Background:Scholarly recommendations for the management of hip and knee osteoarthritis, which emphasize the usefulness of non-pharmacological therapies, are not scaled according to patient’s age and physical condition. We conducted a systematic review of clinical trials on exercise and weight loss in hip and knee osteoarthritis in very old patients.Methods:Electronic search in Medline, Embase, and Pascal databases; systematic search of the Cochrane Reviews; manual search in guidelines and meta-analyses.Results:We identified 83 trials, with only 2 on patients aged ≥ 75 years; we therefore lowered the mean age threshold to 70 years and found 15 trials. Land-based exercise (8 trials) was effective on pain and function (4 controlled trials), with a persistent effect only in case of selfrehabilitation. Aquatic exercise (5 trials) was as effective as land-based exercise. Weight loss (2 trials): only patients under diet along with exercise had significant improvement on symptoms.Conclusion:International recommendations on exercise for hip and knee osteoarthritis also apply to subjects aged 70–80 years. Long-term effectiveness requires a maintenance strategy. Specific trials on very old patients with various comorbidities are mandatory.