An arthritic knee can create a frustrating cycle.

The knee hurts, so you move less. Moving less weakens the muscles that help support the knee. Everyday tasks become harder, confidence drops, and the knee receives even less useful movement.

The answer is not to ignore pain or force your way through an aggressive workout.

It is to find a level of exercise your knee can tolerate, gradually strengthen the surrounding muscles, and adjust the plan when symptoms change.

New 2026 guidance from the American College of Rheumatology reinforces that approach. Exercise remains one of the strongest recommendations for knee and hip osteoarthritis.

The guidance also introduces a new—but much narrower—recommendation involving GLP-1 medications.

That change deserves careful explanation, because a conditional option for weight management is not the same as declaring GLP-1 medications a treatment for every painful knee.

The Bottom Line First

The 2026 American College of Rheumatology (ACR) summary strongly recommends exercise for knee and hip osteoarthritis, and weight loss when someone meets criteria for overweight or obesity. It conditionally recommends considering a GLP-1 receptor agonist only for people with both knee osteoarthritis and obesity, alongside diet and exercise. Personal medical guidance still matters.

The recommendations emphasize beginning with lower-risk options and using shared decision-making rather than applying the same treatment to everyone.

For most readers, the practical message is straightforward:

Keep an appropriate form of movement in your life, strengthen what you can safely strengthen, and make medication or weight-loss decisions with professionals who know your complete medical history.

Why Does Exercise Remain a Primary Treatment?

Exercise does not rebuild a completely worn joint or guarantee that surgery will never be needed.

It can, however, improve the strength, movement capacity, balance, and confidence surrounding that joint. It can also help you keep doing activities that matter while other treatments are considered.

A recent Cochrane review analyzed 139 randomized trials involving 12,468 people with knee osteoarthritis. Compared with no treatment or usual care, exercise produced improvements in pain and physical function. The average benefits were modest, certainty ranged from low to moderate, and not every improvement crossed the researchers' threshold for a clinically important change. Read the Cochrane evidence summary on exercise for knee osteoarthritis.

That is a less dramatic message than “exercise cures arthritis,” but it is a far more useful one.

Exercise helps many people. Results vary. The program still needs to fit the person.

Is There One Best Knee-Arthritis Workout?

Strength training, walking, cycling, aquatic exercise, balance work, tai chi, yoga, and combinations of these approaches can all have a place.

The 2026 VA/DoD guideline concluded that structured exercise is an important part of osteoarthritis management but found insufficient evidence to declare one exercise type or delivery method superior to every other option. In-person, home-based, and remotely supported programs can all be useful. See the 2026 VA/DoD clinical practice guideline.

That means you do not need to find a magical knee routine.

You need an appropriate program you can perform consistently enough to become stronger.

A balanced plan will often include:

  • Lower-body strengthening
  • Comfortable aerobic activity
  • Range-of-motion practice
  • Balance or neuromuscular training
  • Gradual increases based on your response

The exact exercises, resistance, range of motion, and training frequency should reflect your symptoms, diagnosis, balance, experience, and other health conditions. For more examples, see joint-friendly hypertrophy training after 50 and the Over50FitLife exercise guides.

How Can You Strengthen the Leg Without Treating Pain as a Challenge?

The muscles surrounding the hip, knee, and ankle help control how force moves through the leg.

Possible starting exercises include:

  • Sit-to-stands from a raised chair
  • Supported partial squats
  • Seated knee extensions without heavy resistance
  • Low step-ups with a railing
  • Standing hip abduction while holding a counter
  • Supported calf raises
  • Easy cycling
  • Short walking intervals
  • Aquatic exercise when land-based exercise is poorly tolerated

None of these is automatically appropriate for every knee.

A higher chair, shorter step, smaller range of motion, slower pace, lighter resistance, or additional hand support can make an exercise more manageable.

Modification is not cheating. It is how you match the movement to the joint you have today.

What Might a Conservative Beginner Workout Look Like?

For someone who has been cleared to exercise and can perform these movements without instability, a short session might look like this:

  1. Easy warm-up: Walk or use a stationary bike for three to five minutes.
  2. Raised-chair sit-to-stand: Perform five to eight smooth repetitions, using your hands if needed.
  3. Supported calf raise: Perform six to ten controlled repetitions.
  4. Standing hip abduction: Hold a sturdy counter and complete five to eight repetitions per side.
  5. Seated knee extension: Straighten one leg through a comfortable range, pause briefly, and lower it under control.
  6. Easy walk or cycle: Finish with another three to five minutes if the knee feels stable.

One easy round may be enough at first.

The goal is not to exhaust the leg. It is to learn which movements your knee tolerates and create a starting point you can repeat.

Increase only one variable at a time—repetitions, resistance, duration, range, or frequency. You can also use the 5-minute strength routine for adults over 50 as a way to think about short, repeatable practice; adapt it with a clinician if your symptoms or diagnosis call for individualized modifications.

Which Symptoms Need Medical Evaluation?

A knee with osteoarthritis may feel stiff when you begin moving. Muscles that have not trained recently may also become mildly sore.

That does not mean every uncomfortable sensation should be ignored.

