Bad knees? The right kinds of exercise can bring pain relief and improve balance

The Bottom Line

  • Osteoarthritis is a common form of arthritis and causes pain, tenderness and stiffness.
  • People with knee osteoarthritis may also have impaired balance and flexibility, putting them at greater risk of falling.
  • Evidence shows that some forms of exercise can reduce pain, and improve balance and physical function. Ideally, exercises are performed under supervision and at least three times a week.

As we age there’s a tendency to become less physically active for a number of reasons, not the least of which is – it hurts! Arthritis continues to be a painful problem for many older adults and the most common form – osteoarthritis - is particularly troublesome. This condition occurs when the cartilage in joints wears down. Without the cushioning cartilage provides, our joints – particularly our knees – can become damaged resulting in pain, stiffness, tenderness and a loss of flexibility and balance. Serious injuries and death resulting from falls are prevalent in older adults and are reported to be on the rise (1) and there is some evidence that gait and balance problems associated with knee osteoarthritis further increase the risk of falling (2).

What’s the remedy? Pain relievers and anti-inflammatory drugs are widely used but a proven treatment for knee osteoarthritis is actually exercise (3;4).

Physical therapy and various forms of exercise have long been thought to benefit people suffering from osteoarthritis by helping to ease pain, reduce disability, increase confidence, improve mental health, and increase strength, flexibility, and balance (3;4;5). However, pinpointing which exercises are most appropriate and effective, and designing optimal exercise programs have proven to be challenging.

A systematic review published in 2014 sought to address these issues by analyzing the results of 48 randomized controlled trials involving more than 4,000 people aged 52 to 74 with knee osteoarthritis (6). Three categories of exercises were assessed: aerobic (such as walking and swimming); resistance (use of weights, exercise machines or elastic exercise bands) and performance (including movements targeting the lower legs).

The studies also attempted to determine whether it was best to focus on one type of exercise versus a combination, as well as how often exercises should be done for best results. Pain “scores” and other measurements were used to record pain and disability levels before and after exercising, which were compared to those in the control groups.

What the research tells us

Exercise can help reduce pain and disability in people with osteoarthritis. The three categories of exercise appeared to be equally effective, however the evidence suggests that focusing on just one type (versus mixing it up) may provide the best result. Ideally, exercises should be supervised and performed at least three times a week (6). 

These results are backed up by evidence from two newer systematic reviews. The first review aimed to determine whether exercise helps older adults with knee osteoarthritis improve balance and in turn, reduce their risk of falls. Once again participants (close to 1,500) engaged in various types of physical activity including aerobic exercise, strength training and tai chi. All were found to contribute to at least “medium improvement” in terms of enhancing balance and protecting against falls (7). Meanwhile, the second review found that not only can exercise slightly improve pain in people with chronic hip, knee, or hip and knee osteoarthritis, it can improve physical function as well (5). 

It’s another strong argument for making regular exercise part of your lifestyle to help avoid pain, falls and injury.

If you’re experiencing knee pain and other problems, don’t assume your exercising days are behind you. Consult with your doctor and/or a physical therapist to find out how you can ease your symptoms with an exercise program that’s right for you.

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Author Details


  1. Alamgir H, Muazzam S, Nasrullah M. Unintentional falls mortality among elderly in the United States: time for action. Injury. 2012; 43:2065-2071. 
  2. Ng CT, Tan MP. Osteoarthritis and falls in the older person. Age Ageing. 2013; 42:561-566.
  3. Jansen MJ, Viechtbauer W, Lenssen AF et al. Strength training alone, exercise therapy alone, and exercise therapy with passive manual mobilisation each reduce pain and disability in people with knee osteoarthritis: a systematic review. J Physiother. 2011; 57:11-20. 
  4. Iwamoto J, Sato Y, Takeda T et al. Effectiveness of exercise for osteoarthritis of the knee: a review of the literature. World J Orthop 2011; 2:37-42. 
  5. Hurley M, Dickson K, Hallett R, et al. Exercise interventions and patient beliefs for people with hip, knee or hip and knee osteoarthritis: A mixed methods review. Cochrane Database Syst Rev. 2018; 4:CD010842. doi:10.1002/14651858.CD010842.pub2. 
  6. Juhl C, Christensen R, Roos EM et al. Impact of exercise type and dose on pain and disability in knee osteoarthritis: systematic review and network meta-regression analysis of randomized controlled trials. Arthritis Rheumatol. 2014; 66:622-636. 
  7. Mat S, Tan MP, Kamaruzzaman SB et al. Physical therapies for improving balance and reducing falls risk in osteoarthritis of the knee: a systematic review. Age Aging. 2015; 44:16-24.

DISCLAIMER: These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (

Many of our Blog Posts were written before the COVID-19 pandemic and thus do not necessarily reflect the latest public health recommendations. While the content of new and old blogs identify activities that support optimal aging, it is important to defer to the most current public health recommendations. Some of the activities suggested within these blogs may need to be modified or avoided altogether to comply with changing public health recommendations. To view the latest updates from the Public Health Agency of Canada, please visit their website.