Not strength training: Scientists found the best workout to relieve knee pain over 45

A review of over 200 studies has found that walking, cycling or swimming is the best medicine for osteoarthritic knees. Compared to other forms of exercise, aerobic training had the best short and long-term outcomes in terms of pain relief and mobility gains.

Around 30% of adults over the age of 45 show signs of knee osteoarthritis on X-rays. Roughly half of these people will experience knee pain and mobility problems. The study, published in The BMJ, set out to analyze which forms of exercise were best when it came to relieving knee pain.

The analysis looked at 217 clinical trials conducted between 1990 and 2024. The research looked at 15,684 participants and compared multiple exercise categories — aerobic, flexibility, strengthening, mind-body, neuromotor and mixed programs, against control groups.

The trial used the internationally recognized GRADE system to look at pain reduction, physical function, gait performance and quality of life. Participants were assessed at four weeks (short-term), 12 weeks (mid-term) and 24 weeks (long-term).

Researchers found aerobic exercise consistently ranked highest. Exercises like swimming, walking and running effectively reduced short and mid-term pain, enhanced gait performance and improved quality of life. Other exercises showed value too, but the biggest wins were in the aerobic exercise category.

It’s important to note the limitations here — certain studies lacked long-term data, and others were on a small sample size. That said, researchers describe their work as one of the most complete evaluations of exercise for managing knee osteoarthritis. Based on this study, the team advises aerobic exercise as the first line of intervention for knee osteoarthritis.

Aerobic workouts to try

Not sure where to start? Here are a few aerobic workouts worth trying. As a reminder, if you’re a complete beginner or you’re returning to exercise following an injury, it’s always a good idea to check in with a qualified professional before taking on a new routine.

• Japanese walking method: This popular walking method mixes intervals of fast walking with a slower pace recovery.
• Jeffing: If you’re building up to jogging again, Jeffing mixes running with periods of walking. Here’s how to do it.
• Swimming: Swimming is a fantastic way to build cardiovascular fitness, without putting any stress on your joints.

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