Pause the exercise and reassess when you experience:

  • Sharp or rapidly increasing pain
  • Catching or locking
  • New buckling or loss of support
  • A sudden decrease in range of motion
  • Marked swelling
  • Pain that changes your walking pattern
  • Symptoms that keep worsening after the session
  • New calf swelling, redness, or tenderness
  • Pain following a fall or other injury

A hot, red, severely swollen joint—particularly with fever or illness—needs prompt medical evaluation.

Do not use an arbitrary social-media pain rule to diagnose yourself. Your response depends on the cause of the pain, the exercise, and what happens during the hours after training. Our guide Your Joints Are Talking discusses how to pay attention to how your body responds; it does not replace a medical assessment.

When Does Physical Therapy Make Sense?

The 2026 ACR summary includes a good-practice statement supporting physical-therapy referral when pain, fatigue, or functional limitations interfere with exercise or daily activities.

That may be especially useful when:

  • You are unsure which movements are appropriate
  • The knee repeatedly gives way
  • Pain is causing a limp
  • You cannot rise from a chair confidently
  • Stairs have become substantially harder
  • Exercise repeatedly creates a major symptom flare
  • You use a cane or other mobility aid
  • You are preparing for or recovering from surgery
  • You also have significant back, hip, ankle, or balance problems

A physical therapist can evaluate much more than the knee. Hip strength, ankle mobility, walking mechanics, balance, previous injuries, and fear of movement can all affect the plan.

What Does the New GLP-1 Recommendation Really Mean?

The ACR conditionally recommends considering a GLP-1 receptor agonist to help achieve an appropriate weight in people who have both knee osteoarthritis and obesity. The medication is intended to be used with diet and exercise—not in place of them. The ACR describes this as a conditional recommendation with moderate certainty of evidence, which means the decision should be individualized.

The word conditionally matters.

It means the decision should consider expected benefits, side effects, treatment burden, other conditions, affordability, access, and the person's priorities. It is not a recommendation that everyone with knee pain begin a GLP-1 medication.

This recommendation appears to be influenced partly by research such as the STEP 9 trial.

What Did the STEP 9 Trial Find?

The STEP 9 trial included 407 adults with obesity, radiographically confirmed moderate knee osteoarthritis, and at least moderate knee pain.

Participants received either weekly semaglutide at 2.4 milligrams or placebo for 68 weeks. Both groups also received counseling about physical activity and a reduced-calorie diet. The original STEP 9 trial report in the New England Journal of Medicine is indexed on PubMed.

At the end of the trial:

  • Average weight decreased 13.7% with semaglutide and 3.2% with placebo.
  • Knee-pain scores improved more in the semaglutide group.
  • Physical-function scores also improved more with semaglutide.
  • Treatment discontinuation due to adverse events occurred in 6.7% of the semaglutide group and 3% of the placebo group.
  • Gastrointestinal problems were the most common reason for discontinuation.

The average participant was 56 years old, the average BMI was 40.3, and approximately 82% were women. The study was funded by Novo Nordisk, the medication's manufacturer.

Those results are meaningful, but they do not establish that semaglutide directly repairs cartilage or independently treats every form of knee pain.

The trial cannot fully separate the effects of medication, substantial weight loss, dietary change, altered activity, and other metabolic changes. It also tested one medication and dose in a particular population.

How Can Weight Management Protect Function?

When weight loss is medically appropriate, reducing the physical load carried during walking and stair climbing may make movement more comfortable.

But the fastest possible weight loss is not automatically the best outcome after 50.

Weight loss can include lean tissue as well as fat. Reduced appetite can also make it harder to obtain enough food, protein, vitamins, minerals, and fluid to support training and recovery.

A muscle-conscious plan should include, when appropriate:

  • Progressive resistance training
  • Regular monitoring of strength and function
  • Nutrient-dense meals
  • A medically appropriate protein intake
  • Adequate energy and fluid for the individual
  • Attention to dizziness, weakness, and rapid functional decline
  • Communication with the prescribing and rehabilitation teams

Do not assume a high-protein diet is appropriate for everyone. For related planning, read our GLP-1 weight-loss guide for adults over 50.

Chronic kidney disease can substantially change protein, potassium, phosphorus, sodium, and fluid recommendations. Protein needs may also differ depending on whether someone receives dialysis. A nephrologist or renal dietitian should guide those decisions. See Protein After 50: How Much Per Meal and When Kidney Disease Changes the Plan.

What Should People With Diabetes Know About GLP-1s and Exercise?

GLP-1 medicines can lower blood glucose. Hypoglycemia risk may be greater when they are combined with insulin or a sulfonylurea.

Reduced food intake combined with additional exercise can further change glucose response.

People with diabetes should:

  • Follow their established glucose-monitoring plan
  • Discuss changes in appetite and exercise with their care team
  • Report repeated low glucose readings
  • Avoid independently changing insulin or medication
  • Carry out foot and skin care when neuropathy is present
  • Choose stable exercises when sensation or balance is reduced

Nausea, vomiting, or diarrhea can also contribute to dehydration. The FDA prescribing information for Wegovy (semaglutide) warns about acute kidney injury, particularly when gastrointestinal symptoms lead to volume depletion, and advises additional glucose monitoring in people with diabetes.

