Strength training with knee arthritis
Written by Coach Moose. Not yet reviewed by a physiotherapist. · Published 6 November 2026
Somebody told you to take it easy. Maybe it was a friend, maybe it was your own nervous brain after an X-ray report. Here's the good news: major guidelines point the other way.
This page is for people who've already been told they have knee arthritis. If you haven't been assessed, start with a doctor or physio.
The short version
- Major guidelines recommend exercise for people with knee arthritis.123
- The average improvement is modest, so set realistic expectations.45
- You don't need to lift heavy to benefit. In one large trial, high-intensity training did no better than the comparison groups.6
- Pick the exercise you'll keep doing.
What the guidelines say
The American Academy of Orthopaedic Surgeons strongly recommends exercise over no exercise, supervised or not, and warns that temporary soreness is possible.1 EULAR says exercise should be offered to everyone with hip or knee arthritis and tailored to the person.2 NICE in the UK says to offer tailored therapeutic exercise to all, and states that exercise "is not harmful to osteoarthritic joints."3 None of them gives a set dose.
What the numbers say
A 2024 Cochrane review covered 139 trials and 12,468 people. Compared with usual care, exercise improved pain by about 13 points and function by about 12.5 points on a 100-point scale. Compared with an attention control, the gains were about 8.7 and 11.3 points. Those are real changes, but the authors called their clinical importance uncertain, and no type of exercise stood out.4
Exercise may also come with more minor side effects than usual care, on low-certainty evidence.4 A sore knee after training can happen.
A pooled analysis of 4,241 people found people who started with worse symptoms tended to benefit more.5
How heavy should you go?
The START trial followed 377 adults aged 50 and over, averaging 65, for 18 months. High-intensity strength training did not beat low-intensity training or an attention control on pain or knee forces. Non-serious side effects were 53 in the high-intensity group, 30 in the low-intensity group and 4 in the control group.6
Here's the fair read: heavier isn't automatically better for arthritis symptoms. Strength still matters for life, so build it gradually and leave a couple of reps in the tank.
Does exercise wear out your cartilage?
A review of 9 trials and 702 people found exercise "seems not to harm" cartilage, though the evidence was low quality. It doesn't show that strength training rebuilds cartilage.7
For running, studies link recreational running with lower arthritis rates than non-runners, and competitive running with higher rates, but these studies can't prove cause.8 In a study of 1,203 people with knee arthritis, those who chose to run were no more likely to get worse on X-ray.9 Running hasn't been proven to protect knees, so if you enjoy it and your knee tolerates it, talk to your physio about how to keep it in.
What to do in class
Coaching starting points, not study doses.
| If the workout says | Try this first | Build toward |
|---|---|---|
| Heavy squats | Box squat or goblet squat at a moderate load, 3 x 8 to 12 | A load that feels strong and leaves reps in the tank |
| Lunges | Step-ups or supported split squats | Unsupported reverse lunges |
| Box jumps | Step-ups | Only if your knee and your goals want it |
| Running | Bike, rower, or brisk walking | Run-walk if it's tolerated |
| Sled push | Moderate load | Keep this one in |
| Wall balls | Lighter ball to a box | Normal range as tolerated |
Train two or three days a week to start, and check how your knee feels the next morning. A little soreness can be expected. Swelling that keeps coming back or pain that keeps climbing means ease off and check in with your clinician.
Coach note
You don't have to earn your way in. Start where you are, and we'll change what needs changing. If you're 60 or better, have a look at Living Legends.
Quick answers
Is it safe to lift weights with knee arthritis?
Guidelines recommend exercise, and NICE says it isn't harmful to arthritic joints. Temporary soreness can happen, and you should follow your clinician's advice.
Will strength training rebuild my cartilage?
We wouldn't claim that. The research we read doesn't show it.
Should I stop running?
Not automatically. Observational studies don't show running makes knee arthritis worse, but they can't prove it's safe for everyone. Talk it through with your physio.
What's the best exercise?
The Cochrane review didn't find a clear winner, so choose one you'll keep doing.
Want to train with people who get it?
Tell us about your knee and what you want to keep doing. We'll help you find the right way in, including Living Legends if you're 60 or better.
Talk to a coachAbout the author. Dai Manuel, known around the gym as Coach Moose, has 30 years of coaching experience across strength, conditioning and lifestyle coaching, and is a co-owner of CrossFit BC in Vancouver.
This article is general education, not a diagnosis or treatment plan. If you're unsure what's going on, or it isn't improving, see a physiotherapist or physician.
References
- American Academy of Orthopaedic Surgeons. Management of Osteoarthritis of the Knee (Non-Arthroplasty). 2021.
- Moseng T, et al. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis: 2023 update. Ann Rheum Dis. 2024;83(6):730-40.
- National Institute for Health and Care Excellence. Osteoarthritis in over 16s: diagnosis and management. NG226. 2022.
- Lawford BJ, et al. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev. 2024;12:CD004376.
- Holden MA, et al. Moderators of the effect of therapeutic exercise for knee and hip osteoarthritis. Lancet Rheumatol. 2023;5(7):e386-400.
- Messier SP, et al. Effect of high-intensity strength training on knee pain and knee joint compressive forces among adults with knee osteoarthritis. JAMA. 2021;325(7):646-57.
- Bricca A, et al. Impact of exercise on articular cartilage in people at risk of, or with established, knee osteoarthritis. Br J Sports Med. 2019;53(15):940-7.
- Alentorn-Geli E, et al. The association of recreational and competitive running with hip and knee osteoarthritis. J Orthop Sports Phys Ther. 2017;47(6):373-90.
- Lo GH, et al. Running does not increase symptoms or structural progression in people with knee osteoarthritis. Clin Rheumatol. 2018;37(9):2497-504.