Suggest an exercise routine. Severe knee arthritis and lots of pain. Poor balance, so needs to be gentle

The short version: the evidence here is about knee osteoarthritis in general, not about your specific situation of severe pain and poor balance. But the pattern is clear enough to guide you.

The studies consistently show that non-weight-bearing and seated exercises work best for painful knees. One trial found that simple static quadriceps contractions and vastus medialis oblique strengthening, done twice a week for 30 days, significantly improved pain and function compared to doing nothing [1]. Another trial showed that neuromuscular training — exercises that teach your brain to control the joint — beat plain quadriceps work for pain and walking speed [4]. A 2025 study found that adding dynamic neuromuscular stabilization to standard therapy cut pain from about 5.7 to 2.6 on a 10-point scale over four weeks [3].

For your poor balance, the systematic review found that Tai Chi and strength training both improve balance and reduce fall risk in people with knee osteoarthritis [2]. But Tai Chi requires standing. A safer starting point is seated or lying-down work.

Here is what the evidence supports for your situation:

The one thing to avoid: any exercise that hurts during or causes more pain the next day. Pain is a signal, not a challenge to push through. The cycling trial found that high-intensity interval cycling caused more adverse events than moderate cycling, driven by a single Baker's cyst case [5]. That tells you intensity adds risk without clear extra benefit.

My call: start with seated and lying-down exercises only — static quadriceps sets, seated knee extensions, ankle pumps, and upper body resistance work. Add nothing that requires standing until your balance improves. Confidence: moderate — the evidence supports non-weight-bearing exercise for knee OA, but no study here tested your exact combination of severe pain and poor balance.