Guide
What Are the Best Exercises for Knee Arthritis? What the Research and Guidelines Say
The best exercises for knee arthritis are the ones you will keep doing: a mix of leg strengthening (especially the thigh and hip muscles), low-impact aerobic activity such as walking, cycling or swimming, and gentle mind-body movement like tai chi. Major guidelines from the American College of Rheumatology, the Osteoarthritis Research Society International and the UK's NICE all treat exercise as a core, first-line treatment for knee osteoarthritis. No single exercise has been shown to beat all others, so the right plan is the one that fits your body, your pain level and your routine.
This guide explains what the research shows, which types of exercise are recommended, sample moves to discuss with a physical therapist, and how to handle pain when you start.
Does exercise really help knee arthritis?
Yes. A Cochrane systematic review of land-based exercise for knee osteoarthritis pooled 54 studies. High-quality evidence from 44 trials (3,537 participants) showed that exercise reduced pain immediately after treatment by the equivalent of about 12 points on a 0 to 100 scale, and moderate-quality evidence showed physical function improved by about 10 points. Quality of life also improved, and no study reported a serious adverse event (Fransen et al., Cochrane 2015). The review has since been updated (2024), but its core message that exercise helps has guided practice for years.
Benefits were still present two to six months after programs ended, though they were smaller (about 6 points for pain). That is a good reason to treat exercise as an ongoing habit rather than a short course.
What do the major guidelines recommend?
- American College of Rheumatology / Arthritis Foundation (2019): strongly recommends exercise, weight loss for people with knee or hip osteoarthritis who are overweight, self-management programs, and tai chi. Balance exercises and yoga received conditional recommendations (Kolasinski et al., 2020).
- OARSI (2019): lists structured land-based exercise, with or without dietary weight management, plus arthritis education as core treatments for knee osteoarthritis. Aquatic exercise is also listed as a treatment option for knee osteoarthritis (Bannuru et al., 2019).
- NICE (UK, 2022): says to offer therapeutic exercise tailored to the person, "for example, local muscle strengthening, general aerobic fitness," and to consider supervised sessions (NICE guideline NG226).
Which types of exercise are best for knee arthritis?
1. Strengthening exercises
Strong thigh (quadriceps), hamstring and hip muscles help support and control the knee. NICE specifically names local muscle strengthening as an example of therapeutic exercise. Common moves a physical therapist may suggest include:
- Quad sets: sitting or lying with the leg straight, tighten the front of the thigh to press the back of the knee down, hold a few seconds, relax.
- Straight leg raises: lying on your back with one knee bent, tighten the straight leg and lift it to the height of the other knee, then lower slowly.
- Sit-to-stand: stand up from a sturdy chair and sit back down with control, using your hands for help if needed. A higher seat makes it easier.
- Side-lying leg lifts or clamshells: to work the hip muscles that help keep the knee in line.
- Step-ups: on a low step, holding a rail for balance.
Start with an easy level and a small number of repetitions, then build slowly as the movement gets easier.
2. Low-impact aerobic exercise
Aerobic activity improves overall fitness and is the other example NICE gives of therapeutic exercise. Walking, stationary or outdoor cycling, elliptical training and swimming are all lower-impact options. Many people find it easier to begin with short sessions spread through the day and add time gradually.
3. Water-based (aquatic) exercise
Exercising in a pool takes some load off painful joints. A Cochrane review of 13 trials (1,190 participants) with knee or hip osteoarthritis found moderate-quality evidence that aquatic exercise gave small short-term improvements in pain, disability and quality of life, with no serious adverse events reported (Bartels et al., Cochrane 2016). It can be a useful starting point if land exercise hurts too much.
4. Tai chi, balance work and yoga
Tai chi combines slow, controlled movement, weight shifting and balance. The ACR/Arthritis Foundation guideline gives it a strong recommendation for knee osteoarthritis, and gives balance exercises and yoga conditional recommendations (ACR/AF guideline). These options may also suit people who enjoy group classes.
Is it normal for my knee to hurt when I start exercising?
