Walking, cycling and swimming best for knee osteoarthritis, research finds
Aerobic exercise such as walking, cycling or swimming is best for improving function and reducing pain in patients with knee osteoarthritis, researchers have reported.
A large meta-analysis comparing different forms of exercise including strength, flexibility, mind-body exercise or a combination found moderate evidence that aerobic exercise conferred the most benefit.
Reporting the findings in The BMJ, the researchers looked at 217 randomised trials published between 1990 and 2024 involving 15,684 participants.
While exercise is recommended for people with knee osteoarthritis there is less clarity in the guidelines about which type is best, they noted.
Overall, aerobic exercise consistently showed the highest probability of being the best treatment across a range of outcomes, including pain, function, gait performance, and quality of life in the short and longer term.
The analysis also showed that mind-body exercise probably results in a large increase in short term function, neuromotor exercise likely leads to an increase in short term gait performance, while strengthening and mixed exercise seem to be associated with function after three months.
None of the exercise options resulted in more adverse safety events than the control group, suggesting that exercise therapy is a safe treatment approach, they said.
The findings suggest that other exercises may offer complementary benefits to patients, but they should not replace aerobic exercise as the main strategy, the team concluded.
Specifically, they said aerobic exercise should be ‘a first line intervention for knee osteoarthritis management, particularly when the aim is to improve functional capacity and reduce pain’.
If aerobic exercise is not possible owing to individual limitations, ‘alternative forms of structured physical activity may still be beneficial’.
It is estimated that around 30% of people older than 45 years have radiological evidence of knee osteoarthritis, half of whom also have severe knee symptoms.
NICE guidance updated in 2022 said GPs should offer all osteoarthritis patients tailored therapeutic exercise to help manage and reduce symptoms.
The committee said that supervised exercise was likely to have greater benefits for people with osteoarthritis because it may increase adherence and social support.
Patients should be advised that joint pain may increase at first when they start exercising but that doing regular and consistent exercise, even though it may initially cause discomfort, will be beneficial.
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