Experts recommend engaging in regular aerobic exercise to enhance function and alleviate pain.
A new study published in The BMJ reports that aerobic exercises such as walking, cycling, or swimming are likely the most effective ways to improve pain, mobility, walking ability, and overall quality of life for people with knee osteoarthritis.
The researchers note that other types of exercise can be beneficial as part of a broader treatment plan, but they should not replace aerobic activity as the primary approach.
Osteoarthritis develops when the smooth cartilage that cushions the ends of bones wears down, leading to pain, swelling, and restricted movement. Although the condition can affect any joint, it is most common in the knees. Nearly 30% of adults over age 45 show signs of knee osteoarthritis on X-rays, and about half of those individuals experience significant pain and related symptoms.
Exercise remains a cornerstone of osteoarthritis treatment, yet current medical guidelines offer little clarity on which specific forms of physical activity provide the greatest benefits. To address this uncertainty, researchers conducted a detailed evaluation of how different exercise types affect patients with knee osteoarthritis, focusing on both their effectiveness and safety.
Study Overview and Methods
Their findings are based on the results of 217 randomized trials published between 1990 and 2024 involving 15,684 participants that compared common exercise therapies (aerobic, flexibility, strengthening, mind-body, neuromotor, and mixed exercise) with a control group.
The trials were of varying quality, but the researchers were able to assess the certainty of evidence using the recognized GRADE system.
The main measures of interest were pain, function, gait performance, and quality of life, assessed at short-term (four weeks), mid-term (12 weeks), and long-term (24 weeks) follow-up.
Overall, aerobic exercise consistently showed the highest probability of being the best treatment across outcomes among the exercise therapies studied in clinical trials.
Moderate certainty evidence showed that, compared with controls, aerobic exercises were beneficial in relieving short-term and mid-term pain, improving short-term, mid-term, and long-term function, and improving short-term and mid-term gait performance and quality of life.
Moderate certainty evidence also showed that mind-body exercise probably results in a large increase in short-term function, neuromotor exercise probably results in a large increase in short-term gait performance, while strengthening and mixed exercise probably result in a large increase in function at mid-term follow-up.
Safety and Limitations
None of the exercise interventions resulted in more adverse safety events than the control group, suggesting that exercise therapy is a safe treatment approach.
The authors acknowledge some limitations. For example, most results come from indirect comparisons, some outcomes lacked long-term data, and small-study effects may have influenced findings at early timepoints.
However, they say this study presents a comprehensive and up-to-date analysis of the effects of exercise intervention as a treatment strategy for knee osteoarthritis, which could assist clinicians in prescribing therapy to improve treatment outcomes for patients.
Given these findings, they suggest aerobic exercise “as a first line intervention for knee osteoarthritis management, particularly when the aim is to improve functional capacity and reduce pain,” and say if aerobic exercise is not possible owing to individual limitations, “alternative forms of structured physical activity may still be beneficial.”
Reference: “Comparative efficacy and safety of exercise modalities in knee osteoarthritis: systematic review and network meta-analysis” by Lei Yan, Dijun Li, Dan Xing, Zijuan Fan, Guangyuan Du, Jingwei Jiu, Xiaoke Li, Janne Estill, Qi Wang, Ahmed Atef Belal, Chen Tian, Jiao Jiao Li, Songyan Li, Haifeng Liu, Xuanbo Liu, Yijia Ren, Yiqi Yang, Jinxiu Chen, Yihe Hu, Long Ge and Bin Wang, 15 October 2025, BMJ.
DOI: 10.1136/bmj-2025-085242
Funding: National Natural Science Foundation of China
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