BACKGROUND: This study evaluated the effects of chair-based exercises (CBEs) on pain, function, balance, quality of life, and exercise perception in inactive older adults with knee osteoarthritis and explored social policy implications. METHODS: A single-blind, parallel-group, randomized controlled trial, included 40 participants (>= 65 years, Kellgren-Lawrence Grade 2 to 3 knee osteoarthritis, and no regular exercise in the last 3 months). The intervention group (IG; n = 20) performed CBE twice weekly for 8 weeks, while the control group (n = 20) maintained usual activities. Outcomes were assessed using the Western Ontario and McMaster Universities Osteoarthritis index (pain, stiffness, and function), Timed Up-and-Go test (balance/mobility), Exercise Benefits/Barriers Scale, and Nottingham Health Profile. Data were analyzed using analysis of covariance to compare postintervention outcomes while controlling for baseline scores, and qualitative comparative analysis explored factors affecting quality of life. RESULTS: Analysis of covariance revealed that the IG demonstrated statistically significant and clinically substantial improvements in pain, stiffness, and function (Western Ontario and McMaster Universities Osteoarthritis), as well as dynamic balance and mobility (Timed Up and Go), with large treatment effects observed across all measures compared with the control group. Perceived exercise benefits increased, and barriers decreased in the IG. Nottingham Health Profile scores also improved significantly in the IG. Qualitative comparative analysis indicated that quality-of-life improvements resulted from pain reduction, functional gains, and enhanced exercise perception. CONCLUSION: This study provides robust evidence that an 8-week CBE program significantly improves pain, function, balance, and quality of life in older adults with knee osteoarthritis while enhancing exercise motivation. SIGNIFICANCE: As a cost-effective and safe intervention, CBE can support active aging, reduce health care costs, and enhance older adults' social participation. Integrating CBE into public health policies and community programs may promote well-being and independence.

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