168 patients with symptomatic knee osteoarthritis were randomized to undergo either a standardized strengthening exercise program (n=57), aerobic exercise (n=55), or usual care (n=56). The primary outcome of interest was the Knee Injury and Osteoarthritis Outcome Score (KOOS) quality of life subscale at four months and one year. Secondary outcomes of interest included KOOS pain, symptoms, activities of daily living, and sports and recreation subscales, pain on a Numeric Rating Scale (NRS), EuroQol-5 Dimensions (EQ-5D0, arthritis self-efficacy pain and other symptoms, quadriceps and hamstring strength, oxygen consumption (VO2), Global Rating of Change (GRC), and the incidence of adverse events and physiotherapy visits. The strengthening exercise group showed significantly better quadriceps strength scores and VO2 compared to the usual group at four months. Similarly, the strengthening exercise group had significantly better self-efficacy pain scores after one year when compared to usual care. KOOS QoL was similar between the aerobic exercise group and usual care groups. The aerobic exercise group also showed better KOOS symptom results, quadriceps strength, and VO2 at 4 months compared to usual care. All other outcomes at all other time points were similar between the exercise groups against usual care.