What Is the Best Exercise for Knee Arthritis? What the Evidence Says
By Emma - The Hip & Knee Physio
If you have knee arthritis, you have probably been told to exercise.
That advice is correct, but not particularly helpful.
Should you walk? Cycle? Strengthen your quadriceps? Stretch? Swim? Do Pilates? And if one exercise is good, naturally the internet would quite like to know which one is the best exercise for knee arthritis.
A large 2025 review published in the BMJ gives us an interesting answer. Across more than 15,000 people with knee osteoarthritis, aerobic exercise performed particularly well for pain, function, walking performance and quality of life.
But I would not interpret that as “cardio beats strength”.
The more useful message is that good knee arthritis rehab should build several things at once: fitness, strength, movement and the capacity to do the activities that matter to you.
I am Emma Glynn, an APA Titled Musculoskeletal Physiotherapist in Camberwell. I work exclusively with hip and knee conditions, and I regularly see people who have been given a sheet of exercises but still do not know how those exercises are supposed to help them get back to walking, stairs, the gym, hiking or running.
In brief: what is the best exercise for knee arthritis?
There probably is not one exercise that deserves the title.
The latest research suggests aerobic exercise such as walking, cycling or swimming can be particularly effective overall, while strengthening and mixed exercise programs also improve function.
In practice, I usually think about knee arthritis exercise in four areas:
Aerobic exercise to build walking and cardiovascular capacity
Strength training for the quadriceps, hips and calves
Functional exercise for things such as stairs, chairs, hills and balance
Mobility work where stiffness is actually limiting movement
The best exercise program is the one that addresses what your knee is struggling with and can be progressed without repeatedly flaring your symptoms.
If you are looking for specific exercise examples, rather than the evidence comparing different exercise types, my Knee Arthritis Exercises: What Helps and What to Modify guide covers that in more detail.
What did the latest research find?
A 2025 systematic review and network meta-analysis published in the BMJ compared different types of exercise for knee osteoarthritis.
The researchers included 217 randomised controlled trials involving 15,684 participants.
They compared:
Aerobic exercise
Strengthening exercise
Flexibility exercise
Neuromotor exercise
Mind-body exercise
Mixed exercise programs
Aerobic exercise had the strongest overall ranking across pain, physical function, walking performance and quality of life.
Strengthening and mixed exercise were also associated with meaningful improvements in physical function.
That is important because it supports something I think often gets lost in knee arthritis rehabilitation:
Exercise is not simply about making the quadriceps stronger. Your ability to walk, move, tolerate activity and maintain cardiovascular fitness matters too.
Does that mean cardio is better than strength training?
Not quite.
Network meta-analyses allow researchers to compare several treatment types, including some that have not been compared directly in every study. They are extremely useful, but they should not be interpreted as proving that every person with knee arthritis should prioritise aerobic exercise over strength training.
There was also variation in the quality of the included studies, the exercise programs used and the people taking part.
Most importantly, different forms of exercise target different problems.
If you can walk comfortably for an hour but struggle badly to get out of a chair because your quadriceps are weak, simply adding more walking may not address your biggest limitation.
If you have strong legs but can only tolerate ten minutes of walking before your knee becomes uncomfortable, adding aerobic capacity may matter more.
If stairs are the main issue, you may need a combination of strength, control and task-specific loading.
Rather than asking which exercise type wins, I would ask which physical capacity is currently limiting you.
1. Aerobic exercise
Aerobic exercise includes activities such as:
Walking
Cycling
Swimming
Pool exercise
Cross trainer
Other sustained activities that increase your heart rate
The BMJ review found particularly strong overall results for aerobic exercise.
This makes sense clinically. Knee arthritis can gradually shrink someone's activity world.
A 40-minute walk becomes 20 minutes. Hills disappear. Shopping centres become strategic military operations. Eventually, general fitness falls as well as leg strength.
Aerobic exercise can help maintain or rebuild that capacity.
For many people with knee arthritis, the aim should be to find a form of aerobic activity they can perform consistently rather than searching for a theoretically perfect option.
