The best exercises to help manage severe knee pain

Walking, cycling and swimming are the best exercises to improve knee pain in patients with osteoarthritis, researchers have found.

An estimated 10 million people in the UK have osteoarthritis - a degenerative joint disease that causes pain, stiffness, and swelling when the protective cartilage in a joint breaks down and wears away.

According to the National Institute for Health and Care Excellence, almost half of over-50s have experienced knee pain, leaving many to rely on painkillers long-term.

While any joint can be affected, it’s most common in the knees, with nearly 30 per cent of people over the age of 45 showing signs of knee osteoarthritis on X-rays, and half suffering from severe knee symptoms.

Exercise is one of the main treatments for osteoarthritis, but current guidelines provide limited information about the specific types of exercise that should be recommended for patients with it in their knees.

“Aerobic exercises such as walking, cycling, and swimming are excellent first-line options for people with knee osteoarthritis," London-based osteopath Danny Morgan told The Independent.

“They improve circulation to the joint, help maintain mobility, support weight management, and can reduce pain over time by strengthening the surrounding muscles and improving overall function.”

However, he suggests that combining different types of exercise is also beneficial. He said: “The most effective long-term approach typically combines aerobic exercise with targeted strengthening, flexibility work, and, where appropriate, neuromotor training to improve balance and coordination. This helps stabilise the joint and reduce future flare-ups.”

To help improve current guidelines, researchers from Zhejiang University School of Medicine in China and Johns Hopkins University School of Medicine in the US set out to assess the effectiveness and safety of various types of exercise for managing knee osteoarthritis.

The study, published in the British Medical Journal, reviewed 217 randomised trials published between 1990 and 2024 involving 15,684 participants. The studies compared common exercise therapies (aerobic, flexibility, strengthening, mind-body, neuromotor, and mixed exercise) with a control group.

The researchers focused on pain, function, gait performance (the patient’s walking patterns) and quality of life, and assessed these markers at four, 12, and 24 weeks after starting treatment.

Overall, aerobic exercise, such as walking and swimming, consistently showed the highest probability of being the best treatment course for people suffering from chronic knee pain.

Study authors suggested aerobic exercise “as a first line intervention for knee osteoarthritis management, particularly when the aim is to improve functional capacity and reduce pain”, and said if aerobic exercise is not possible owing to individual limitations, then “alternative forms of structured physical activity may still be beneficial”.

Researchers found aerobic exercises were beneficial in relieving short-term and mid-term pain, improving short-term, mid-term, and long-term function, and improving short-term and mid-term gait performance and quality of life.

This type of exercise also improved short-term, mid-term and long-term function compared to controls. However, the study authors did not highlight how many minutes of exercise were needed.