Knee Arthritis Exercises: A Safe Way to Start

Ask the world’s major treatment guidelines what to do first about an arthritic knee, and the answer isn’t a pill, an injection, or an operation. The UK’s NICE guideline names therapeutic exercise — alongside weight management where appropriate, plus information and support — as a core treatment for osteoarthritis (NICE NG226). Which is exactly why searching for knee arthritis exercises feels so frustrating: everyone agrees you should move, and almost nobody explains how to start when the knee in question complains about stairs. That’s what this guide is for — the exercise types research keeps coming back to, what a structured program actually looks like, and the honest version of what the evidence does and doesn’t show.

What the guidelines actually say

The American Academy of Orthopaedic Surgeons lists exercise among recommended treatments for knee arthritis to help with pain and function, and suggests a practical trade rather than a shutdown: swap high-impact activities like jogging or tennis for lower-impact ones like swimming or cycling, so you stay active while putting less stress on the knee (AAOS OrthoInfo). NICE goes a step further on the “what”: exercise should be offered to all people with osteoarthritis, tailored to their needs — naming local muscle strengthening and general aerobic fitness as examples — and supervised sessions should be considered (NICE NG226).

Neither source promises a specific result, and neither will this article. AAOS is plain that arthritis has no cure — the goal of treatment is managing symptoms and staying active (AAOS OrthoInfo). Exercise is associated with improved pain and function in research; how much any one person improves varies, and some people improve little.

Knee arthritis exercises the research keeps coming back to

A 2025 umbrella review in BMJ Open pulled together 58 systematic reviews of exercise therapy for knee osteoarthritis — the widest recent lens on this question. Two types dominated the studied programs: muscle-strengthening exercise appeared in 74.1% of them and aerobic exercise in 48.2%, and 63.7% of the reviews reported that exercise therapy improved all the outcomes they measured (BMJ Open 2025). AAOS adds a third ingredient: balance, agility, and coordination work, combined with traditional exercise, may help improve function and walking speed (AAOS OrthoInfo).

Honest caveat, because you deserve the whole picture: the same umbrella review judged 87.4% of those systematic reviews to be critically low quality by formal standards, and concluded the current evidence is inadequate to crown any one exercise type the winner — while still noting exercise therapy can be considered for conservative treatment (BMJ Open 2025). The research argument isn’t “exercise is magic.” It’s that exercise is the most consistently recommended starting point, with few reported downsides.

A safe way to start: three moves before any workout

1. Get a green light and a starting point. Check with your clinician before beginning — AAOS notes that a clinician or physical therapist can develop an individualized program based on your needs and lifestyle, which beats guessing at one (AAOS OrthoInfo).
2. Trade impact, don’t trade away movement. Start with the lower-impact options — pool work, a stationary bike, flat walking — rather than reintroducing running or court sports on day one (AAOS OrthoInfo).
3. Expect the knee to grumble at first — and say so out loud. NICE specifically advises telling people that joint pain may increase when they first start therapeutic exercise (NICE NG226). That early protest is a known part of starting, not automatically a sign of damage. If anything about it worries you, stop and check with your clinician rather than pushing through or quitting quietly.

What a structured program looks like

If you want a picture of “doing this properly,” Denmark built one at national scale. The GLA:D program — Good Life with osteoArthritis in Denmark — combines patient education with 12 supervised neuromuscular exercise sessions: twice a week, about 60 minutes each, over 6 weeks, delivered by trained physiotherapists (GLA:D, BMC Musculoskeletal Disorders). The program’s design leans on what its authors describe as strong evidence from more than 50 randomized controlled trials supporting exercise for knee osteoarthritis.

Its registry results are encouraging, with an asterisk. Participants reported pain intensity improving by about 12 points on a 100-point scale at three months and about 14 points at twelve months, alongside measurable gains in walking speed and sit-to-stand ability (GLA:D). The asterisk: the evaluation had no control group, and the authors themselves note that likely overestimates the specific treatment effect. Two details matter more for you than any single number. First, exercise was feasible for people at all severity levels — including those already eligible for knee replacement. Second, adverse events related to exercise were described as uncommon, mild, and temporary (GLA:D). Across the wider evidence, the 2025 umbrella review similarly found the number of intervention-related adverse events was small, with knee joint pain the most frequently reported one (BMJ Open 2025).

You don’t need to live in Denmark to borrow the shape: education plus supervised, progressive exercise a couple of times a week, for weeks — not a random YouTube workout on an angry Tuesday. Ask your clinician or a physical therapist what the closest local version looks like, and stop and check with them if any exercise doesn’t feel right.

If surgery is already part of your conversation

Some readers here don’t have a surgery date and hope never to need one; others are circling the question with their surgical team. The same movement habits serve both paths — and if a knee replacement does land on your calendar, the work shifts from general conditioning to targeted preparation. That version is covered in our knee replacement prehab guide, and the wider arc afterward in the week-by-week recovery timeline. Decisions about whether surgery is right for you belong entirely to you and your surgical team — exercise guidance is not a referendum on that question.

The bottom line

Every major source in this article lands in the same place: for knee arthritis, movement is the starting treatment, not the reward for getting better (NICE NG226; AAOS OrthoInfo). The evidence is imperfect — the reviews say so themselves — but it consistently favors strengthening plus low-impact aerobic work, ideally supervised at the start, begun gently and expected to grumble before it settles. Get your clinician’s green light, borrow the structure that worked at national scale, and let their judgment — not a website — set your limits.