Best Exercises for Knee Arthritis: What Science Says
- Michael Dilworth
- Dec 12, 2025
- 6 min read
You walk down the stairs in the morning and feel that familiar ache in your knee. Maybe there’s a crunch, a pinch, or just a stiff, heavy feeling that makes you grab the handrail a little tighter. Part of you wants to move more. Part of you is scared you’ll make it worse. Maybe you’ve even Googled “best exercises for knee arthritis” and found a hundred different answers.
I’m Coach Michael, a spinal-fusion survivor and personal trainer. I work with adults 35 and up who are juggling aches, injuries, and a real fear of getting hurt again. If that’s you, I want to walk you through what a big 2025 study actually found about exercise and knee arthritis, and how we can use it in real life without playing “no pain, no gain.” [1]
Before we dive in, a quick disclaimer: This article is for education, not medical advice. I’m a personal trainer and corrective exercise specialist, not a doctor. If you’ve had surgery, injections, severe arthritis, or other medical conditions, please check in with your doctor or surgeon before making big changes to your exercise routine.
When Your Knees Hurt, Moving Feels Risky
Knee pain doesn’t just live in the joint. It shows up when you’re getting off the couch, going down the stairs, pushing a grocery cart, or trying to keep up on a walk with family.
You might feel:
Frustrated that “simple” things now feel hard
Scared you’re wearing your knees out faster
Ashamed or annoyed that you’re slower than you used to be
Stuck between “I know I should exercise” and “I don’t want to wreck my joints”
If you’ve also had back issues, you might worry that limping or “babying” one leg will flare your back up too. You’re not imagining it, how you move at your knees absolutely affects how your spine feels over time.
That’s why the question isn’t “exercise or rest?” The real question is: what kind of exercise, how much, and how do we do it safely?
What This Big Study Found About Exercise and Knee Arthritis
In 2025, researchers combined 217 clinical trials with over 15,000 people who had knee osteoarthritis. They wanted to know which exercise types were most effective and safe for knee arthritis. [1]
Who was studied and what they tried
Participants were mostly middle-aged and older adults with diagnosed knee osteoarthritis. They compared:
Aerobic exercise (walking, cycling, pool walking, etc.)
Strength training
Flexibility/stretching
Mind–body exercise (Tai Chi, yoga, Pilates)
Balance/neuromotor training
Mixed programs combining several of these
Control groups who didn’t do structured exercise
Most programs ran somewhere in the 4–24 week range.
The clear winner: low-impact aerobic exercise
Across the board, low-impact aerobic exercise came out on top for:
Reducing knee pain
Improving everyday function (walking, getting around)
Improving walking performance
Boosting overall quality of life
In plain English: steady, low-impact movement like walking or cycling helped the most, especially over the first 3 months.
Where strength, balance, and mind–body work fit in
That doesn’t mean strength or stretching are useless. The study also found:
Strength training and mixed programs improved function a lot
Mind–body exercise (like Tai Chi) helped with function and confidence
Balance/neuromotor training improved walking and control
So aerobic work was the overall MVP, but the supporting cast, strength, balance, and mind–body work, still had important roles.
So What Are the Best Exercises for Knee Arthritis?
When you pull all this together, the best exercises for knee arthritis form a team, not a single magic move.
Aerobic work: walking, cycling, and pool options
Aerobic work is your base:
Brisk walking on flat ground or a treadmill
Stationary cycling or a recumbent bike
Pool walking or shallow-water aerobics
These help circulation, lubricate the joint, and train your body to move without loading the knee with big impacts. The study suggests that this type of exercise made the biggest difference in pain and function.
Strength work: building “knee armor” with muscle
Muscle acts like active armor around the joint. Smart strength work might include:
Sit-to-stands from a chair
Short-range squats
Step-ups to a low step
Hip strengthening (bridges, standing hip abductions)
Stronger legs mean your joints don’t have to do all the work. The study showed that when people did strengthening programs, their ability to function in daily life improved significantly. [1]
Balance and mind–body work for confidence and control
Balance and mind–body exercises help you feel more stable and less fearful:
Heel-to-toe walking
Single-leg balance with light support
Tai Chi or gentle yoga flows
These modes showed clear benefits for function and walking control in the research.
What This Means If You’re 35+ With Knee Pain
If you’re in your 40s, 50s, 60s, or beyond, the goal isn’t to become a marathon runner. It’s to keep doing the things that make life feel like your life, walking with family, climbing stairs, playing with grandkids, moving around your home confidently.
If you’ve had a spinal fusion or chronic back pain, the way your knees move matters even more. When knee pain makes you twist, lean, or avoid loading one leg, your spine can pay the price later.
So here’s how I’d translate this study into real life for someone like you:
We don’t avoid movement; we choose the right movement. The research is very clear that exercise, done well, is safe and helpful for knee arthritis.
We build your “movement budget” slowly. Instead of going from zero to an intense class, we start with short, low-impact sessions and build up.
We respect your back as much as your knees. That means using hip-hinge patterns, good posture, and controlled ranges of motion, especially if you have fused segments.
You don’t have to pick between “wrecking your knees” and “losing all your fitness.” There’s a middle path.
Where to Start: Small, Safe Steps You Can Take This Month
You don’t need a perfect program to begin. You need a reasonable one. Here’s a simple way to get started, based on the kinds of exercise that did well in the research.
Try this: a simple starter plan
Week 1–2: Build the habit
10–15 minutes of easy walking, 3–4 days per week (treadmill, track, or outdoors if it’s safe and flat).
1–2 sets of 8–10 sit-to-stands from a sturdy chair, 2–3 days per week.
20–30 seconds of heel-to-toe balance, 1–2 times per day.
Week 3–4: Gently progress
Increase walks to 15–20 minutes if your knees tolerate it.
Add a low step-up (4–6 inches) for 1–2 sets of 6–8 reps per leg.
Add a simple mind–body element: 5 minutes of gentle, slow-paced movements (like Tai Chi-style weight shifts or a very gentle yoga flow).
As you go, keep these guidelines in mind:
Aim for discomfort that feels manageable, not sharp or biting pain.
Mild soreness the next day is okay; big spikes or limping are signals to back off.
If you have a significant back history, avoid deep bending, twisting, or sudden impact, and get clearance from your doctor before starting.
The research tells us that consistent, low-impact aerobic exercise plus some strength and balance is a smart, science-backed strategy. That’s what I mean when I talk about the best exercises for knee arthritis, they’re joint-friendly, repeatable, and build you up instead of breaking you down.
You Don’t Have to Figure This Out Alone
If you’re feeling confused, you’re not failing. The fitness world throws a lot at you: “never run again,” “just rest,” “lift heavy or it doesn’t count,” and everything in between.
Here’s what I want you to hear:
You’re allowed to be cautious. You’re allowed to be hopeful. You’re allowed to ask for help.
If you’d like support putting this into a plan that respects your knees, your back, and your real life, consider reaching out to a qualified coach who understands older and middle-aged bodies, injuries, and fear of getting hurt. That might mean contacting a trainer you trust, booking a consultation, or sharing this article with your healthcare team and asking how exercise can fit into your overall plan.
You don’t have to move like you did at 20. But you absolutely can build a stronger, more confident version of the body you have now, one walk, one sit-to-stand, one joint-friendly session at a time.
REFERENCES
[1] Yan L, Li D, Xing D, et al. Comparative efficacy and safety of exercise modalities in knee osteoarthritis: systematic review and network meta-analysis. BMJ. 2025;391:e085242. Available from: PubMed Read My Summary