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Best Exercise for Knee Osteoarthritis

By Carrie Hall, PT, MHS

May is National Arthritis Awareness month. In recognition of this important cause, I have decided to blog about Arthritis, particularly knee osteoarthritis (OA) and…wait for it…EXERCISE!

As a physical therapist, I can barely get through the grocery store, cocktail party, sideline viewing of a kids sporting event, etc. without being asked a myriad of questions related to aches and pains. That is a good thing and I am more than happy to share my knowledge and, in particular, my conviction about the importance of a physical therapist on one’s health care team.

One of the most prevalent questions asked relates to knee pain. The typical query comes from a middle age man or woman who has knee pain and has stopped all weight bearing exercise out of fear of making it worse. The question is, “what is the best exercise for my knee?”

Good question. However, let me set the record straight that asking a physical therapist to provide this answer during a “drive-by” consultation is not far from asking a cardiologist what medication you should take for shortness of breath. There is no “one size fits all” response and as simple as it may seem, prescribing exercise is quite complex and requires taking a thorough history and performing a comprehensive examination. But, you are waiting for an answer, so here it goes… Generally, any exercise that you can commit to on a regular basis (lifestyle habit) is a great start, and 2) do not avoid weight bearing exercise!


The simple answer is, “NO!” We are BIOmechanical beings. We do not wear out with use.



Actually, evidence supports that OA is more of a “if you don’t use it, you lose it” condition (referring in this instance to articular cartilage). I will not bore you with a review of the research, but trust me, I take great pride in discovering literature that promotes my beliefs and have a plethora of research in my files to back up this notion.

Moderate exercise has been shown time and time again to be effective in reducing pain and improving function in knee and hip OA (1) However, exercise remains underutilized as a therapy for OA, and more than 60% of US adults with arthritis do not satisfy the recommendations for physical activity (2,3). In fact, many fear exercise, thinking it will make their condition worse (4,5)

The hallmark of structural changes occurring in the OA joint is cartilage loss, but what exactly is the underlying driver of this loss has historically been thought to be “wear and tear.” This theory has been researched, and debunked in the past decade.

One such study was performed in 2005 (yes, 2005 – 11 years ago!) (6). This study asked the question, “is weight bearing exercise harmful or beneficial for cartilage?” This study involved middle-age patients who previously underwent meniscectomy because of a degenerative meniscus tear, a group who are considered at high risk of developing radiographic OA (my typical drive-by consultation demographic).


The objectives of the intervention were to improve neuromuscular control (alignment and movement patterns), muscle strength, and aerobic capacity. The patients participated in physical therapist led group exercise classes lasting one hour, 3 times a week for 4 months. The warm-up period consisted of ergometer cycling, rope skipping, and jogging on a trampoline. Examples of individually progressed weight-bearing strengthening exercises are given in below.

Arthritis & Rheumatism
Volume 52, Issue 11, pages 3507-3514, 28 OCT 2005 DOI: 10.1002/art.21415

Miraculously (and I say this facetiously), this study shows compositional changes in adult joint cartilage as a result of increased exercise. The changes imply that human cartilage responds to physiologic loading in a way similar to that exhibited by muscle and bone, and that previously established positive effects on symptoms of exercise in patients with OA may occur in parallel to or even be caused by improved cartilage properties. Let me repeat this, weight bearing exercise has a positive effect on cartilage!

So, can we refrain from saying that OA is a condition caused by “wear and tear” and stop perpetuating the fear that weight bearing exercise is going to make cartilage worse??



Having said that, consulting with your PT is vital to understanding how to alter patterns of movement to optimize the distribution of forces loading your joints. In addition, your PT will prescribe appropriate strength training and mobility exercises as well as guide you through gradual exposure to weight bearing activity. You will be coached through a process of self-efficacy to gain confidence in the benefits of exercise and what pain is considered normal and what pain indicates something needs to be tweaked.

The message is clear, exercise is good, no exercise is not good. Weight bearing exercise is NOT TO BE FEARED if prescribed by a PT in the correct dosage with optimal loading. Cartilage improves with loading, and atrophies with lack of loading, imagine that….

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1. Fransen M, McConnell S, Bell M. Exercise for osteoarthritis of the hip or knee. Cochrane Database Syst Rev. 2003;3:CD004286.
2. Jordan KM, Sawyer S, Coakley P, Smith HE, Cooper C, Arden NK. The use of conventional and complementary treatments for knee osteoarthritis in the community. Rheumatology (Oxford) 2004; 43: 381–4.
3. Fontaine KR, Heo M, Bathon J. Are US adults with arthritis meeting public health recommendations for physical activity? Arthritis Rheum 2004; 50: 624–8.
4. Campbell R, Evans M, Tucker M, Quilty B, Dieppe P, Donovan JL. Why don’t patients do their exercises? Understanding non-compliance with physiotherapy in patients with osteoarthritis of the knee. J Epidemiol Community Health 2001; 55: 132–8.
5. Thorstenson CA, Roos EM, Petersson IF, Arvidsson B. How do patients conceive exercise as treatment of knee osteoarthritis? Disabil Rehabil 2005.
6. Roos, E. M. and Dahlberg, L. Positive effects of moderate exercise on glycosaminoglycan content in knee cartilage: A four-month, randomized, controlled trial in patients at risk of osteoarthritis. Arthritis & Rheumatism, 2005;52: 3507–3514.