# Savonia Article Pro: Strengthening the Path to Pain-Free Knees: Progressive Resistance Exercise for Knee Osteoarthritis ##### Savonia Article Pro is a collection of multidisciplinary Savonia expertise on various topics. 26.10.2026 [Articles Pro](https://www.savonia.fi/en/category/articles-pro)[Sosiaali- ja terveysala](https://www.savonia.fi/en/category/sosiaali-ja-terveysala) ## Introduction Knee osteoarthritis (OA) is one of the most common chronic musculoskeletal conditions affecting adults worldwide, significantly reducing a person’s physical independence and health-related quality of life. The main clinical features of knee OA include joint pain, stiffness, reduced range of motion, and progressive muscle weakness, particularly in the quadriceps and hip musculature. According to the Finnish Current Care Guidelines (Käypä hoito -suositus, 2018) and international recommendations (NICE, 2022), exercise therapy is considered a cornerstone of conservative knee OA management. Despite these guidelines, therapeutic exercise protocols in clinical practice often vary considerably in intensity, frequency, and progression. Progressive resistance exercise (PRE) a modality where external resistance is systematically adjusted as muscle strength improves—offers a structured approach to restoring joint stability, easing pain, and improving overall mobility. This article was prepared within the Professional in Physiotherapy course included in the physiotherapy degree programme. The article represents students’ work completed as part of the evidence-based physiotherapy component of the course. During the course, students work collaboratively in small groups to practice the key stages of a systematic review process by conducting a mini review. This includes systematic literature searching, critical appraisal using the PEDro scale (n.d.) data synthesis, and reporting the findings in the form of a scientific manuscript. This blog article synthesizes the key findings of a mini-literature review conducted by physiotherapy students at Savonia University of Applied Sciences, exploring the clinical impact of progressive resistance exercise in managing knee osteoarthritis. ## Methods To evaluate the effectiveness of progressive resistance exercise, a systematic search was performed across medical databases guided by the PICO framework: - Population (P): Adults diagnosed with knee osteoarthritis. - Intervention (I): Progressive resistance or strength training protocols. - Comparison (C): Usual care, non-exercise control, or sham exercise. - Outcome (O): Joint pain intensity, muscle strength, physical function, and quality of life. Four high-quality Randomized Controlled Trials (RCTs) were selected for analysis: - Jorge et al. (2014): 12-week RCT evaluating twice-weekly PRE targeting knee and hip muscles in women with knee OA (n = 60). - Vincent & Vincent (2020): 4-month RCT comparing concentric versus eccentric PRE against a non-exercise control group (n = 88). - Foroughi et al. (2011): 6-month RCT examining supervised high-intensity PRE (80% 1RM) compared to sham exercise in women (n = 54). - Rafiq et al. (2021): 12-week RCT evaluating home-based PRE combined with standard care advice in obese adults with knee OA (n = 56). The methodological quality of the included studies was appraised using the PEDro scale (0–10 points) (n.d.). The scores reflected moderate to high methodological rigor: Jorge et al. scored 8/10, Vincent & Vincent scored 7/10, Foroughi et al. scored 5/10, and Rafiq et al. scored 4/10. ## Results ### Pain Relief and Reduced Medication Use Across all four RCTs, progressive resistance exercise consistently produced clinically meaningful reductions in knee pain compared to control conditions. Jorge et al. (2014) reported a substantial decrease in Visual Analog Scale (VAS) pain scores from 7.0 to 4.3 in the exercise group. Vincent & Vincent (2020) demonstrated that concentric resistance training was particularly effective for walking-related joint pain, while patients engaging in PRE required significantly less rescue analgesic medication. ### Improvements in Muscle Strength and Functional Capacity Systematic loading generated significant isometric and dynamic strength gains in knee extensors and flexors. Furthermore, strengthening hip abductors and adductors (Jorge et al., 2014) improved dynamic lower-limb alignment and overall joint stability. In obese individuals, a structured, 12-week home-based progressive resistance training program combined with standard care advice significantly improved functional capacity, body mass index (BMI), and quality of life (Rafiq et al., 2021). High exercise completion rates (up