Knee osteoarthritis: combining endurance and strength training appears beneficial in the short term

Comparing several forms of exercise

The researchers brought together 35 randomized trials involving people with knee osteoarthritis. Their literature search covered publications available through July 2025. They compared aerobic exercise, resistance exercise and interventions combining the two.

The analysis distinguished short-term interventions, lasting up to and including 12 weeks, from those lasting more than 12 weeks. Three outcomes were studied: pain, function and quality of life.

A network meta-analysis compares several interventions by combining direct and indirect comparisons. Its ranking therefore does not mean that every program was directly compared with all the others.

Combined exercise ranks first in the short term

Combining aerobic exercise and strengthening over a period of up to 12 weeks produced the most favorable effect estimates for all three outcomes. The authors describe the improvement in pain as clinically meaningful. However, the certainty of the evidence for these results remains low.

For function, aerobic exercise lasting more than 12 weeks ranked next, but with very low-certainty evidence. This finding does not establish that it would remain preferable to other forms of exercise over time.

A ranking is not a prescription

The abstract reports improvements with the different forms of exercise, alone or combined. It therefore does not justify dismissing endurance or strength training on their own simply because their combination ranks first.

The effects are expressed in a standardized form that allows different measurement scales to be compared. The abstract provides neither an absolute reduction in pain on a common scale nor details of the comparators. There is no way to infer how many points of pain reduction a person can expect.

Data on the clinical relevance of interventions lasting more than 12 weeks remain limited. The abstract also provides insufficient detail on the programs or their adverse effects to develop a practical protocol.

What we can take away

Combining endurance and strength training is an approach supported by this review for short-term symptom relief. Its superiority remains uncertain, and these results do not demonstrate any change in the progression of osteoarthritis.