Effectiveness of exercise in rotator cuff-related shoulder pain: a systematic review with meta-analysis.

OBJECTIVE: To study the effectiveness of exercise in rotator cuff-related shoulder pain by analyzing the changes produced in performance, disability, pain, and adherence. METHODS: A systematic review of the bibliography collected in the databases MEDLINE, EMBASE, SPORTDiscus, PEDro, and Web of Science was carried out, collecting the data available until November 4, 2025. Risk of bias was measured using the Version 2 of the Cochrane Risk-of-Bias tool. A review and meta-analysis of randomized controlled clinical trials interventional studies on the effects of exercise interventions on performance, disability, pain, and adherence in people with rotator cuff-related shoulder pain was carried out following the Preferred Items for Reporting in Systematic Review and Meta-Analyses guidelines. RESULTS: Thirty-four articles encompassing 2019 subjects were included. Exercise produced significant improvements in disability in 15 studies, showing a significant reduction in DASH-measured disability compared with no intervention (MD = -8.50), with no differences versus other interventions. SPADI analyses showed no significant differences between exercise and either no intervention or non-exercise interventions. For pain, 11 studies reported significant improvements in favor of exercise, with reduced pain during activity or movement compared with non-exercise controls (SMD = -1.61), and greater effects versus no intervention (SMD = -1.87), while no significant effects were observed for pain at rest except for a borderline trend versus no intervention (SMD = -0.72). Mean adherence across studies was 83.6%. Most trials showed a high risk of bias, and the overall certainty of evidence was low. CONCLUSION: Exercise interventions appear to improve pain, disability, performance, and adherence in rotator cuff-related shoulder pain. However, due to substantial heterogeneity in exercise type and low certainty of evidence, exercise was not consistently superior to other rehabilitation modalities, and no specific exercise approach can be recommended as clearly most effective.