For an older patient with knee osteoarthritis, what intervention is considered first-line for pain relief?

• A. Exercise
• B. Acetaminophen
• C. Ibuprofen
• D. Tramadol

Answer: (A)

Starting with regular, structured exercise is the best first step for knee osteoarthritis in older adults because it directly addresses the mechanics of the joint while improving pain, function, and quality of life. A focused program—especially quadriceps and hip-strengthening exercises, plus aerobic activity and flexibility work—stabilizes the knee, improves gait, reduces the load on the joint over time, and can slow functional decline. Importantly, exercise has a broad benefit with a very favorable safety profile in older patients, and a physical therapist can tailor it to individual abilities and comorbidities to maximize benefit and minimize risk.

Medications may be added if pain persists, but they come with trade-offs. Acetaminophen provides modest relief and does not improve function as directly as strengthening exercises; NSAIDs can carry gastrointestinal, renal, and cardiovascular risks in older adults; tramadol has risks of sedation, confusion, constipation, and falls. So the exercise-based approach is prioritized, with pharmacologic options used as needed.