These Exercises Are Best for Knee Pain, Research Finds

“We kept seeing guidelines say, ‘Exercise is a core treatment for knee osteoarthritis,’ but very little clarity on which exercise to prioritize,” says Bin Wang, PhD, a professor of orthopedic surgery at Zhejiang University School of Medicine in Hangzhou, China. Dr. Wang and fellow researchers dove into data from more than 200 clinical trials to find an answer.

What Are the Best Exercises for Knee Osteoarthritis?

The research team analyzed data from 217 randomized exercise trials involving more than 15,500 people with knee osteoarthritis. Those exercises were categorized as:

• Aerobic
• Neuromotor activities like dance, which require balance and coordination
• Flexibility-focused
• Strength training
• Mind-body practices like yoga
• Some combination of the above

The researchers looked at measurements of pain, mobility, impact on gait, and quality of life at 4 weeks, 12 weeks, and 24 weeks.

They found that aerobic exercise consistently came out as the best treatment across all those factors.

Compared with controls (participants who weren’t given any prescribed exercise plan), the evidence suggested that aerobic exercises like walking, swimming, and cycling were helpful at relieving pain after 4 and 12 weeks, improved function and mobility throughout the study periods, and improved gait and quality of life in the short-term and mid-term.

The other exercises still had benefits, though:

• Mind-body exercise like yoga and tai chi improved short-term function
• Neuromotor exercise helped with gait in the short-term
• Strength training and mixed exercises led to large increases in function during the 12-week follow-up

“Overall, aerobic exercise consistently showed the highest probability of being the best treatment,” the researchers wrote.

Low-Impact Cardio Is Ideal for Knee Pain, Doctors Say

Wang says it was difficult to distinguish different types of cardio in the study, but he and other doctors agree that walking, cycling, and swimming are some of the best options for knee osteoarthritis, especially the last two.

“Activity modification is very important when we’re treating arthritis, and a big part of that is doing things that are less irritating to the knee,” says Clint Soppe, MD, an orthopedic surgeon and sports medicine specialist at Cedars-Sinai Orthopaedics in Los Angeles. “Forces through the knee can cause pain.”

Exercises like walking, cycling, and swimming put less impact on the knee, while stimulating the production of synovial fluid, which lubricates the joints, explains Joseph J. Ciotola, MD, an orthopedic surgeon at Baltimore's Mercy Medical Center in Maryland. “It’s a little oil for rusty hinges,” he says.

“Movement is good, and low-impact exercises are even better because they don’t cause the cartilage to wear out while hydrating the joints,” Dr. Ciotola says.

Activity can also help the body release endorphins, “which are the body’s natural painkillers,” says Adenrele Olajide, MD, an assistant professor of rheumatology and immunology at Vanderbilt University Medical Center in Nashville, Tennessee.

Each Exercise Offers Its Own Perks

“Walking is a low-impact exercise which helps to improve circulation, reduce joint stiffness, and increase muscle strength,” Dr. Olajide says. Cycling helps build and strengthen muscles, while lowering the stress of the body’s weight on the knee, he adds.

Swimming is also a “nearly weightless” exercise that is still good for synovial fluid production and cardiovascular benefits, Dr. Soppe says.

If you have to choose between the three, Soppe recommends cycling and swimming over walking. “Walking isn’t as good with arthritis compared with cycling and swimming because there is more impact-loading,” he says. “It is still good to do a weight-bearing activity like this, but I don’t recommend it as much as the other exercises.”

How to Keep Moving Once Cold Weather Sets In

Cold weather can aggravate joint pain and make it more challenging to get outside. Doctors suggest taking workouts indoors during the winter months whenever possible.

“An indoor recombinant bike is usually what I recommend because it burns calories, helps strengthen the quads and is a little easier on the body,” Ciotola says.

For swimming, Soppe suggests joining a gym with an indoor pool, if possible. If there’s snow on the ground, he also recommends taking up cross-country skiing and snowshoeing. “Snow creates less of an impact, which is easier on the knees,” he says.

Yoga, Pilates, weight training and other low-impact exercises can also be helpful, Soppe says. Ultimately, doctors recommend doing what you can to stay mobile and reduce stress on your knee joints. “Movement is good for the knees,” Ciotola says.