Adverse events of exercise therapy in randomised controlled trials: a systematic review and meta-analysis
Open accessAbstract
Objective: To evaluate the relative risk (RR) of serious and non-serious adverse events in patients treated with exercise therapy compared with those in a non-exercising control group. Design: Systematic review and meta-analysis. Data sources: Primary studies were identified based on The Cochrane Database of Systematic Reviews investigating the effect of exercise therapy. Eligibility criteria: At least two of the authors independently evaluated all identified reviews and primary studies. Randomised controlled trials were included if they compared any exercise therapy intervention with a non-exercising control. Two authors independently extracted data. The RR of serious and non-serious adverse events was estimated separately. Results: 180 Cochrane reviews were included and from these, 773 primary studies were identified. Of these, 378 studies (n=38 368 participants) reported serious adverse events and 375 studies (n=38 517 participants) reported non-serious adverse events. We found no increase in risk of serious adverse events (RR=0.96 (95%CI 0.90 to 1.02, I 2 : 0.0%) due to exercise therapy. There was, however, an increase in non-serious adverse events (RR=1.19 (95%CI 1.09 to 1.30, I 2 : 0.0%). The number needed to treat for an additional harmful outcome for non-serious adverse events was 6 [95%CI 4 to 11). Conclusion: Participating in an exercise intervention increased the relative risk of non-serious adverse events, but not of serious adverse events. Exercise therapy may therefore be recommended as a relatively safe intervention. PROSPERO registration number CRD42014014819.
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The risk of nonserious adverse events was not different than aerobic exercise.
“The risk of nonserious adverse events (e.g., pain, fatigue, bursitis, and edema) was not different than aerobic exercise in terms of injury rate or risk (182).”
From American College of Sports Medicine Position Stand. Resistance Training Prescription for Muscle Function, Hypertrophy, and Physical Performance in Healthy Adults: An Overview of Reviews (2026) · cites this paper as [182]
The Subgroup analysis on risk of adverse events of different intervention characteristics (page unavailable) reports no difference between exercise types in a meta-regression of adverse-event risk, and Data collection lists aerobic exercise as one of those types. The paper does not report a direct comparison with aerobic exercise or a separate injury-rate outcome, so those specifics are not supported. (LLM, conf=0.82)
Experimental — accuracy not yet measuredOne systematic review of 375 exercise trials across health conditions found an increase in risk of experiencing a non-serious adverse event of 19% in exercise interventions compared to non-exercising controls (RR 1.19, 95% CI 1.09 to 1.30).
“One systematic review of 375 exercise trials across health conditions found an increase in risk of experiencing a non-serious adverse event of 19% in exercise interventions compared to non-exercising controls (risk ratio (RR) 1.19, 95% CI 1.09 to 1.30) (Niemeijer 2020).”
From Exercise for the treatment of anxiety in children and adolescents (2022) · cites this paper as Niemeijer 2020
There was no increased risk of serious adverse events associated with exercise.
“However, there was no increased risk of serious adverse events associated with exercise.”
From Exercise for the treatment of anxiety in children and adolescents (2022) · cites this paper as Niemeijer 2020
Exercise did not increase the risk of serious adverse events in an analysis of >38,000 participants.
“In an analysis of >38,000 participants (>6700 RT participants), of which >11,000 were older adults, exercise did not increase the risk of serious adverse events.”
Serious adverse events are unlikely with exercise and CBT.
“Serious adverse events are unlikely with exercise 45 and CBT 46”
From Management of chronic pain associated with temporomandibular disorders: a clinical practice guideline (2023) · cites this paper as [45]
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- Authors
- Niemeijer, A., Lund, H., Stafne, S. N., Ipsen, T., Goldschmidt, C. L., Jørgensen, C. T., & Juhl, C. B.
- Affiliations
- University of Southern Denmark (DK)
- Western Norway University of Applied Sciences (NO)
- Norwegian University of Science and Technology (NO)
- University of Copenhagen (DK)
- Corresponding author
- Lund, Hans
- Venue
- British Journal of Sports Medicine
- Publisher
- BMJ
- Published
- 2019-09-28
- Volume
- 54
- Issue
- 18
- Pages
- 1073-1080
- ISSN
- 0306-3674 (ISSN-L)
- 1473-0480
- OpenAlex
- W2975068031
- Cited by
- 157
- References
- 25
- Citations by year
- 2026: 17 · 2025: 27 · 2024: 24 · 2023: 25 · 2022: 41 · 2021: 16 · 2020: 7
- FWCI
- 1.88
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of Sports Medicine (publishedVersion)
- PubMed (publishedVersion)
- NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
- NORA - Norwegian Open Research Archives (submittedVersion, cc-by-nc)
- HighWire Press Open Archive (submittedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion, cc-by-nc)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Keywords
- exercise therapy, adverse events, serious adverse events, non-serious adverse events, relative risk, number needed to harm
- MeSH terms
- Exercise Therapy, Humans, Risk Factors, Time Factors, Randomized Controlled Trials as Topic
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