How to read this page
Each approach is graded on randomised trials for pain and function. Where the trials were in people living at home, or in younger adults, that is stated.
Exercise trials cannot hide from participants which group they are in. In the Cochrane review of exercise for back pain, 79% of trials were judged at risk of bias for that reason 12.
The approaches
Exercise for knee osteoarthritis
Supported by trial evidenceLand-based exercise reduces knee pain and improves function, and some of the benefit lasts two to six months after a program ends.
The evidence
A Cochrane review pooled 44 trials. Immediately after treatment, exercise reduced pain by 12 points on a 100-point scale (95% CI 10 to 15) and improved physical function by 10 points (95% CI 8 to 13). In 12 trials with follow-up two to six months after treatment ended, a smaller benefit for pain remained, 6 points (95% CI 3 to 9). The authors noted that the results may be vulnerable to selection, attrition and detection bias 11.
In practice
The participants were not aged care residents. The knee standard states that exercise is safe for the knee even with severe osteoarthritis 13. For a resident, the useful exercise is whatever they can do and are willing to keep doing, often set up by a physiotherapist.
Exercise for persistent low back pain
Supported by trial evidenceExercise probably reduces chronic back pain by a clinically important amount. The effect on function is small.
The evidence
Across 249 trials, exercise reduced pain compared with no treatment, usual care or placebo by 15.2 points on a 100-point scale (95% CI 12.2 to 18.3; moderate certainty). Functional limitation improved by 6.8 points (95% CI 5.3 to 8.3), below the threshold the reviewers set as clinically important. Reported adverse effects were mostly minor, such as muscle soreness 12.
In practice
The average participant was 44, so how far this applies to residents in their eighties and nineties is uncertain 12.
Exercise programs in nursing homes, for pain
Uncertain / conflictingTwo small studies disagree: one found less pain, the other found no difference.
The evidence
In 10 Hong Kong nursing homes, 396 residents with chronic pain, average age 85, took part in eight weekly exercise sessions led by a physiotherapist and nurses. Pain scores fell from 4.2 to 2.7 out of 10, significantly more than in the comparison group. The authors describe the study as quasi-experimental, and the abstract gives no confidence interval for the difference 18. In French nursing homes, six months of exercise for 44 residents with dementia made no significant difference to pain compared with a social activity program for 47 residents 19.
In practice
Exercise has other reasons to continue in aged care. The falls section describes what supervised strength and balance training does for falls.
Heat
Promising, not yet provenA heat wrap gave a small, short-term reduction in recent back pain. There is too little evidence to judge cold.
The evidence
A Cochrane review of nine trials (1,117 participants) found moderate evidence, from a small number of trials, that heat wrap therapy gave a small short-term reduction in pain and disability in people with acute and subacute low back pain, and that adding exercise reduced pain further. There was insufficient evidence on cold, and conflicting evidence comparing heat with cold 15.
In practice
The trials were in adults with recent back pain, not in aged care residents with long-term pain 15. Skin that is fragile or has reduced feeling needs checking when heat is used, particularly in a resident who cannot say it is too hot.
TENS (transcutaneous electrical nerve stimulation)
Uncertain / conflictingWhether TENS helps knee osteoarthritis pain could not be confirmed.
The evidence
A Cochrane review of 18 small trials (813 participants) found poor-quality, inconsistent evidence. When the results were adjusted to what a trial as large as the largest would be expected to show, the effect on pain was close to zero (standardised mean difference −0.07, 95% CI −0.46 to 0.32) 16.
Psychological approaches, including cognitive behavioural therapy
Supported by trial evidenceSmall benefits for pain and for confidence in managing it, in older adults with chronic pain.
The evidence
A meta-analysis of 22 randomised trials (2,608 participants, average age 72) found small reductions in pain intensity and catastrophising and an improvement in self-efficacy for managing pain at the end of treatment. Only the effect on pain lasted beyond the end of treatment, and group programs did better than individual ones 17.
In practice
These programs ask a person to take part in conversation and practise skills, so they suit residents without significant cognitive impairment.
Other approaches
Massage, music, acupuncture and other approaches were not reviewed for this page, so no grade is given here.
Comfort measures such as positioning, pressure care, a warm shower before activity and an unhurried routine for painful care are part of ordinary good care. They do not need a trial to be worth doing for a resident who finds them helpful.
Related pages on this site
Sources cited on this page
- 11 Fransen M, McConnell S, Harmer AR, Van der Esch M, Simic M, Bennell KL. Exercise for osteoarthritis of the knee: a Cochrane systematic review. Br J Sports Med. 2015;49(24):1554–7. View source
- 12 Hayden JA, Ellis J, Ogilvie R, Malmivaara A, van Tulder MW. Exercise therapy for chronic low back pain. Cochrane Database Syst Rev. 2021;9:CD009790. (249 trials; mean participant age 43.7 years.) View source
- 13 Australian Commission on Safety and Quality in Health Care. Osteoarthritis of the Knee Clinical Care Standard. Sydney: ACSQHC; first released 2017, revised August 2024. (Scope: people aged 45 and over.) View source
- 14 Australian Commission on Safety and Quality in Health Care. Low Back Pain Clinical Care Standard. Sydney: ACSQHC; September 2022. (Scope: people aged 16 and over in primary care and emergency departments.) View source
- 15 French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database Syst Rev. 2006;(1):CD004750. View source
- 16 Rutjes AW, Nüesch E, Sterchi R, et al. Transcutaneous electrostimulation for osteoarthritis of the knee. Cochrane Database Syst Rev. 2009;(4):CD002823. View source
- 17 Niknejad B, Bolier R, Henderson CR, et al. Association between psychological interventions and chronic pain outcomes in older adults: a systematic review and meta-analysis. JAMA Intern Med. 2018;178(6):830–9. (22 randomised trials; mean age 71.9 years.) View source
- 18 Tse MM, Tang SK, Wan VT, et al. The effectiveness of physical exercise training in pain, mobility, and psychological well-being of older persons living in nursing homes. Pain Manag Nurs. 2014;15(4):778–88. (Described by its authors as quasi-experimental; 10 Hong Kong nursing homes.) View source
- 19 Maltais M, Rolland Y, Vellas B, et al. Effect of exercise on behavioral symptoms and pain in patients with dementia living in nursing homes. Am J Alzheimers Dis Other Demen. 2019;34(2):89–94. View source
Written by Dr Josh Hatch, FRACGP. General information only, reflecting his reading of the published evidence as at November 2026. It is not individual medical advice, does not create a doctor–patient relationship, and must not be used to start, stop or change any treatment. It gives no doses, and it does not recommend any procedure, clinic or practitioner. Evidence and Australian regulatory and PBS arrangements change — always confirm current advice with the treating GP, pharmacist or specialist.
This is general education, not a clinical protocol. The doctors who practise with Umbrella Aged Care are independent general practitioners, and each makes their own clinical decisions with the resident and family. Your GP’s advice for an individual may differ from what is written here. If it does, please ask them to talk it through with you.