Is walking good for knee arthritis?
Walking can be an excellent option if your knee tolerates it.
It is accessible, relevant to everyday life and easy to progress through changes in duration, pace, frequency, terrain and hills.
But walking is not automatically the best choice every day.
If a 40-minute walk repeatedly leaves your knee substantially more painful or swollen later that day or the following morning, that does not mean walking is damaging your knee. It may simply mean the current dose is too high.
You might temporarily:
Walk for less time
Split one long walk into two shorter walks
Choose flatter terrain
Slow the pace
Alternate walking and cycling
Build up more gradually
I cover this in more detail in my guide to walking with knee arthritis.
2. Strength training
Aerobic exercise performing well in one review does not make strengthening unimportant.
The quadriceps, glutes and calves all contribute to activities such as:
Walking
Getting out of chairs
Climbing stairs
Going downhill
Hiking
Gym training
Running
The BMJ review also found that strengthening exercise probably improves physical function at medium-term follow-up.
If weakness is limiting what you can do, strength training should usually form part of your knee arthritis rehabilitation.
Common exercises might include:
Sit-to-stand or squats
Leg press
Knee extension
Step-ups
Calf raises
Hip strengthening
The particular exercise matters less than whether it is appropriate for you, loaded sufficiently to create an adaptation, and progressed over time.
Doing the same easy set of ten exercises indefinitely because someone printed them on an A4 sheet in 2019 is technically exercise. It is not necessarily a progressive rehabilitation program.
3. Functional and balance exercise
Strength in the gym is useful, but ultimately we want that capacity to transfer back into life.
That might mean being able to:
Walk down stairs confidently
Get out of a low chair
Walk downhill
Carry shopping
Garden
Play golf
Hike
Travel
Return to sport
This is where functional and neuromotor exercise can be valuable.
Examples may include:
Step-ups
Step-downs
Single-leg balance
Split squats
Direction changes
Uneven-surface work
Stair practice
Walking at different speeds
The BMJ review found that neuromotor exercise also performed well for some measures of walking performance.
Your exercise program should eventually resemble the things you are trying to get better at.
A calf raise may build calf strength. It does not magically teach you to hike down Mount Macedon for three hours. At some stage, rehabilitation needs to become specific.
4. What about stretching and mobility?
Stretching can feel good when a knee is stiff, but stretching alone is rarely the whole answer for knee osteoarthritis.
Mobility work may be helpful if you have genuinely lost knee movement, particularly if you struggle to straighten the knee fully or bending has become restricted.
Examples might include:
Gentle knee bending
Knee extension work
Calf mobility
Movement after prolonged sitting
Easy cycling for repeated knee movement
Mobility exercise is most useful when restricted movement is actually one of the problems you need to solve.
If your knee already moves well, spending most of your rehabilitation stretching rather than improving strength, fitness or function is unlikely to be the best use of your time.
Should exercise hurt if you have knee arthritis?
Exercise does not always need to be completely pain-free.
The Australian Osteoarthritis of the Knee Clinical Care Standard specifically advises that exercise is safe for people with knee OA, including people with severe osteoarthritis, and that exercise can be adjusted according to symptoms.
That does not mean you should simply grit your teeth through escalating pain.
I am usually more interested in how your knee responds.
Ask:
Was the discomfort manageable while exercising?
Did you start limping afterwards?
Did the knee swell substantially?
Did your normal walking become harder?
Was the knee clearly worse later that day?
Was it back around baseline by the following day?
A little discomfort may be acceptable. A program that repeatedly produces significant flare-ups usually needs adjusting.
That adjustment might involve changing:
Load
Range
Repetitions
Sets
Walking duration
Exercise frequency
Recovery between sessions
The exercise itself
Is walking enough for knee arthritis?
Sometimes it is a very good starting point.
But for many people, walking alone will not address everything.
Walking provides repetitive aerobic activity, but it may not provide enough stimulus to rebuild substantial quadriceps, calf or hip strength.
That is why I generally prefer a combination of aerobic activity and strengthening rather than treating the two as competitors.
