Exercise interventions for rotator cuff-related shoulder pain in middle-aged and older adults: a systematic review and meta-analysis

BACKGROUND/OBJECTIVES: Rotator cuff-related shoulder pain is highly prevalent in middle-aged and older adults and is associated with pain, functional limitations, and reduced quality of life. This systematic review and meta-analysis aimed to evaluate the effectiveness of exercise-based interventions on pain, function, range of motion (ROM), and strength in middle-aged and older adults with rotator cuff-related shoulder pain. METHODS: A systematic review and meta-analysis were conducted according to PRISMA 2020 guidelines and registered in PROSPERO (CRD420251236625). Searches were performed in PubMed, Scopus, Web of Science, PEDro, and Cochrane Library databases for studies published within the last 10 years. Randomized controlled trials including adults with rotator cuff-related shoulder pain were included. A total of 1,152 participants across 21 studies were analyzed. Exercise-based interventions primarily targeted the rotator cuff and scapular stabilizer muscles through strengthening, stretching, stabilization, and neuromuscular exercise programs, and were compared with usual care, other exercise approaches, or adjunct therapies. Functional outcomes were mainly assessed using validated instruments such as SPADI, DASH/QuickDASH, and the Constant-Murley Score. Effect sizes were calculated using standardized mean differences, and heterogeneity was assessed with the I² statistic. RESULTS: Twenty-one randomized controlled trials were included. Exercise-based interventions produced significant improvements in pain (g = -1.454, p < 0.001), function (g = 0.457, p < 0.001), and ROM (g = -2.477, p < 0.001). Improvements in strength were smaller and did not reach statistical significance (g = 0.229, p = 0.085). Although strengthening exercises showed positive trends across studies, the pooled effect on strength was not statistically significant. High heterogeneity was observed (I² = 95.96%), likely due to differences in intervention protocols, participant characteristics, and outcome assessment methods. CONCLUSIONS: Exercise-based interventions are effective in reducing pain and improving function and ROM in middle-aged and older adults with rotator cuff-related shoulder pain. However, effects on strength appear more limited. Further high-quality studies using standardized exercise protocols and longer follow-up periods are needed to optimize rehabilitation strategies.