Physical energy-based therapies are non-invasive adjunctive interventions that deliver mechanical, electromagnetic, light, or radiofrequency/thermal energy to tissues with the aim of reducing symptoms and improving tolerance of active rehabilitation. Osteoarthritis (OA) is a heterogeneous whole-joint disorder in which cartilage degeneration, subchondral bone remodeling, synovitis, peri-articular tissue dysfunction, neuromuscular impairment, and pain sensitization may interact to produce pain, stiffness, and activity restriction. As conservative therapy for OA, education, progressive therapeutic exercise, weight management when indicated, and self-management remain the core of care. Nevertheless, some patients cannot fully participate in exercise because of pain, fear of movement, load intolerance, comorbidity, or limited access to supervised rehabilitation. This narrative review synthesizes evidence published mainly between 2016 and 2026 for extracorporeal shock wave therapy (ESWT), photobiomodulation/low-level laser therapy (PBMT/LLLT), pulsed electromagnetic field therapy (PEMF), transfer energy capacitive and resistive/capacitive–resistive electric transfer (TECAR/CRET) therapy, body weight support and aquatic unloading strategies, and mechanosonic vibration therapies. The available literature suggests that ESWT and PBMT/LLLT may provide short- to mid-term pain and function benefits in selected patients with knee OA when parameters are aligned with evidence-supported dosing windows. PEMF and vibration therapies show promising but less consistent effects because protocols, devices, sham conditions, and populations vary. TECAR/CRET and unloading approaches are best interpreted as enabling tools that may reduce guarding, improve walking tolerance, or increase the quality of therapeutic exercise, rather than stand-alone disease-modifying treatments. Current national and society guidelines consistently prioritize exercise, education, and weight management; most of the modalities reviewed here are absent from guidelines or are supported only indirectly, which justifies cautious wording and individualized use. A practical application model is, therefore, time-limited and goal-oriented: identify the barrier to rehabilitation, select a modality with a plausible mechanism and published protocol, monitor pain and functional response, and discontinue the modality if it does not improve participation in active care.

Background: Weight regain and loss of cardiometabolic benefit commonly follow the withdrawal of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and dual glucose-dependent insulinotropic polypeptide/GLP-1 receptor agonists, yet maintenance strategies are incompletely characterized. Methods: We conducted a systematic review reported according to PRISMA 2020 of primary studies in adults with overweight or obesity, with or without type 2 diabetes. PubMed/MEDLINE, Europe PMC and ClinicalTrials.gov were searched from inception to September 2026, supplemented by backward/forward citation searching and cross-checking of recent systematic reviews. Eligible reports quantified weight or cardiometabolic outcomes at least 12 weeks after planned or unplanned treatment cessation, or tested a post-cessation maintenance strategy. Randomized reports were assessed with RoB 2 and non-randomized reports with ROBINS-I. Owing to incompatible estimands, follow-up schedules, cointerventions and overlapping trial families, results were synthesized narratively without a new pooled estimate. Results: Eighteen reports representing 16 study families were included. Randomized withdrawal trials showed renewed weight gain after treatment cessation: +6.9% over 48 weeks after switching from semaglutide to placebo in STEP 4, and +14.0% over 52 weeks after switching from tirzepatide to placebo in SURMOUNT-4. In the STEP 1 extension, participants regained 11.6 percentage points over one year, approximately two-thirds of their prior loss, while several cardiometabolic measures moved toward baseline. Real-world estimates were smaller and more variable because discontinuation was often inferred from prescriptions, follow-up weights were missing, and many patients restarted or switched therapy. Cardiometabolic rebound was associated with the degree of weight regain, but clinical cardiovascular events were not evaluated. Evidence for maintenance strategies was sparse: one randomized post-treatment study supported supervised exercise, with the exercise-plus-liraglutide group retaining an additional 5.1 kg of weight loss one year after both interventions ended compared with liraglutide alone; a small pilot supported sitagliptin plus metformin after liraglutide in polycystic ovary syndrome. No eligible controlled trial isolated a specific diet after cessation. Conclusions: Weight regain is frequent after stopping GLP-1-based therapy, although magnitude varies by drug, design, follow-up and subsequent treatment. Structured exercise may help reduce regain and preserve lean mass, but evidence for dietary, behavioral, tapering or pharmacologic transition strategies remains limited. Discontinuation should therefore be planned as part of chronic obesity care, with explicit monitoring and shared decision-making, rather than presented as a predictable short course.