People living with knee osteoarthritis may find aerobic activities such as walking, cycling or swimming to be the best way to ease pain, researchers have concluded after monitoring over 15,000 participants.
Aerobic exercises such as walking, cycling and swimming offer the clearest benefits for people living with knee osteoarthritis, delivering greater improvements in pain relief, mobility and long-term function than other forms of exercise – without increasing the risk of side effects – according to new research.
The international review, led by scientists at Zhejiang University in China and published in The BMJ, found that while strength training, flexibility work and mind-body practices such as yoga can all play a role, aerobic activity stood out as the most effective and reliable way to ease symptoms and improve quality of life.
“Aerobic exercise should be the foundation of knee osteoarthritis management,” the researchers concluded, “as it provides the most consistent improvements in pain, mobility, and quality of life.”
What is osteoarthritis?
Osteoarthritis occurs when the cartilage that cushions joints gradually wears down, leading to swelling, stiffness and pain. It can affect any joint but the knees are particularly vulnerable. Around 30% of adults over 45 show signs of knee osteoarthritis on X-rays, and about half of them experience significant pain or mobility problems.
Exercise has long been considered a cornerstone of osteoarthritis care, yet medical guidelines have often lacked clear direction about which types of exercise work best. This new analysis helps fill that gap with evidence favouring aerobic training.
How was the research carried out?
Researchers analysed 217 randomised controlled trials published between 1990 and 2024. Together, these studies included 15,684 participants and compared various exercise programs – including aerobic, flexibility, strengthening, mind-body, neuromotor and mixed routines – against non-exercise control groups.
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Using the internationally-recognised GRADE system to assess evidence quality, the team evaluated several key outcomes: pain reduction, physical function, walking performance and quality of life. They looked at results across short-term (four weeks), mid-term (12 weeks) and long-term (24 weeks) follow-ups.
How did aerobic exercise compare to other exercise?
Across nearly every outcome measured, aerobic exercise came out on top. Evidence that was graded with 'Moderate' certainty (which is only bettered by 'High') showed that aerobic programs significantly reduced pain in the short and mid term, improved function in both the short and long term and enhanced gait and overall well-being.
Other exercise types still offered benefits: mind-body activities such as yoga improved short-term function, neuromotor exercises boosted gait and strengthening or mixed programs helped with mid-term function. But none matched the broad and consistent effects of aerobic activity.
The authors recommend aerobic exercise as the first-line treatment for managing knee osteoarthritis, particularly for those seeking to reduce pain and maintain function. For individuals unable to perform aerobic workouts, alternative forms of structured physical activity can still offer meaningful benefits.
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