to 87.5%) verified that PRE intensities between 50% and 80% 1RM are well-tolerated and safe. ## What Do the Results Mean for Physiotherapy Practice? For clinical physiotherapists, these findings emphasize that exercise prescription for knee OA should be active, progressive, and targeted. Key clinical recommendations include: - Comprehensive Muscle Targeting: Include both knee extensors/flexors and hip musculature (abductors/adductors) to ensure optimal joint stability and alignment. - Systematic Progression: Start at moderate intensity (50% 1RM) and progress toward 70–80% 1RM as tolerance develops to maximize neuromuscular adaptations. - Individual Customization & Safety: Adapt loading based on daily pain fluctuations and joint inflammation. Both supervised clinical sessions and structured home exercise programs yield substantial benefits. The methodological quality based on the of the included studies was appraised using the PEDro scale (0–10 points) (n.d.). The scores reflected moderate to high methodological rigor: Jorge et al. scored 8/10, Vincent & Vincent scored 7/10, Foroughi et al. scored 5/10, and Rafiq et al. scored 4/10. ## Limitations of the Literature Review Several limitations should be considered when interpreting these results. Three of the four included studies focused exclusively on female participants, which limits the direct generalizability to male patients. In addition, study durations ranged from 3 to 6 months, highlighting the need for long-term follow-up research to determine the long-term sustainability of functional gains. ## Conclusions Progressive resistance exercise is a highly effective, safe, and evidence-based non-pharmacological treatment for adults with knee osteoarthritis. Systematically increasing resistance alleviates joint pain, strengthens lower-extremity musculature, and enhances functional independence, making PRE an essential component of modern physiotherapy management. #### Authors Veeti Seppänen, Physiotherapy Students, Savonia University of Applied Sciences Tommi Suhonen, Physiotherapy Students, Savonia University of Applied Sciences Markku Tuoma, Physiotherapy Students, Savonia University of Applied Sciences Antton Ylitalo, Physiotherapy Students, Savonia University of Applied Sciences Marja Äijö PhD, Principal lecturer of gerontology and rehabilitation, Savonia University of Applied Sciences This article was prepared with the help of AI. #### References We used artificial intelligence (AI) to combine the research findings and organize them into a coherent whole. AI was used as a supporting tool to structure the text and improve the overall flow of the article. The content and findings were based on the original research sources. Foroughi, N., Smith, R. M., Lange, A. K., Fiatarone Singh, M. A., & Vanwanseele, B. (2011). Progressive resistance training and dynamic alignment in osteoarthritis: A single-blind randomised controlled trial. Clinical Biomechanics, 26(1), 71–77. [https://doi.org/10.1016/j.clinbiomech.2010.08.006](https://doi.org/10.1016/j.clinbiomech.2010.08.006) Jorge, R. T. B., de Souza, M. C., Chiari, A., Jones, A., Fernandes, A. R. C., Lombardi Júnior, I., & Natour, J. (2014). Progressive resistance exercise in women with osteoarthritis of the knee: A randomized controlled trial. Clinical Rehabilitation, 28(11), 1093–1102. [https://doi.org/10.1177/0269215514540920](https://doi.org/10.1177/0269215514540920) Käypä hoito -suositus (2018). Polvi- ja lonkkanivelrikko. Suomalaisen Lääkäriseuran Duodecimin ja Suomen Ortopediyhdistyksen asettama työryhmä. Helsinki: Suomalainen Lääkäriseura Duodecim. Saatavilla: [www.kaypahoito.fi](https://www.kaypahoito.fi) NICE (2022). Osteoarthritis in over 16s: diagnosis and management. National Institute for Health and Care Excellence (NICE) guideline [NG226]. PEDro. (n.d.). PEDro scale. PEDro – PEDro scale. In available: [https://pedro.org.au/english/resources/pedro-scale/](https://pedro.org.au/english/resources/pedro-scale/) Rafiq, M., Hamid, M. S., & Hafiz, E. (2021). Effect of progressive resistance training on pain, function and quality of life in obese patients with knee osteoarthritis. Journal of Clinical & Diagnostic Research, 15(4). Vincent, K. R., & Vincent, H. K. (2020). Concentric and eccentric resistance training comparison on physical function and functional pain outcomes in knee osteoarthritis: A randomized controlled trial. American Journal of Physical Medicine & Rehabilitation, 99(10), 932–940. [https://doi.org/10.1097/PHM.0000000000001450](https://doi.org/10.1097/PHM.0000000000001450) Photo Credits / Image Sources Figure 1: Photo by Unsplash / Pexels (Free to use license / Creative Commons Zero).