Some extra discomfort is common at first. NICE advises telling people that joint pain may increase when they start therapeutic exercise, and that regular, consistent exercise will still be beneficial for their joints in the long run (NICE NG226). The Cochrane review noted that the adverse events reported were increased knee or low back pain linked to the exercise program, with no serious adverse events.
Practical ways to manage it:
- Warm up with gentle movement for a few minutes.
- Reduce the range, load or number of repetitions on bad days instead of stopping completely.
- Spread activity through the week rather than doing a lot in one day.
- Stop and get checked if you have sharp pain, the knee gives way or locks, or there is new swelling, warmth or redness.
Should I do exercises on my own or with a physical therapist?
Both can work, but supervision has advantages. NICE recommends considering supervised exercise sessions, and the Cochrane review found that individually delivered programs tended to produce larger improvements in pain and function than class-based or home-based programs. A physical therapist can check your form, tailor the plan to which part of the knee is affected, and progress it safely.
Some therapists combine exercise with hands-on treatment. A recent review we covered found that adding manual therapy to exercise may ease knee arthritis pain in the short term, though not long term. By contrast, a sham-controlled trial found that adding TENS electrical stimulation to exercise gave no extra pain relief. Remote, video-based programs are another option: a small trial found tele-prehabilitation programs improved function in people waiting for joint replacement.
Does losing weight help knee arthritis alongside exercise?
For people who are overweight, yes. The ACR/Arthritis Foundation guideline strongly recommends weight loss for people with knee or hip osteoarthritis who are overweight or obese, and OARSI pairs exercise with dietary weight management as a core treatment. NICE advises that any amount of weight loss is likely to help, but that losing 10% of body weight is likely to be better than 5%. Exercise and diet work best together.
How often should I exercise for knee arthritis?
The guidelines above do not set one fixed prescription, and the trials used many different programs. What matters most is consistency: NICE notes that sticking with an exercise plan increases its benefits for pain, function and quality of life. A practical approach is to do some movement on most days, include strengthening a few times a week, and build up gradually with guidance from a clinician. The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases also lists exercise among the main ways to manage osteoarthritis (NIAMS).
Exercises to be cautious with
High-impact activities such as jumping and repeated deep squats or kneeling may aggravate a painful knee for some people. That does not mean they are forbidden, but it is sensible to start with lower-impact options and ask a clinician before adding high-load moves, especially if you have had knee surgery or have a lot of swelling.
The bottom line
There is no single "best" exercise for knee arthritis. The best-supported plan combines strengthening, low-impact aerobic activity and, if you like it, tai chi or water exercise, done consistently over time. Expect some discomfort at the start, progress gradually, and consider working with a physical therapist to get a plan that fits your knee.
Frequently asked questions
- What is the single best exercise for knee arthritis?
- No single exercise has been shown to be best. Research supports a combination of strengthening, low-impact aerobic exercise and options such as tai chi or water exercise. The best choice is the one you can do consistently.
- Is walking good for knee arthritis?
- Walking is a low-impact aerobic activity, and NICE lists general aerobic fitness as one example of therapeutic exercise for osteoarthritis. Starting with short walks and building up gradually is a common approach.
- Should I exercise if my knee hurts?
- Some extra discomfort when starting is common. NICE advises that pain may increase at first but regular exercise is still beneficial long term. Stop and see a clinician for sharp pain, locking, giving way, or new swelling, warmth or redness.
- Is swimming or water exercise good for knee arthritis?
- A Cochrane review of 13 trials found moderate-quality evidence that aquatic exercise gives small short-term improvements in pain, disability and quality of life for knee and hip osteoarthritis.
- Do I need a physical therapist?
- Not always, but it can help. NICE suggests considering supervised exercise, and the Cochrane review found individually delivered programs tended to give larger improvements than class-based or home programs.
- Can exercise make knee arthritis worse?
- In the Cochrane review of 54 studies, no study reported a serious adverse event from exercise; reported problems were increased knee or back pain. Starting gently and progressing slowly helps.
Sudden severe pain, swelling, or can't bear weight? Seek medical care promptly. In an emergency call 911.