• Osteoarthritis, a condition that affects the joints, is growing increasingly common.
• Although exercise is a useful lifestyle intervention to ease pain, experts are unsure of the best type of exercise to prescribe.
• A recent analysis concludes that in patients with osteoarthritis of the knee, aerobic exercise is likely the most beneficial.

Although scientists have shown that exercise can alleviate the pain of osteoarthritis, previous studies investigating which type of exercise is most beneficial have been inconclusive.

A new systematic review and network meta-analysis compiles data from multiple studies to find a clearer answer.

Published in the BMJTrusted Source, the authors conclude that aerobic activities may be best for reducing pain. They also appeared better for overall function, gait performance (or the effectiveness of a person’s walking pattern), and, importantly, quality of life.

Osteoarthritis is a degenerative joint disease. Unlike rheumatoid arthritis, which is driven by an autoimmune reaction, osteoarthritis is caused by “wear and tear.”

Specifically, cartilage, which prevents bones from rubbing together at joints, is slowly degraded, causing pain and a loss of function. Most commonly, osteoarthritis affects the knee joint.

Osteoarthritis is becoming more prevalent. This increase is likely for a number of reasons, but two are particularly important. Firstly, it is increasing in line with the rise in obesity, which puts additional stress on joints. Secondly, because osteoarthritis is primarily associated with advanced age, the rising average age of the population also plays a part.

According to the authors of the new analysis, approximately 1 in 3 people over the age of 45 already have signs of osteoarthritis. More worryingly, half of these individuals already have severe knee symptoms.

Although there is a range of treatments, including medications, exercise should form an important part of the treatment plan. However, which exercise modality is best is still an open question.

The authors of the new paper write, “Many earlier studies failed to capture the full range of exercise types, leading to incomplete comparisons and reduced general disability.”

Also, because osteoarthritis is a long term, progressive condition, they believe that not enough research has assessed the “short, medium, and long-term outcomes.”

Their new analysis helps bring some clarity to this important question.

As with any difficult-to-answer question, analyzing large amounts of good-quality data is a good way to develop a clearer picture.

In this case, the scientists combined data from 217 randomized controlled trials (RCTs), including a total of 15,684 participants.

All of the included studies focused on knee osteoarthritis only. Additionally, they all compared some form of exercise to either a control condition or another form of exercise. Studies also had to take into account at least one of these outcomes:

• function
• pain
• quality of life
• how well they could walk
• adverse events

Importantly, the authors also assessed each trial for its quality, including the risk of bias. Using this and other information, the researchers were able to evaluate the certainty of the evidence.

Once they had crunched many, many numbers, they concluded that, compared with control participants, aerobic exercises improved:

• Pain: Short-term and mid-term follow-up.
• Function: Short-term, mid-term, and long-term follow-up.
• Gait performance (Walking ability:) Short-term and mid-term follow-up.
• Quality of life: Short-term and mid-term follow-up.

However, other types of exercise also had benefits. Mind-body exercise, which combines cognitive focus and breathing exercises with physical activity, seemed to increase function.

Also, neuromotor exercises, which focus on aspects such as balance, coordination, walking, and agility, were particularly beneficial for walking ability in the short term.

Strength training and mixed exercise seemed to produce large increases in function at mid-term follow-up, and flexibility exercises resulted in significant pain reduction in the long term.

Importantly, none of the exercise types caused any more adverse events than was experienced by those in the control groups.

This study has limitations. Notably, it only applies to people with knee osteoarthritis — studies on people with knee and hip osteoarthritis, for instance, were removed from the analysis.

They also explain that many of the studies on this topic are not of high quality, and call for larger and higher-quality studies. Importantly, only 5.5% of the studies looked at longer-term outcomes, which is an important omission when attempting to understand a lifelong condition like osteoarthritis.

Medical News Today contacted Matthew Bennett, MD, an orthopedic spine surgeon and functional medicine expert who was not involved in the study.