Walking builds your ability to walk. Strength training builds some of the physical capacity that helps make walking, stairs and daily activity easier.
They complement each other.
What if you want to hike, run or train at the gym?
This is where the idea of one “best exercise” becomes particularly unhelpful.
Someone who wants to walk around the neighbourhood comfortably needs a different endpoint from someone who wants to hike, ski, play tennis or run.
For an active adult with knee arthritis, rehabilitation may eventually need to include:
Heavier strength training
Single-leg exercises
Step-down control
Hills
Longer-duration aerobic work
Faster walking
Impact preparation
Sport-specific loading
Knee arthritis does not automatically mean those activities are forbidden.
If running is one of your goals, I have also written about whether you can keep running with knee osteoarthritis.
Your diagnosis should inform your exercise plan, not automatically shrink your goals.
How much exercise should you do?
There is no single dose that works for everyone with knee arthritis.
Australian clinical guidance recommends tailoring physical activity and exercise to the individual's needs, preferences and clinical situation, while using a sufficient dose and duration to improve fitness and strength.
That is the important bit.
Exercise needs to be:
Tolerable enough that you can keep doing it
Challenging enough to create adaptation
Progressive as your capacity improves
Relevant to your goals
Someone who is currently struggling to walk for ten minutes should not be handed the same starting program as someone who is still playing doubles tennis three times a week.
The correct dose is determined by your starting point and your response, not simply by your diagnosis.
So what is the best knee arthritis exercise program?
For most people, I would not choose between cardio and strength.
I would build a program that addresses the different physical qualities needed to reach their goals.
That might include:
Aerobic work
Walking, cycling, swimming or another tolerable form of cardiovascular exercise.
Strength
Progressive exercises targeting the quadriceps, hips and calves.
Function
Exercises that build capacity for stairs, chairs, hills, balance and whatever activities matter to you.
Mobility
Enough movement to maintain or improve useful knee range where required.
Progression
Gradually increasing the challenge as your knee adapts.
Knee arthritis rehabilitation should be multi-dimensional because the things people want to return to are multi-dimensional too.
If you want examples of how those elements can be turned into a practical program, read my knee arthritis exercises guide.
For a broader overview of treatment beyond exercise, my guide to non-surgical treatment for knee osteoarthritis explains the other options that may form part of management.
When should you get your knee assessed?
If you are exercising comfortably, making progress and doing the things you want to do, you may not need someone to complicate matters.
An assessment becomes more useful if:
Walking distance is falling
Stairs are increasingly difficult
The knee repeatedly swells after activity
Gym exercises keep flaring symptoms
You have stopped hiking, running or sport because of the knee
You are unsure how hard to exercise
You have tried generic exercises without progressing
You have been told you have arthritis but do not have a clear plan
The aim of an assessment is not simply to give you more exercises. It is to work out what is limiting you and build a plan around that.
You can learn more about how I approach knee osteoarthritis on my Knee Osteoarthritis page.
If knee arthritis is limiting your walking, stairs, gym, hiking, running or the activities you want to keep doing, you can book an in-person knee assessment with me in Camberwell.
Emma
References
Australian Commission on Safety and Quality in Health Care. (2024). Osteoarthritis of the knee clinical care standard. Australian Commission on Safety and Quality in Health Care.
Yan, L., Li, D., Xing, D., Fan, Z., Du, G., Jiu, J., Li, X., Estill, J., Wang, Q., Belal, A. A., Tian, C., Li, J. J., et al. (2025). Comparative efficacy and safety of exercise modalities in knee osteoarthritis: Systematic review and network meta-analysis. BMJ, 391, e085242. https://doi.org/10.1136/bmj-2025-085242
Medical disclaimer
This article provides general educational information and does not replace individual medical advice, diagnosis or treatment. Exercise should be adapted to your symptoms, medical history, physical capacity and goals. Seek medical assessment for new severe pain, a hot or markedly swollen knee, inability to weight-bear, significant trauma, fever, calf swelling, shortness of breath, true locking, or other symptoms that concern you.
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