Abstract: Introduction: Internet-based cognitive behavioural therapy (iCBT) and exercises have been used widely to treat chronic musculoskeletal pain. We aimed to examine the effects of a combined iCBT with a standardized exercise program in chronic knee patients with psychological distress. Methods: This was a 2-arm quasi-randomized controlled trial of eight weeks of intervention involving eight sessions of standardized exercise program and either concomitant iCBT and educational sessions or educational sessions only. Measurements were taken at baseline and eight weeks immediately following the intervention. Primary outcome measures were a numerical pain rating scale, 40-m Fast- Paced Walk Test, Step Test, and 30 seconds Chair Stand Test. Secondary outcome measures were Patient Health Questionnaire, Psychological Distress, Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form, Health-Related Quality of Life-Short Form-12, and Quadriceps Maximum Isometric Muscle Strength. Results: Thirty-seven participants aged (Mean ± SD) 55.5 ± 7.9 years with chronic knee pain at a certain level of psychological distress were enrolled. In the intervention group (19 participants), there were significant differences in all the primary and secondary outcome measures post-treatment. Furthermore, there were statistically significant differences between both groups in pain levels (MD = 1.79, [95%CI 0.5 to 3.08], P=0.008), and step test (MD =- 1.74, [95%CI-3.38 to -0,9], P=0.04) favouring the intervention group post-treatment. Yet, there were no significant differences between both groups post-treatment in walking speed (MD = -0.07, [95%CI -0.24 to - 0.11], P = 0.449) nor in 30s CST (MD = -1.86, [95%CI -3.99 to 0.26], P = 0.084). Lastly, there was no significant difference between the groups in any secondary outcome measure post-treatment. Conclusion: A combined iCBT and a standardized exercise program intervention can effectively improve pain, function, patient's reported outcomes and the quadriceps muscle strength in chronic knee patients with psychological distress. However, when compared to a control group, only pain and step test had improved significantly. Future studies should investigate the effects of the combined iCBT and standardized exercise program intervention on a larger number of participants. Additionally, longer term effects of the intervention should be investigated.