Contact the prescribing clinician when symptoms are persistent, food or fluid intake becomes difficult, or weakness and dizziness are affecting daily function.

What About NSAIDs, Injections, and Supplements?

The ACR strongly recommends topical NSAIDs for knee osteoarthritis and conditionally recommends choosing a topical NSAID over an oral one. The guideline also strongly recommends oral NSAIDs for people with knee, hip, or hand osteoarthritis. That does not mean an over-the-counter product is automatically safe.

Oral NSAIDs such as ibuprofen and naproxen can increase the risk of kidney injury, gastrointestinal bleeding, fluid retention, and cardiovascular complications. Risk may be higher with chronic kidney disease, heart failure, a history of ulcers, anticoagulants, certain blood-pressure medicines, or long-term use.

Topical NSAIDs generally produce less systemic exposure, but they can still cause problems and interact with an existing treatment plan.

The guidance also conditionally recommends acetaminophen and strongly supports intra-articular glucocorticoid injections for selected knee or hip cases. These choices still require clinical judgment:

  • Acetaminophen can be unsafe at excessive doses or with certain liver conditions.
  • Steroid injections may temporarily raise glucose in people with diabetes.
  • Repeated injections and procedure timing should be discussed with the treating clinician.
  • No medication should be added, stopped, or substituted based on a general fitness article.

“Strongly recommended” means the guideline panel judged the benefits favorably in the intended population. It does not erase contraindications.

How Should You Evaluate Expensive Joint-Treatment Claims?

The new ACR summary strongly recommends against platelet-rich plasma treatment and stem-cell injections for knee and hip osteoarthritis.

It also strongly recommends against glucosamine and chondroitin products, while conditionally recommending against vitamin D and fish oil specifically as osteoarthritis treatments.

That last point needs context.

It does not mean vitamin D has no role in health or that a diagnosed deficiency should go untreated. It means the guideline does not support using vitamin D as a treatment for osteoarthritis itself.

Similarly, the recommendations do not prove that every person who received an injection or supplement experienced no benefit. They indicate that the available evidence did not justify routine use when benefits, harms, cost, and uncertainty were considered.

Be cautious when a clinic promises:

  • Cartilage regrowth
  • Permanent joint repair
  • Guaranteed avoidance of surgery
  • A “natural” injection with no meaningful risk
  • The same treatment for every painful knee

Pain relief, structural repair, and improved function are different outcomes. Marketing often blends them together.

How Can You Measure Progress Beyond the Scale?

The scale is not the only measure, and pain is not the only measure.

Useful signs of progress may include:

  • Rising from a chair more confidently
  • Walking farther before needing a break
  • Using stairs with better control
  • Less morning stiffness
  • Better balance
  • Fewer episodes of buckling
  • Recovering more predictably after activity
  • Returning to gardening, travel, golf, or other valued activities

Improvement is rarely perfectly linear.

The aim is not to force the knee to feel identical every day. It is to gradually expand what you can do without repeatedly creating major setbacks. Our article on walking speed after 50 explains one simple functional measure that can be useful when interpreted in context.

Coach Bob’s Takeaway

Knee osteoarthritis is not a command to stop moving.

It is a reason to become more thoughtful about how you move.

The new guidelines do not replace exercise with medication. They keep exercise at the center and add more options around it.

Start with a range you can control. Strengthen the leg gradually. Use a bike, pool, walking intervals, chair, or support rail when those options make movement more manageable. Get professional help when pain, instability, or fatigue prevents you from making progress.

If weight management is part of your medical plan, protect muscle and function while the weight comes off.

And if a medication, injection, supplement, or expensive procedure is being sold as the one answer to knee arthritis, slow the conversation down.

Your knee deserves a complete plan—not a miracle claim.

Want Help Building a Knee-Conscious Strength Plan?

Over50FitLife coaching can help you organize joint-conscious strength and mobility work around your current ability, equipment, and goals.

If a clinician has also recommended nutrition or weight management, NutriPlanPro 50+ can help make the day-to-day meal-planning side more practical. Neither service replaces medical treatment, physical therapy, renal nutrition, diabetes care, or medication management.

Explore Over50FitLife coaching, learn about NutriPlanPro 50+, or browse our exercise guides.

Health Disclaimer

This article provides general health and fitness education. It is not medical advice, diagnosis, treatment, rehabilitation, medication management, or an individualized exercise, nutrition, or weight-loss prescription.

Knee pain can have causes other than osteoarthritis. Consult an appropriate healthcare professional before beginning or changing an exercise or weight-management program, particularly if you have significant swelling, instability, recent injury or surgery, cardiovascular disease, diabetes, kidney disease, neuropathy, osteoporosis, a history of falls, or take medication affecting glucose, kidney function, bleeding, blood pressure, balance, appetite, or hydration.

Do not begin, stop, or change a GLP-1 medication, pain medication, injection, supplement, insulin, renal diet, protein target, or other prescribed treatment based on this article.

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