The Efficacy of Exercise Therapy for Rotator Cuff–Related Shoulder Pain According to the FITT Principle: A Systematic Review With Meta-analyses

OBJECTIVE: To evaluate the efficacy of exercise interventions with differing frequency, intensity, type, and time (FITT) on shoulder pain and disability in people with rotator cuff–related shoulder pain (RCRSP). DESIGN: Intervention systematic review with meta-analyses. LITERATURE SEARCH: Electronic searches were conducted up to May 2023. STUDY SELECTION CRITERIA: Randomized controlled trials (RCTs) comparing the effects of exercise interventions differing in prescription according to the FITT principle, in people with RCRSP. DATA SYNTHESIS: Separate meta-analyses comparing exercise type (specific versus nonspecific exercise) and intensity (high versus low) were conducted. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) was used to evaluate the certainty of evidence. RESULTS: Twenty-two RCTs (n = 1281) were included. There was moderate-certainty evidence that motor control exercise programs, when compared to nonspecific exercise programs, significantly reduced disability in the short (SMD: −0.29; 95% CI: −0.51, −0.07; n = 323; 7 RCTs) and medium terms (SMD: −0.33; 95% CI: −0.57, −0.09; n = 286; 5 RCTs), but not pain in the short term (SMD: −0.19; 95% CI: −0.41, 0.03; n = 323; 7 RCTs). Uncertainties remained regarding other exercise types (eccentric and scapula-focused exercise programs) versus nonspecific exercise programs, and exercise intensity due to low- to very low–certainty evidence. No trials were identified that compared different frequencies or times. CONCLUSION: For adults with RCRSP, motor control exercise programs were probably slightly superior to nonspecific exercise programs. However, it is unclear if the effects were due to motor control exercise or to other program characteristics such as progression and tailoring. J Orthop Sports Phys Ther 2024;54(8):499-512. Epub 7 June 2024. doi:10.2519/jospt.2024.12453