BMJ

Aerobic exercise comes out on top for knee osteoarthritis relief

October 20, 2025

Study details: This systematic review and network meta-analysis included 217 randomized trials with 15,684 participants, comparing 7 exercise modalities (aerobic, flexibility, mind-body, neuromotor, strengthening, mixed, and control) for knee OA.

Results: Aerobic exercise consistently provided the greatest improvements in pain (standardized mean difference [SMD], -1.10 to -1.19), function (SMD, 1.78), gait performance (SMD, 0.85), and quality of life (SMD, 1.53) at short- (4 weeks) and mid-term (12 weeks) follow-up, with moderate certainty. Mind-body and neuromotor exercises also improved function and gait, respectively. At long-term, flexibility and mixed exercise showed benefits, but with lower certainty. Safety data were limited, but no clear differences in adverse events were observed between exercise types and control.

Clinical impact: Aerobic exercise should be prioritized as the first-line exercise modality for knee OA, given its superior efficacy across key outcomes and favorable safety profile. Other modalities may be considered for specific functional goals or patient preferences.

Source:

Yan L, et al. (2025, October 15). BMJ. Comparative efficacy and safety of exercise modalities in knee osteoarthritis: systematic review and network meta-analysis. https://pubmed.ncbi.nlm.nih.gov/41093618/