Scientists reveal the best exercise to relieve knee osteoarthritis pain

Although other types of exercise can provide additional benefits, the researchers stressed that aerobic activity should remain the basis of treatment. Osteoarthritis develops when the cartilage that surrounds the ends of bones wears down, leading to swelling, stiffness, and discomfort. It can affect any joint, but the knees are most commonly affected. About 30% of adults over age 45 show signs of knee osteoarthritis on X-rays, and about half of them experience significant pain and problems moving.

Closing the evidence gap in exercise guidelines

Exercise is a cornerstone of osteoarthritis treatment, but many medical guidelines lack clear guidance on which types of knee osteoarthritis specifically are most beneficial. To illustrate this, researchers analyzed the effectiveness and safety of several exercise methods.

Their comprehensive analysis was based on 217 randomized clinical trials conducted between 1990 and 2024. In total, the research included 15,684 participants and compared multiple exercise categories – including aerobic, flexibility, strengthening, mind-body, neurokinetic and mixed programs – against control groups.

Evaluate pain relief, function and mobility

The quality of the trials varied, but the team assessed the strength of the evidence using the internationally recognized GRADE system. They examined several key outcomes: pain reduction, physical function, walking performance, and quality of life. Each was measured at short-term (four weeks), medium-term (12 weeks), and long-term (24 weeks) follow-up periods.

Across these studies, exercise consistently ranked highest in improving outcomes among all types of exercise tested.

Aerobic activities provide the greatest benefits

Moderately certain evidence showed that exercise, compared to control groups, effectively reduced short- and medium-term pain and improved short- and long-term function. It also enhanced gait performance and quality of life over short and medium-term periods.

Other forms of exercise have shown value as well. It is likely that mind-body exercises provided a significant improvement in short-term function, neuromotor exercises likely enhanced walking performance in the short-term, and a strengthening or mixed routine improved function in the medium-term.

Safe and effective for long-term use

Importantly, neither type of exercise resulted in more adverse events than the control groups, suggesting that these treatments are generally safe.

The authors acknowledged some study limitations. Many results came from indirect comparisons, some results lacked long-term data, and smaller studies may have influenced some of the early results.

The obvious takeaway for patients and doctorsDespite these limitations, the researchers describe their work as one of the most complete and up-to-date evaluations of exercise for the management of knee osteoarthritis. They believe the findings will help doctors make more targeted recommendations.

Based on the evidence, the team advises exercise “as a first-line intervention for the management of knee osteoarthritis, especially when the goal is to improve functional ability and reduce pain” and says that if exercise is not possible due to individual limitations, “alternative forms of structured physical activity may still be beneficial.”