Supervised versus unsupervised walking exercise programs for pain relief and functional improvement in adults with knee osteoarthritis: a systematic review of evidence from 1993 to 2025
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Published: September 18, 2026
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Page: 1744-1760
Abstract
Knee osteoarthritis is a leading cause of chronic pain, mobility restriction, and disability among adults worldwide, yet many affected individuals remain physically inactive. Walking is an accessible, low-cost mode of physical activity, but the effectiveness of structured walking exercise programs for pain relief and functional improvement has not been consolidated across walking modalities. This systematic literature review synthesised evidence on the effects of walking exercise programs in adults with knee osteoarthritis, following the PRISMA 2020 framework. A structured Boolean search of the Scopus database identified 263 records, and after removal of duplicates and multistage screening against predefined eligibility criteria, 20 primary studies were included. The included studies encompassed overground, community, treadmill-based, aquatic, and retro-walking programs delivered across nine countries and diverse designs. Synthesis showed that walking exercise programs consistently reduced knee pain and improved physical function, walking capacity, and lower-limb strength, with supervised, progressively dosed, and education-supported programs yielding the most consistent benefits. Findings support walking as an effective first-line self-management strategy while highlighting heterogeneity in dosing and outcome measurement. Future trials should standardise dosing parameters, extend follow-up, and strengthen methodological rigour to confirm long-term structural and symptomatic effects.
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