The 3 Best Exercises for Knee Arthritis
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The three best exercises for knee arthritis are daily walking, a squat or a leg press, and one single-leg quad movement. But one of the most common issues I see is that people either go too hard and flare up their knee, or they don't know how to progress and never see results.
I'm a sports medicine physician currently practicing in the San Francisco Bay Area, and I have my patients focus on these three exercises because they target the quadriceps, reduce pain, and protect the knee long term.
How should I start walking with knee arthritis?
Let's first talk about walking. For patients with a lot of pain, I tell them to pick a time that they can manage comfortably. That could mean starting with just 10 minutes and then gradually increasing the duration over time. Maybe add 5 minutes, then reassess how you feel. The goal is to get to 30 minutes every day.
Here's how to judge whether you can increase the time. Soreness during the walk, or maybe slightly worse pain afterward, is okay. If it improves by the next day, you can keep going and add time. If pain gets worse or persists the next morning, that walk was too long or too hard. Cut back the time and then slowly build again in a few days. The goal is consistency.
If you really can't walk 10 minutes because the pain is so bad, consider lower-impact options like cycling, an elliptical, or even swimming. Anything that lets the knee move in a cyclical, repetitive motion will help.
Why does walking help?
Walking matters because movement stimulates synovial fluid production, which nourishes and lubricates the knee joint. The more you walk, the more lubricated your knee is, and what you'll find is that your knee will feel less pain and less stiffness over time. The other thing to keep in mind is that pain does not mean you are damaging your joint. That pain reflects inflammation and tissue sensitivity. Walking is actually protective.
What squat or leg press options work?
Next, we want to add strength work, and we'll start first with the squat. This can be a barbell squat, dumbbell squat, goblet squat, suitcase squat, or a leg press machine. These all work the muscles slightly differently, but I treat them as interchangeable. The squat is probably the king of lower extremity exercises because it trains the quads, the glutes, and the entire functional chain.
This matters because weak quadriceps strength is linked to worse knee pain, a higher chance that knee arthritis becomes more symptomatic, and, in some patients, a higher chance of later knee replacement. That's why walking alone is not sufficient. We need to challenge the muscles to build strength.
Now a lot of people are scared to squat because it hurts or they don't have the range of motion. The good news is you don't have to squat all the way down. Honestly, most people with severe pain or arthritis should start with a half squat, and maybe even just bodyweight. Only increase your range of motion and add weight when you can move through the full range with control. The key thing to remember is to do what your knee allows. A leg press machine at the gym is a great option if standing squats are painful.
Why add a single-leg quad exercise?
That's our double leg exercise, now we move on to the single leg quadriceps exercise. This can be a split squat, a reverse lunge or a forward lunge, or it could be a single leg knee extension machine at the gym. Pick the one you feel most comfortable with. Isolation exercises matter because side-to-side muscle imbalances are incredibly common. When one quad is a lot weaker than the other, you get less stability at that knee, and this leads to more wear and tear over time.
A physical therapy study by Eitzen and colleagues (2016) actually quantified just how big this side to side asymmetry can get when you have knee problems. After a degenerative meniscus tear, the quadriceps muscle on that side was about 20% weaker. After a focal cartilage injury, it was about 40% weaker. Now keep in mind, it's normal to have up to a 10% side-to-side difference. But most people I see with knee issues or knee arthritis are well past that 10%.
Doing double leg exercises like the squat will help get everything stronger, but your body can compensate for the weak side when both feet are on the ground. That's why these single leg motions are so important.
With that said, lunges can be really painful if you have severe pain or arthritis. This is why a split squat or maybe even a single leg knee extension machine at the gym are better options. Use the same rule as the squat. Go only as far down as your knee and range of motion allows. For a lot of people, this means going only halfway. Or, if using the knee extension machine, do only terminal knee extensions. Don't force your knee into a range that the joint doesn't like.
How do I progress strength without flaring my knee?
So those are the exercises, but this last part may be the most important concept to understand when it comes to strength training, and that's progressive overload. If the exercise never gets harder, the muscle doesn't get stronger. That's why many people who do bodyweight squats or lunges for months don't see any results.
I recommend my patients to aim for strength exercises twice a week. For the double leg squatting motion, start with 3 sets of 8. For the single-leg exercise, start with 2 sets of 8. That's 5 working sets in a session, 10 sets for the week. A lot of the strength-training research suggests that around 10 hard sets per muscle per week is where you start to see meaningful strength gains and muscle growth.
You want to start by picking a weight around 50-70% of your maximum lift. So here's how I ask my patients to progress. If the knee is quiet the morning after a strength training session, add a rep the next workout. Keep using that same next-morning rule. Once you reach 12 reps, increase the weight a little and drop back to 8 reps. Realistically, that means the weight goes up every few weeks, not every day.
The goal isn't to be a bodybuilder. I have my patients go slow with their reps. Three seconds down, three seconds up. It will feel really difficult at first, even with less weight. But that's the point. Longer reps increase time under tension and let us challenge the muscle without piling on load. This approach is usually much easier on the joint.
If your pain is worse the next morning, then that set was too much. Don't go so far down, maybe do fewer reps, or decrease the weight. Try to figure out which variable triggered or aggravated the joint. Use the same rule that we talked about during walking. Consistency wins.
Also keep in mind the concept of weekly allotment of tissue capacity, almost like a bucket of how much load your knee can handle within a given week. If you fill the bucket and it overflows, the knee flares. The whole point of the strength work is to make that bucket bigger over time so you can do more in a week. But when you first start lifting, those two strength sessions fill a lot of it. So you have to manage the rest of the week. That might mean keeping walks shorter, skipping the long hike, or not jumping back into a full weekend of sports on top of the lifting. As the muscles get stronger, the bucket gets bigger, and then you can do more. Early on, don't overflow it. Later, you will have more room.
Bottom Line
The three best exercises for knee arthritis are daily walking, a squat or leg press, and one single-leg quad movement — progressed slowly enough that the knee stays quiet the next morning. Start walking with a comfortable duration and build toward 30 minutes a day. Add strength twice a week with progressive overload (about 10 hard sets per week), slow 3-second tempos, and the same next-morning pain rule. If pain still limits walking or these strength exercises, the joint may still be too angry for the quad to get stronger. Exercise is still the foundation, but it cannot be the only thing — ranking which treatments actually calm the joint down long enough for this program to work is a separate topic.
If you want help building a knee arthritis exercise plan around your current flare threshold, schedule a consultation at my Campbell clinic.
Related Reading
References
Eitzen I, Grindem H, Nilstad A, Moksnes H, Risberg MA. Quantifying Quadriceps Muscle Strength in Patients With ACL Injury, Focal Cartilage Lesions, and Degenerative Meniscus Tears: Differences and Clinical Implications. Orthop J Sports Med. 2016;4(10):2325967116667717. doi:10.1177/2325967116667717. PMID: 27766275. PubMed 27766275
This content is for educational purposes only and does not substitute for the medical advice of a physician. Always consult your healthcare provider before beginning any new treatment program. The information presented reflects the opinion of Dr. Jeffrey Peng and does not represent the views of his employers or affiliated hospital systems.
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