Exercise for knee osteoarthritis: building strength and managing symptoms

What exercise is trying to achieve

Exercise is a core part of knee osteoarthritis care. NICE recommends a programme selected for the person's needs, including muscle strengthening and aerobic fitness, with supervision considered where helpful. Australian guidance also supports individualised exercise and taking account of your preferences, capacity and access to facilities. [1, 2]

The goals might include walking further, managing stairs, getting up from a chair more comfortably or having enough stamina for work. These give the plan a purpose beyond completing a list of exercises. They also provide something concrete to review when pain varies.

Exercise can help pain and physical function, but improvement is not guaranteed or identical for everyone. A 2024 Cochrane review found low- to moderate-certainty evidence of short-term benefits; whether the average changes reached the review's thresholds for an important difference was uncertain. The studies used different programmes and comparison treatments, and many had methodological limitations. [3]

That is a reason to agree on useful goals and review your own response. It is not evidence that a particular exercise will regrow cartilage, remove every symptom or prevent the need for surgery. Your wider treatment decisions belong with your treating team.

Strength, fitness and daily movement have different roles

Strength work challenges the muscles used to support and move you. Depending on your starting point, this might involve a supported movement, a machine, a resistance band or an exercise using body weight. Choosing the exercise is only part of the task. The range of movement, resistance, amount of work and support available also affect the demand.

Aerobic activity develops the ability to sustain effort. Walking, cycling or suitable water-based activity may be options to discuss. The best fit depends on what you can manage, enjoy and access consistently. A pool is not essential, and an activity does not become the right choice simply because someone else finds it comfortable. [2]

Daily movement adds another layer. Time on your feet at work, housework, shopping and stairs all form part of your week. A formal exercise session might be unchanged while the rest of your day has become much more demanding. Recording that context can make an unexpected response easier to discuss.

You do not need to turn every ordinary task into a test. It helps to know which activities the exercise plan is intended to support, and whether the weekly schedule leaves a realistic opportunity to practise them.

Start with what you can do now

A useful starting discussion includes the activities you manage, what you avoid, previous exercise experience and any treatment advice or restrictions. Tell the practitioner about episodes of swelling, locking or giving way, other health conditions and what has happened with previous programmes. These details can influence both the starting point and whether further assessment is needed.

An assessment should help explain the purpose of the exercises and how you will use them. Ask what would justify increasing the difficulty, what you could adjust if a session is difficult, and when to contact the practitioner. You should not have to guess what counts as useful progress.

For example, someone whose goal is to use the stairs at home could describe the number of steps, whether they use a rail and what changes over the day. That is an educational example, not a reason to repeatedly test a painful staircase. The practitioner can decide which observations or tests are appropriate and repeatable.

If you already exercise, bring the programme you actually follow. Names, resistance, repetitions and frequency are more useful than “I do some leg exercises”. Include classes and sport as well as prescribed rehabilitation.

When symptoms change, look at the pattern

Some discomfort can occur when starting therapeutic exercise. NICE advises explaining this alongside the value of regular participation. That does not mean every increase in pain is harmless or that you should push through a concerning change. [1]

Useful observations include when symptoms began, what the activity involved, how you moved afterwards and whether ordinary tasks became harder. Note a change in swelling or stability, and whether the response is familiar or different from your usual pattern. A pain rating may help describe intensity, but it does not contain all that information.

There is no single pain number or fixed recovery deadline in this article that determines what is safe for every knee. Agree on a response plan with a practitioner who knows your situation. It should leave room for adjusting exercise and for reassessing symptoms that do not fit the expected pattern.

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This table is a conversation aid. It is not a traffic-light system for deciding whether an injury or illness is present.

Adjusting the plan without losing its purpose

A review might consider a different exercise, more support, a different movement range or a change in resistance, repetitions or session length. The right adjustment depends on what has changed. Ask which part of the programme should continue and when to review the response, rather than making several large changes without a clear reason.

It can help to distinguish a session you could not complete from a plan that is difficult to fit into ordinary life. Travel, work and access to equipment may need a scheduling solution. Persistent or changing symptoms may need clinical reassessment. Both are legitimate reasons to revisit the plan.

Progression should remain connected to the goal. More weight on an exercise is useful information, but it may not fully answer whether you can manage the activity that brought you to treatment. Discuss both the exercise record and the tasks that matter outside the session.

Recognise when medical assessment takes priority

Seek urgent medical care for a badly swollen or misshapen knee, knee pain after a major injury, or a red, hot knee with fever. These are not situations for testing a modified workout. Healthdirect also advises seeing a doctor if you cannot move or put weight on the knee, if it locks or gives way, or if it is very painful. [4]

Bring a new or unexplained deterioration to your treating clinician even if you have a longstanding osteoarthritis diagnosis. A routine exercise appointment or callback request is not an urgent-care service.

Measure progress in more than one way

Choose a small number of outcomes that you and your practitioner can interpret together. These might include a meaningful daily task, an appropriate strength or function measure, confidence in an activity and how consistently the programme fits your week. Keep the conditions similar when comparing a task over time.

Pain still matters. The point is to give it context. A person may report the same pain score while managing an activity more comfortably, or less pain because they have stopped most of the activities they value. Those situations call for different discussions.

Next step

Write down one activity you want to manage better and a brief account of your current exercise and symptom pattern. Take it to your existing treating team or use it to prepare for an exercise review. You do not need to purchase a test or become a Longevico client to use that record.

The Clinical Exercise Assessment provides a focused starting point for exercise planning. Direct booking is for the existing clinic appointment at Longevico at Banyo Fitness. For mobile Exercise Physiology in Redlands and Bayside, discuss location, scheduling and suitability before arranging a home visit. A clinic booking does not reserve a mobile appointment.

Related reading

Returning to exercise after injury explains how a return goal can be broken into stages. Fees and funding explains the existing appointment pathways.