)
• [L1] An educational handout is noninferior to hand therapy for achieving full ROM in composite flexion but not TAM. [70] (10.1016/j.jht.2020.03.017)
• [Paper] Exercise therapy is effective for some adolescents but not all, and adherence to exercises is a challenge, with those doing home exercises three times per week or more being four times more likely to be recovered after 12 months. [71] (10.1136/bjsports-2016-096268)
• [L1] Physical activity interventions that combine self-monitoring with other components provide an additional modest yet sustained increase in step count compared with self-monitoring alone. [72] (10.1136/bjsports-2021-105198)
• [L1] Teachers at intervention schools recorded a greater increase in weekly minutes of PA implemented than teachers assigned to the control schools by approximately 44.2 min (95% CI 32.8 to 55.7) from baseline to 12-month follow-up. [73] (10.1136/bjsports-2020-103764)
• [L1] Exercise therapy was not associated with an increased risk of non-serious adverse events (risk ratio 0.96) and appeared to reduce the risk of serious adverse events such as hospitalisation and pneumonia (risk ratio 0.62). [74] (10.1136/bjsports-2021-104367)
• [L1] The study highlights that despite scientific evidence, many coaches are unaware of the benefits of these programmes and do not deliver them, leading to low compliance and limited success in injury prevention. [75] (10.1136/bjsports-2012-091797)
• [L1] To realise the greatest effects, players should complete the programme at least three times per week. [76] (10.1136/bjsports-2016-097434)
• [Paper] Exercise is associated with improvements in physical and mental health. [77] (10.1136/bjsports-2021-104754)
• [L1] Future research should focus on optimizing current exercise regimens for people with knee OA and exploring how to improve adherence while minimizing symptom exacerbation by other exercise modalities. [78] (10.1186/s12891-025-08746-1)
• [L4] It has the advantage of being performed in a clinic setting, and it is cost-effective. [79] (10.1016/s0894-1130(03)00037-1)
• [L3] Adhering to PA guidelines (150–300 min per week) and surpassing them (≥300 min per week) were associated with 23% and 37% lower risk of incident CVD, respectively, compared with those with the lowest PA duration (0–75 min per week). [80] (10.1136/bjsports-2024-108734)
• [Paper] The Prisma in Exercise, Rehabilitation, Sport medicine and SporTs science (PERSiST) guidance attempts to address the problem of poor reporting of medical and healthcare systematic reviews in the sports and exercise medicine, musculoskeletal rehabilitation, and sports science fields. [81] (10.1136/bjsports-2021-103987)
• [L1] However, most of these differences did not reach the minimum threshold to be considered clinically important. [82] (10.1016/j.jht.2024.07.006)
• [L4] These findings suggest potential benefits of this treatment approach, though randomized controlled trials are needed for definitive efficacy assessment. [83] (10.1186/s13018-025-05768-2)
• [Paper] There is widespread omission of basic teaching elements, such as the Chief Medical Officer recommendations and guidance on PA, which has been endorsed by all four UK Departments of Health. [84] (10.1136/bjsports-2012-091380)
• [L5] Consensus was reached in 46/49 (94%) statements. [85] (10.1136/bjsports-2024-109104)
• [L1] There is not strong research evidence for or against the value of hand exercise in the treatment of persons with rheumatoid arthritis, although results of this review suggest that appropriate exercise might lead to long-term strength changes and very short-term changes in stiffness. [86] (10.1197/j.jht.2004.02.006)
• [L1] More adequately powered and rigorous trials are needed to evaluate the effect of exercise interventions on SRC incidence, and on linear and rotational head accelerations. [87] (10.1136/bjsports-2024-108260)
• [L1] Nevertheless, the modest volume of the prospective epidemiological evidence base and the moderate consistency between observational and laboratory evidence inhibits definitive conclusions. [88] (10.1136/bjsports-2017-097563)

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