Strength Training, Tai Chi, and Aerobics May Improve Balance in People With Knee Osteoarthritis

Osteoarthritis is a progressive, degenerative joint disease that causes joint pain and limited movement. Overtime, arthritis can lead to deconditioning of the area due to the arthritis itself and the lack of physical activity due to pain. Both the arthritis and deconditioning in major joints like the hip and knee, can increase the risk of falls in older adults. Falls are the leading cause in injury in older adults and injuries can range from minor bruises to serious fractures and disability. Exercise has been shown to decrease the symptoms of arthritis and decrease the risk of falls but finding exercise that has the most balance and does not exacerbate arthritis is not clear.

Researchers from Malaysia wanted to evaluate the effectiveness of physical conditioning in improving balance and reducing the risk of falls among patients with knee osteoarthritis. The study, published in Age and Ageing, found that strength training, Tai Chi, and aerobics exercises improved balance and reduced the risk of falls in older adults with knee osteoarthrits.

About the Study

The systematic review included 15 randomized controlled trials with 1,482 patients with knee osteoarthritis and an average age of 60 years old. The patients participated in a physical activity for anywhere between 2 weeks to 18 months. Studied activities included strength training, aerobic exercise, Tai Chi, water-based exercise, walking programs, power training, vibration, e-stim exercise, and light therapy. Balance was tested by having patients timed while standing on one foot, standing on balance board, or step up test. The risk of falls was assessed with a survey and assessment profile.

Of all the physical activity types studied strength training, Tai Chi, and aerobics exercises were only activities associated with improved balance and reduced the risk of falls. Water-based exercise and light treatment did not significantly improve balance outcomes but vibration training and walking were both associated with improvement in balance.

How Does this Affect You?

A systematic review is considered a reliable form of research because it combines several smaller studies. The higher the number of participants, the more reliable the results may be. However, the systematic review is only as reliable as the studies that were included. In this case, the trials evaluated the risk of falls through a survey instead of follow up to count actual number of falls which does not show a true effect of interventions. All the trial also used significantly different activities and testing methods which makes it difficult to truly compare each activities benefits. More studies will need to be done to determine which physical activity may best reduce the risk of falls in older adults.

Physical activity has been shown to reduce the impact of osteoarthritis on everyday activities. The best activity is one that you actually do and that does not cause more pain. Look for activities or plans that have both strength and aerobic elements. Work with your doctor and fitness professionals to find activities that may work best for you. Progress your routine gradually to avoid exacerbating arthritis.


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Falls among older adults: an overview. Centers for Disease Control and Prevention website. Available at:
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Updated December 30, 2014. Accessed January 5, 2015.
Mat S, Tan MP, et al. Physical therapies for improving balance and reducing falls risk in osteoarthritis of the knee: a systematic review. Age Ageing. 2015 Jan;44(1):16-24. Available at:
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Accessed January 5, 2015.
Last reviewed January 2015 by Michael Woods, MD

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