What exercises are recommended for knee arthritis?

Recommended Exercises for Knee Arthritis

For patients with knee osteoarthritis, a comprehensive exercise program should include low-impact aerobic exercises, quadriceps strengthening, and range-of-motion exercises to reduce pain and improve function. 1

Core Exercise Components

Aerobic Exercise

• Low-impact aerobic exercises such as walking, cycling, and swimming are strongly recommended for reducing pain and improving function in knee osteoarthritis 1
• Aerobic exercise has demonstrated statistically significant effects on pain relief (effect size 0.52) and disability reduction (effect size 0.46) 1
• Aim for 30-60 minutes of moderate-intensity aerobic activity most days of the week 1
• Aquatic exercises performed in warm water (86°F) provide additional pain relief through buoyancy that reduces joint loading 1

Strengthening Exercises

• Quadriceps strengthening exercises are specifically recommended for knee osteoarthritis and show significant improvements in pain and function 1
• Home-based quadriceps exercises that can be performed include:
  • Quad sets: Squeeze the muscles on top of thigh, hold for 6-7 seconds, then relax 1
  • Short-arc quad sets: Place a firm pillow under the knee, straighten leg, hold for 6-7 seconds 1
  • Long-arc quad sets: Sitting with back straight, slowly lift foot until leg is straight, hold for 6-7 seconds 1
  • Closed-chain exercises: Partial squats with back support 1
• Perform strengthening exercises 3-5 times per week, 5-7 repetitions per exercise, 3-5 times daily 1

Range-of-Motion/Flexibility Exercises

• Range-of-motion exercises are conditionally recommended to address joint stiffness and limited motion 1
• While specific evidence is limited (Level V evidence), these exercises have low cost and limited harms 1
• Focus on gentle stretching of muscles around the knee joint 1

Implementation Strategy

Exercise Delivery Methods

• Supervised exercise programs are more effective than self-directed programs 1, 2
• Individually delivered programs tend to result in greater pain reduction and functional improvement compared to class-based or home-based programs 3
• Aim for at least 12 supervised sessions for optimal results 4
• Exercise should be performed at least 3 times per week for maximum benefit 5

Exercise Progression

• Start with exercises within your capability and gradually increase intensity over several months 4
• Begin with low resistance and increase as strength improves 1
• Avoid high-impact activities that involve rapid loading of the joint 1

Additional Therapeutic Approaches

Weight Management

• Weight loss is strongly recommended for patients with knee osteoarthritis who are overweight (BMI >25) 1
• A minimum 5% reduction in body weight can significantly improve function 1
• Combine dietary modification with exercise for optimal results 1

Self-Management Programs

• Participation in self-management education programs is conditionally recommended 1
• These programs help with goal-setting, problem-solving, and coping strategies 4

Special Considerations and Caveats

• Pain during exercise should not prevent participation, as clinical trials demonstrate improvements even in patients with pain 1
• However, high-impact exercises should be avoided as they may increase joint damage 1
• Exercise programs should be modified if they exacerbate pain significantly 1
• While various exercise types (aerobic, resistance, performance) show similar efficacy, single-type exercise programs appear more effective than mixed programs 5
• Balance exercises may be included as a complementary component, especially for older adults 1

Exercise Selection Algorithm

1. For patients with minimal pain and good mobility: Focus on low-impact aerobic exercise (walking, cycling) plus quadriceps strengthening 1, 5
2. For patients with moderate pain: Begin with aquatic exercises and gentle strengthening, then progress to land-based exercises as tolerated 1, 2
3. For patients with severe pain or limited mobility: Start with seated or lying strengthening exercises and range-of-motion exercises before progressing to weight-bearing activities 1