When we asked about limitations, he said, “This was a well-designed and thoughtfully executed study. The researchers did an excellent job pulling together a massive amount of data and organizing it in a way that gives us a clearer picture than we’ve had before.”

“That said, no study is perfect,” he continued. “One of the biggest challenges here is that it groups very different activities into broad categories. Walking, cycling, and swimming are all considered ‘aerobic,’ but anyone with knee arthritis knows these don’t feel remotely the same.”

“Swimming is much lower impact. Cycling may be doable when walking isn’t. So while the category might show benefit overall, it doesn’t mean each individual activity is right for every person.”
— Matthew Bennett, MD

Although aerobic activity is already recommended, it is given a similar weight to other modalities.

Medical News Today reached out to Ashley Caravelli, MD, a board certified family medicine physician who was not involved in the research. We asked for her thoughts on the study:

“I think this study is great news for anyone with knee arthritis. It shows that simple aerobic exercise really helps to reduce pain and improve how people move and feel.”

“What surprised me most,” she continued, “was how much of a difference these activities made across so many people and types of exercise programs.”

In line with their findings, the authors recommend “aerobic exercise as a first-line intervention for knee osteoarthritis management, particularly when the aim is to improve functional capacity and reduce pain. While other exercises may offer complementary benefits to patients, they should not replace aerobic exercise as the primary strategy.”

Taken together, Caravelli told MNT that the study “suggests that regular movement is one of the most powerful tools we have.”

The authors of the new study recommend regular indulgence in aerobic activities, like cycling, walking, and swimming. However, they also explain that it is important to speak with your doctor before adopting new exercise routines.

“We often assume that if we have arthritis, our best days are behind us, or that we’re on a fixed path toward joint replacement. But that’s not always true,” concludes Bennett.

Share this article

In the United States, according to the Arthritis Foundation, osteoarthritis (OA) occurs in about 27 million people.

OA is most common in the knees, hips, lower back, neck, small joints of the fingers, and the bases of the thumb and big toe. Cartilage provides a lubricated surface between two bones, and when this wears down, it can cause swelling, stiffness, and joint pain.

Though arthritis can occur in joints all over the body, according to the American College of Rheumatology, the lifetime risk of developing OA in the knee is about 46 percent, making it one of the most commonly affected areas.

While an individual cannot reverse the damage done by OA, physical exercise is useful for managing the progression of the disease. Exercise can help to improve muscle strength, decrease joint pain and stiffness, and also reduce the risk of disability.

However, exercising with OA can be uncomfortable. Choosing the right footwear can help ease a person with the disease into physical activity and support the joints during exercise.

In this article, we look at how to choose footwear that supports OA and the different types available.

Athletic shoes fall into two main categories: Stability shoes and neutral shoes.

Stability shoes

These consist of a dense, cushioned midsole and heel that help control motion and prevent overpronation.

Overpronation is the tendency of the foot to roll inward more than it needs to for weight distribution and shock absorption.

Stability shoes help keep the foot in a neutral position. This is highly important for people with OA of the knee to reduce pressure and stress on the knee joint.

For people whose feet roll unevenly, stability shoes also provide good cushioning and motion control.

Neutral shoes

Neutral shoes do not correct for uneven foot rolling but offer good shock absorption and cushioning.

The neutral design also makes adding an insert or custom-molded orthotic easier. Orthopedic doctors and physical therapists often prescribe orthotic insoles to help people with OA.

Assessing normal foot movement

People may not be sure whether their feet roll normally, as they may be overcompensating in their movement or getting used to the motion of the feet.

A podiatrist, orthopedic surgeon, or physical therapist can help recognize abnormal foot motion. They can look at the distinctive wear patterns of running or walking shoes and determine if the cause relates to abnormal pronation.

The importance of shoe choice in knee OA

While the choice of shoe seems to focus on the feet rather than the knees, well-supported feet alleviate pressure from the knees and reduce the wear-and-tear that OA causes.

