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Regular, tailored therapeutic exercise is a well-supported way to reduce knee osteoarthritis symptoms and improve function without relying on pills or surgery. It is not a cure, and results are not guaranteed or immediate, but guidelines recommend exercise as a core part of care. The right plan can include strengthening and aerobic activity, adjusted to your abilities and needs.
Why exercise can help knee arthritis
Knee osteoarthritis can make movement uncomfortable, and pain may increase when you first begin exercising. That does not necessarily mean the activity is harming the joint. NICE advises clinicians to explain that consistent therapeutic exercise can benefit joints and that sticking with it over time can improve pain, physical function, and quality of life.
NICE recommends therapeutic exercise for everyone with osteoarthritis, tailored to individual needs. Its examples include local muscle strengthening and general aerobic fitness. The American Academy of Orthopaedic Surgeons likewise supports supervised, unsupervised, or aquatic exercise over no exercise for improving pain and function in knee osteoarthritis.
What kinds of exercise should you consider?
There is no single exercise type or ideal dose that guidelines establish as best for every person. The American College of Rheumatology and Arthritis Foundation support exercise broadly but say the evidence is insufficient to recommend one specific exercise prescription. A useful plan is one you can do safely and consistently, with adjustments for your symptoms, fitness, access, and preferences.
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Strengthening
Local muscle strengthening is one example NICE gives of therapeutic exercise. A clinician or physical therapist can help choose movements that suit your knee and current ability. Resistance bands may be used as an optional aid, but equipment is not required and guidelines do not specifically recommend bands over other ways of strengthening.
Aerobic and aquatic activity
General aerobic fitness is another NICE example. The AAOS guideline overview supports aquatic exercise as one option, alongside supervised or self-directed exercise. Choose an approach that fits your circumstances rather than assuming one format is superior for everyone.
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Supervised or self-directed exercise
Exercise may be done on your own or with support. NICE says supervised therapeutic exercise sessions may be considered and recommends considering exercise alongside education or behavior-change support. If you are unsure how to start, have trouble adapting activity to your symptoms, or would benefit from accountability, ask a healthcare professional about supervised options.
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- Discuss your starting point. If you have substantial pain, other health conditions, or uncertainty about suitable activity, ask a healthcare professional to help tailor a plan.
- Choose a manageable approach. Consider strengthening, aerobic activity, aquatic exercise, or a combination. The plan should fit your needs and what you can access.
- Expect a possible adjustment period. NICE notes that pain may increase when therapeutic exercise begins. Ask for advice if you are concerned about how your symptoms respond; do not assume you need to push through every level of pain.
- Build consistency over time. NICE says long-term adherence increases the benefits for pain, function, and quality of life. Regularity matters more than chasing a supposedly universal routine.
- Add support if useful. Education or behavior-change support, and possibly supervised sessions, can help you follow a plan suited to you.
When weight management may also help
For people with osteoarthritis who are living with overweight or obesity, NICE says any amount of weight loss is likely to help symptoms. It also states that “losing 10% of their body weight is likely to be better than 5%.” This is specific to that group, not a weight-loss target for everyone. The ACR/Arthritis Foundation guideline describes a dose-response pattern and says combining exercise with weight loss enhances the effect of weight loss on osteoarthritis symptoms.
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Exercise is important, but it is not a reason to avoid care
Exercise is a core non-surgical management option, not a guarantee that you will never need medication or surgery. If knee symptoms substantially affect your quality of life and non-surgical management is ineffective or unsuitable, NICE says clinicians should consider referral to discuss joint replacement. An individualized care plan can include exercise while also addressing other appropriate options.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.Sources and scope
- NICE guideline NG226: Osteoarthritis in over 16s, recommendations (published 2022).
- American Academy of Orthopaedic Surgeons: Management of Osteoarthritis of the Knee, guideline overview (published 2021).
- American College of Rheumatology and Arthritis Foundation: 2019 Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee (published 2020).
These are clinical guidelines supporting tailored exercise approaches, not evidence that one branded program, device, or routine guarantees a particular amount or speed of relief.
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