Objective.To assess the benefits and harms of exercise compared with other interventions, including placebo or no intervention, in people with hand osteoarthritis (OA).Methods.Systematic review using Cochrane Collaboration methodology. Six electronic databases were searched up until September 2015. Inclusion criteria: randomized or controlled clinical trials comparing therapeutic exercise versus no exercise, or comparing different exercise programs. Main outcomes: hand pain, hand function, finger joint stiffness, quality of life, adverse events, and withdrawals because of adverse effects. Risk of bias and quality of the evidence were assessed.Results.Seven trials were included in the review, and up to 5 trials (n = 381) were included in the pooled analyses with data from postintervention. Compared to no exercise, low-quality evidence indicated that exercise may improve hand pain [5 trials, standardized mean difference (SMD) −0.27, 95% CI −0.47 to −0.07], hand function (4 trials, SMD −0.28, 95% CI −0.58 to 0.02), and finger joint stiffness (4 trials, SMD −0.36, 95% CI −0.58 to −0.15) in people with hand OA. Quality of life was evaluated by 1 study (113 participants) showing very low-quality evidence for no difference. Three studies reported on adverse events, which were very few and not severe.Conclusion.Pooled results from 5 studies with low risk of bias showed low-quality evidence for small to moderate beneficial effects of exercise on hand pain, function, and finger joint stiffness postintervention. Estimated effect sizes were small, and whether they represent a clinically important change may be debated.