A new study published in The BMJ has found that aerobic exercises like walking, cycling, and swimming may be the best way to ease pain and improve movement for people with knee osteoarthritis.
The research suggests that these types of exercises can help patients feel better, move more easily, and enjoy a better quality of life.
Osteoarthritis is one of the most common joint diseases, especially in older adults. It happens when the smooth cartilage that protects the ends of bones wears down over time. This leads to pain, stiffness, and swelling in the joints.
The knees are the most commonly affected, with nearly one in three people over the age of 45 showing signs of knee osteoarthritis on X-rays. For many, the pain and loss of movement can make everyday activities difficult, such as walking, climbing stairs, or standing for long periods.
Doctors often recommend exercise as one of the main treatments for osteoarthritis. However, there has long been debate about which type of exercise is best.
Some experts have recommended strength training to build muscle around the knee, while others have focused on stretching, balance, or mind–body exercises like yoga or tai chi. Until now, there has not been enough evidence to say clearly which kind of exercise works best for pain and movement.
To find out, researchers reviewed data from 217 clinical trials conducted between 1990 and 2024. These trials involved over 15,000 people with knee osteoarthritis.
The researchers compared different types of exercises, including aerobic, flexibility, strengthening, mind–body, neuromotor (balance and coordination), and mixed routines. They looked at how these exercises affected pain, physical function, walking performance, and quality of life.
The results were clear: aerobic exercises showed the strongest and most consistent benefits across nearly all areas. People who did aerobic activities such as walking, cycling, or swimming had less pain, better movement, and improved walking ability.
These benefits were seen both in the short term (after a few weeks) and in the long term (after several months). People also reported feeling more confident and having a better quality of life.
The study also found that other types of exercise can still be helpful. Mind–body exercises, like yoga and tai chi, improved short-term physical function, while neuromotor exercises boosted balance and coordination.
Strength training and mixed routines were found to improve function at mid-term follow-up. However, none of these were as consistently effective as aerobic activities.
Importantly, all forms of exercise were found to be safe. None of the trials reported more side effects from exercise compared with people who didn’t exercise. This shows that physical activity is a safe and effective option for managing knee osteoarthritis.
The researchers noted some limitations. Many studies relied on indirect comparisons, and some did not include long-term data. Smaller studies might also have influenced early results.
Even so, this is one of the most complete and up-to-date reviews of exercise therapy for knee osteoarthritis to date. The findings provide strong evidence that aerobic exercise should be the first choice for most patients.
The research team recommends aerobic exercises as a first-line treatment for knee osteoarthritis, especially for improving daily movement and reducing pain. They also note that if aerobic exercise is difficult due to other health problems, patients can still benefit from alternative forms of structured activity such as stretching or mind–body exercise.
Overall, this study reinforces the importance of regular movement for joint health. Instead of relying only on medication or rest, people with knee osteoarthritis can take an active role in managing their condition.
Walking around the neighborhood, swimming a few laps, or cycling at an easy pace could be some of the best ways to protect knee health, reduce pain, and stay active as we age.
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The study is published in The BMJ.
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