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There is evidence of benefit for multimodal treatments including exercise in the management of lateral epicondylalgia (LE), but little is known of the effects of isometric exercise alone. We investigated the effect of an 8 week home program of graded isometric exercise compared to wait-and-see on clinical outcomes in people with unilateral LE.Forty patients with LE were randomised to either wait-and-see (n=19) or an 8 week home exercise program (n=21). During a single session, patients assigned to exercise were instructed to complete a standardised daily program of isometric wrist extension with weekly increase in exercise volume. Primary outcomes were global rating of change (GROC) and Patient-rated Tennis Elbow Evaluation (PRTEE) at 8 weeks. Secondary outcomes were pain on an 11-point numerical rating scale, pain-free grip force, and thermal and pressure pain thresholds as a measure of nervous system sensitisation at 8 weeks.The home exercise group had lower PRTEE scores at 8 weeks compared to the wait–and-see group (standardised mean difference: 0.86, 95% confidence interval 0.2 to 1.5). No significant differences were observed between groups for all other measures.Compared to wait-and-see, a home program of graded isometric exercise improved a validated measure of pain and disability for patients with LE. Success rates in both groups for the 8 week trial were comparable to wait-and-see in previous clinical trials, suggesting exercise alone may be insufficient in improving GROC. Isometric exercise may not have an effect on nervous system sensitisation in patients with LE.