Osteoarthritis and Exercise

When a knee or hip aches, resting it can feel safer than asking it to do more. Humanic Blue follows the evidence on exercise and osteoarthritis, a joint condition that can cause pain and difficulty moving, including why movement can help without eliminating the condition. The average benefit varies.

The American College of Rheumatology’s 2026 update strongly recommends exercise for knee and hip osteoarthritis; hand exercise receives a conditional recommendation because the evidence is less certain and the decision depends more on individual circumstances. A 2024 Cochrane review found modest average improvements in knee pain and physical function, and a 2025 clinical review found no evidence from the systematic reviews it assessed that therapeutic exercise generally damages knee cartilage, the smooth tissue covering the ends of bones in a joint. For living longer and better, the demonstrated outcomes here are pain, mobility and daily function—not proof that an arthritis exercise program extends life.

Fear 1: Will exercise wear out my joint?

A 2025 clinical review in the Journal of Orthopaedic & Sports Physical Therapy assessed systematic reviews of imaging and biomarker research in people with or at risk of knee osteoarthritis. The evidence it summarized did not indicate that therapeutic exercise generally damaged cartilage structure or quality. That conclusion applies to the exercise therapy studied; it does not mean every movement, training load or painful episode is harmless for every person.

Fear 2: Does running cause arthritis?

In a 2017 systematic review and meta-analysis, the authors combined 17 studies. Hip or knee osteoarthritis occurred less often among recreational runners than among sedentary comparison groups or competitive runners. These differences in how many people had osteoarthritis do not prove that recreational running protects joints or that competitive running causes osteoarthritis. Prior injuries, training exposure and the tendency of people with healthier joints to keep running could influence the result.

What would help separate running itself from injury and other differences between study groups?

Fear 3: Will it really help?

The 2024 Cochrane review assessed 139 randomized trials in adults with knee osteoarthritis. Land-based exercise improved pain and daily function on average immediately after treatment, compared with no treatment, usual care or limited education. Quality-of-life gains were smaller.

The average changes were near or below the review’s thresholds for a difference that patients would find important, and statistical uncertainty meant the reviewers could not be sure how noticeable the benefit would be. Benefits were smaller against comparison programs that supplied attention or a placebo treatment. Participants usually knew whether they were exercising, which could influence symptom reports.

Safety reporting was limited. In some comparisons exercise may have increased adverse events; sparse, low-certainty evidence does not establish an absence of harm. Exact score changes and comparison details are below.

A newer 2025 network meta-analysis combined 217 randomized trials in people with knee osteoarthritis. Aerobic exercise had the highest probability of ranking best across pain, function, walking and quality-of-life outcomes, with several short- and mid-term comparisons supported by moderate-certainty evidence. But three quarters of assessed comparisons raised some risk-of-bias concerns, 21% were at high risk, and only 40 trials reported safety outcomes. A network review can compare treatments indirectly through a shared comparator even when they were not tested against each other. That makes a ranking less straightforward than a direct contest between programs.

How do symptom improvements, adverse events and joint structure answer different exercise questions?

What do guidelines recommend for osteoarthritis?

The 2026 American College of Rheumatology update makes a strong recommendation, based on moderate-certainty evidence, for exercise in knee and hip osteoarthritis. It conditionally recommends hand exercise, tai chi for knee and hip osteoarthritis, and yoga for knee osteoarthritis. It also strongly recommends weight loss for people with knee or hip osteoarthritis who meet criteria for overweight or obesity. The update says care should be personalized around symptoms, other health conditions, treatment risks, access and the person’s preferences.

The 2026 Department of Veterans Affairs and Department of Defense (VA/DoD) guideline suggests structured physical therapy for hip and knee osteoarthritis. It also concludes that the evidence is insufficient to recommend one type of structured exercise—or one delivery method, such as in person, at home or by telehealth—over another. That broader clinical conclusion tempers the knee-only network ranking above.

What does exercise for osteoarthritis look like?

Studied programs include aerobic activity that raises breathing and heart rate, strengthening, flexibility work, mind-body approaches such as tai chi, movement-control training and combinations of these. The evidence does not supply one universal routine or training amount. The ACR places program decisions within individualized care, accounting for the affected joint, current function, other health conditions and preferences. The ACR says physical-therapy referral is appropriate when pain, fatigue or functional limits interfere with exercise or daily life. Strength training principles are covered in Build Muscle After 60, and balance work in Improve Balance After 60.