There is no such thing as the best exercise. Exercise promotes a variety of physiological benefits, including but not limited to improvements in metabolic health, cardiovascular health, muscle mass, bone mineral density, and mental health. To achieve specific benefits, however, baseline intensities of specific exercise types need to be performed, such as heavy loading or impact activity. The physical activity guidelines help us achieve these foundational goals (150 min of moderate or 75 min of vigorous physical activity plus 2 days per week of resistance training). But what about the types of exercises that fall in the broad aerobic and anaerobic or resistance training categories? Is cycling superior to running? Should yoga be prioritized over Pilates? What about bodybuilding vs. powerlifting? Do all the recommendations change once pain enters the equation? The research does not support exercise hierarchies.
This systematic review of systematic reviews assessed 45 SRs and Mas. The authors specifically assessed the effects of various exercise approaches on pain and disability. They found small, short-term benefits for motor control exercises, Pilates, resistance training, traditional Chinese exercises, and yoga compared to no or minimal intervention. The critical factor is the outcome measures used. When assessing pain and function, choose the exercise the patient is most likely to adhere to. The type you choose doesn’t matter. It all works. If you are aiming to improve specific health markers such as muscle mass and bone mineral density, then some specificity is needed, but there are still a lot of ways to successfully program structured exercises to achieve those goals.