Elevated pressure on the joints during walking can cause OA to progress more rapidly.

As a result, people should take care to find the right type of shoe to wear, whether performing normal daily activities or walking or running to get in some exercise. However, the choice of footwear becomes especially important during physical exertion, which increases pressure on many joints, including the knee.

Wearing the wrong type of shoe might only make existing problems worse.

People with OA should keep the following factors in mind when shopping for athletic shoes:

Choose well-cushioned shoes

Shoes with plenty of cushioning help prevent shock to the knees while walking or running.

If a shoe has a lot of padding, it will absorb more impact as the foot hits the ground, reducing stress on the knees. Much of the shock never even reaches the knees.

Well-cushioned shoes also help to reduce the impact of walking and even standing on hard surfaces, such as concrete sidewalks.

Pay attention to the soles

Firm midsoles can help prevent feet from rolling inward too much.

When feet roll too far inward, the lower leg and knee rotate inward to a similar extent each time the foot hits the ground. This repetitive inward motion can lead to knee strain and pain.

Make sure they have arch support

Arch supports “build up” the arches, which helps to reduce pain and make walking or running more comfortable.

They are critical for people with extremely flat feet but can provide support for anyone looking to exercise, especially those with OA of the knee.

A lack of support can cause discomfort when walking or running, but arch supports can help alleviate this problem. They also distribute weight evenly, helping with balance.

More importantly, they provide additional shock absorption and relieve pressure from sore areas, such as the ball of the foot. If one foot becomes sore, a person may distribute more weight onto their other leg, placing more stress on that knee.

Get the right size

Many people forgo getting a shoe in the right size and shape for fashion reasons, but for walking and running, a comfortable, well-fitting shoe is vital.

People with wider feet should shop for wider shoes that leave plenty of room in the toe area. Shoes that do not provide enough space for the toes can lead to blisters and other types of foot discomfort.

Lace them up

Athletic shoes should have shoelaces. Lacing up shoes helps minimize pain and the risk of injury from tripping. Tightly laced shoes cut down on uneven foot rolling and reduce the amount of impact on the feet and knees.

Lacing shoes up tightly also reduces the pressure on the outside of the foot.

Firmly anchoring the foot in the shoe reduces friction. This helps to prevent blisters. Make sure that the heel does not slip out of the shoe when walking or running.

These steps help to provide robust support for the feet, cutting down on foot, ankle, and knee injuries.

Visit a shoe store where staffers are trained to help customers choose the right athletic shoe. They can make sure that the best shoe for foot type and activity is chosen.

Some shoes are better geared toward running, and others are designed for people who prefer walking.

Be sure to ask questions and try on different types of shoes before finding the right pair. All feet are different, so a doctor might recommend shoes for low arches, unevenness, or knee support, but their suggestion may not necessarily be effective for everyone with OA of the knee.

A person should not have to “break in” shoes. If they are too tight in the store, they may never adapt to the individual’s foot size and shape. Be highly selective – the right pair can support the knee during OA degeneration, but the wrong pair can cause further damage and discomfort.

Visit a podiatrist or another specialist for information about special inserts or orthotics that may help to reduce stress on the joints.

While OA of the knee is not a reversible disease, lifestyle choices, such as exercise and shoe choice, can support the management of the OA and limit the progression of symptoms.

Effective footwear can alleviate OA symptoms in the knee, as it can help facilitate beneficial exercise and reduce stress on the knee joints.

Speak to a physical therapist, podiatrist, footwear store specialist, or orthopedic doctor about whether you should choose neutral or stability shoes. Choose well-padded shoes that are wide enough to accommodate foot shape and long enough to leave space for the toes.

When finding the best walking or running shoes for knee OA, investing in appropriate athletic shoes is important to avoid aggravating the condition further. Be sure to try on as many pairs as you need to ensure that the pair is the right fit and supports the feet well.