What Is the Best Exercise for Osteoarthritis?

When people come into my clinic in Tooting, Instant Physio, with knee or hip osteoarthritis, one of the first questions they ask is:

“What’s the best exercise for arthritis?”

It’s a fair question. Most of us want a straightforward answer, one routine or one quick fix. The truth is more nuanced, but it’s also far more positive. There isn’t a single exercise that works for everyone. Instead, a combination of strengthening and aerobic activity consistently comes out on top in research studies across the world.

In this article, we’ll look at the evidence, explore the findings from recent systematic reviews, and explain why exercise is such a powerful treatment for arthritis.

Why Exercise and Not Surgery or Injections?

The evidence is remarkably consistent. Exercise is the first line of treatment for osteoarthritis.

The NICE guidelines (https://www.nice.org.uk/guidance/ng226), which guide NHS practice, recommend that everyone with knee or hip osteoarthritis should be offered therapeutic exercise. Not injections. Not surgery. Exercise.

And ideally, this should be a mix of strengthening work and aerobic activity, tailored to the individual.

What the Research Says

Here’s a snapshot of some of the most relevant high-quality studies from the last couple of years:

South Korea, 2024
A review led by Junis Lim at Yonsei University looked at hundreds of patients. They found that resistance training reliably improved pain, muscle strength, and day-to-day function in people with osteoarthritis.
Beijing, 2023
Lu Mao and colleagues combined results from over 3,000 participants. They compared five exercise types for knee arthritis and found aerobic exercise was especially effective for pain relief. Yoga, meanwhile, was particularly good for stiffness and function.
Belgium, 2023
Charlotte Teerlinc and her team analysed around 1,000 patients with hip arthritis. Their conclusion was striking. Exercise therapy is so effective that further trials are unlikely to change the answer.
Spain, 2023
Researchers at the University of Zaragoza, led by Laura Cabellos Later, concluded that strengthening and aerobic exercise, especially when used together, produced the best results for knee arthritis.
China, 2024
Yuan Jiang and colleagues at Zhejiang University tested three types of resistance training in 118 patients with knee arthritis. The most effective approach was progressive, multi-joint exercise such as squats, step-ups and hip hinges.
Shanghai, 2025
Feng Wang’s team studied 960 patients and compared aerobic options. Pilates was best for overall function, while Tai Chi helped reduce pain the most.

The pattern is clear. Different exercise styles help in different ways, but progressive strengthening and aerobic work are consistently the most effective.

Why Exercise Works for Arthritis

At first glance it may seem unlikely that movement could have such a big impact on a joint condition. The benefits actually play out on several levels:

1. Stronger Muscles = Less Joint Load

When the muscles surrounding an arthritic joint are stronger, they act like shock absorbers. They share the load, reduce stress on cartilage, and improve control. This doesn’t just ease discomfort, it also builds confidence to move again.

2. Pain Modulation

Aerobic exercise such as walking, cycling, swimming, Pilates, or Tai Chi helps in another way. Moving at a steady pace prompts the body to release its own natural pain-relieving chemicals. It also alters how the nervous system processes pain signals. In effect, your body learns that movement is safe rather than threatening.

3. Better Metabolic Health

Large population studies such as the UK Biobank (370,000 participants) (https://www.ukbiobank.ac.uk/) and the CHARLS cohort in China show that factors like central obesity, high blood sugar, and abnormal blood fats increase arthritis risk. Regular exercise improves these markers, reduces inflammation, and supports the body’s natural repair systems.

So exercise is not just helping the joint directly. It is changing the whole body environment that contributes to arthritis.

Strength Training for Osteoarthritis

Strength training does not mean bodybuilding or heaving barbells in a noisy gym. It simply means applying resistance to muscles so they adapt and grow stronger.

The research is very clear:

Aim for 2–3 sessions per week
Focus on functional movements such as sit-to-stand, step-ups, hip hinges and calf raises
Start light and gradually increase resistance over time

The key word is progressive. Sticking with the same light weights or bands will not provide lasting benefits. Your body thrives on gradually increased challenge.

Aerobic Exercise for Osteoarthritis

Aerobic activity has wide-ranging benefits for pain, stiffness, confidence, and overall health. The most effective options include walking, swimming, cycling, Pilates, and Tai Chi.

Research suggests:

3–5 sessions per week
20–40 minutes each time
Choose something you enjoy, as you are much more likely to keep it up

Consistency matters more than intensity. Steady, regular activity accumulates benefits over time.

Managing Flare-Ups and Pain

It’s normal to feel an increase in pain when you first start moving more. This is sometimes described as “exercise noise.” It doesn’t mean harm is being done. It’s usually your body adapting.

This is where support from a physiotherapist is useful. We can distinguish between expected responses and signs that adjustments are needed.

Putting It All Together

So, what is the best exercise for osteoarthritis?

Not a single magic move. The best outcomes come from combining strengthening and aerobic work:

Strength training: 2–3 times per week
Aerobic exercise: 3–5 times per week, 20–40 minutes each session
Progress gradually: build up resistance and volume over time
Stay consistent: benefits come from weeks and months of training, not a single workout

Done regularly, this combination eases pain, restores function, and protects your joints for the long term.

Final Thoughts

If you’ve ever been told to rest your joints or avoid activity, the evidence suggests the opposite. Movement really is medicine.

Combining strength and aerobic training tackles osteoarthritis from every angle. You get stronger muscles, less load on the joints, better pain control, improved metabolic health, and the confidence to stay active for years to come.

At Instant Physio in Tooting, we’ve seen hundreds of patients improve with this approach. We even run short, 15-minute online arthritis sessions to make the process simple and accessible. In the next blog, I’ll break down what a 12-week programme looks like and how people use it to recover, including those who have gone through a knee replacement.

For now, remember this: the best exercise for arthritis is the one you can do regularly, enjoy, and gradually progress.

Best Exercises for Osteoarthritis | Instant Physio