We aimed to investigate existing literature on the impact of physical activity and exercise (PA) on joint biochemical markers (BM) and magnetic resonance imaging (MRI) outcomes in osteoarthritis (OA), and on this basis propose directions for future research. Literature Review. Original papers were identified in PubMed, Embase, and Scopus and data on study populations, activity, biomarkers, imaging, and outcomes were extracted and reviewed. 24 papers, mainly on knee OA, were included. PA indicated acute increase in cartilage turnover in OA patients, as indicated by changes in markers of extra cellular matrix (ECM) turnover. Acute impact of PA on MRI outcomes in OA appears to constitute a gap in the literature, as only 1 study was identified. Long‐term effects of PA may be chondroprotective, judged from decreased serum BM. Studies of long‐term effects of PA on MRI measures showed various neutral, and both discrete positive and negative effects. Impact of PA on BM warrants further studies including information of potential coexisting inflammatory and structural changes on the joint level on MRI, in order to determine the significance of the BM findings. Development of a standardized method for clinical evaluation of BM dynamics following PA is warranted.