Arthritis and exercise: why movement helps

In osteoarthritis, the UK's NICE guidance names therapeutic exercise, tailored to the person, as a core treatment, with weight management where it applies, rather than an extra to try if there is time. For people with rheumatoid arthritis or another inflammatory arthritis, keeping active is both safe and helpful, and European recommendations updated in 2025 make encouraging physical activity part of standard care in both inflammatory arthritis and osteoarthritis. Whatever kind of arthritis you have, few things you can do for your joints are as useful as staying active, which is why the guidelines recommend it.

That fear holds many people back, so it deserves a straight answer: sensible, regular exercise does not wear out joints with arthritis.

• In osteoarthritis, NICE advises that joint pain may increase when you first start, and that regular, consistent exercise is good for the joint and, kept up over the long term, eases pain and helps it work better.
• In rheumatoid arthritis, a two-year trial of intensive exercise found that damage to the large joints on X-ray did not increase, except possibly in people who already had a lot of damage in those joints, whose damage progressed slightly more in both groups and more clearly with the intensive exercise. If that applies to you, have your programme tailored with your specialist or a physiotherapist.

The caution is about pace and type. Doing too much too quickly, or the wrong sort of exercise, can harm a joint, which is why a plan from your GP or a physiotherapist helps. Exercise also builds up the muscles around a joint, which usually helps the symptoms.

The gains reach further than the joints:

• Better function, and some ease of pain. In knee osteoarthritis, a review of many trials found that exercise probably improves how well the knee works and may ease pain. In rheumatoid arthritis, a review of trials found aerobic exercise safe, with gains in fitness and function and some relief of pain.
• Beyond the joints. Activity lifts mood and can reduce fatigue, and it lowers the risk of heart disease, which matters because rheumatoid arthritis and other inflammatory arthritis carry a higher risk of it. And by helping you shed excess weight, it takes load off joints with osteoarthritis.

Three kinds of activity complement one another, and none has to be gruelling:

• Aerobic exercise, enough to make you breathe a bit harder: a brisk walk, a swim or a bike ride.
• Muscle-building work, with weights, bands or your own body weight, to strengthen what holds each joint in place.
• Stretching and range-of-movement work, which keeps joints supple; balance exercises help too.

Low-impact activities are the gentlest way to begin. Swimming puts very little strain on the joints, and some people prefer warmer water. Tai chi is another gentle option.

UK guidance for adults is to aim for at least 150 minutes of moderate activity a week, with strengthening activities on at least two days. Treat that as a target to work towards rather than a starting point: begin with what you can manage, warm up first, and build up gradually. If you have not exercised for some time, or have other health conditions or concerns, speak to your GP before you start.

If a new activity seems to make things worse at first, try doing it less often, and less of it each time, to see whether that helps; very bad pain after a fall or injury belongs in the first list below, and pain in a joint that turns severe all at once, with no fall or injury, in the same-day list. During a flare, let swollen, tender joints settle and keep them moving with gentle range-of-movement exercises rather than stopping altogether, then return to your usual level as it eases.

Exercise is recommended for people with all kinds of arthritis, but a few signs, during exercise or at any other time, need help, and the lists below say who to contact for each, the most urgent first.

Treat any of these as a 999 or A&E emergency: call 999 and do not drive yourself to A&E.

• Severe illness with suspected sepsis: a high fever with shaking, confusion, rapid breathing, or feeling dramatically worse over hours
• With a fever or feeling unwell, a rash that does not fade when you press it, a stiff neck with eyes that cannot bear bright light, or skin, lips or tongue turning blue, grey, pale or blotchy, since these can be signs of meningitis or sepsis, as can a very bad headache, confusion or a first seizure with a fever or feeling unwell; on black or brown skin the rash and the change of colour may be easier to see on the palms of the hands or the soles of the feet
• A joint you cannot put weight on or move, or that has moved out of place, or, after a fall or injury, very bad pain or any tingling or numbness
• After an injury, a crack heard as it happened, or skin around it that has turned blue, grey or cold, since these can be signs of a broken bone
• Chest pain that is crushing, tight or like a pressure, that spreads to an arm, the jaw, the neck, the stomach or the back, that comes with breathlessness, sweating, feeling sick or feeling light-headed, or that came on suddenly and does not go away
• Breathlessness that is severe, with gasping, choking or no breath to get words out; or coughing up blood
• Palpitations happening now that do not stop, or that come with chest pain, breathlessness, feeling faint or fainting, since a heart whose muscle or rhythm is affected has to be checked at once
• A faint after which you cannot be woken within a minute, do not fully recover, or have trouble speaking or moving, or a faint with chest pain, a pounding, fluttering or irregular heartbeat, a seizure or a serious injury, or one that happened during exercise or while lying down, since these can mean a problem with the heart or the brain
• Lips, mouth, throat or tongue that suddenly swell, a throat that feels tight, very fast breathing or a struggle to breathe or to swallow, skin, tongue or lips turning blue, grey or pale (on black or brown skin this may be easier to see on the palms of the hands or the soles of the feet), becoming suddenly very confused, drowsy or dizzy, or fainting and not being able to be woken, since this can be a severe allergic reaction, anaphylaxis, which can follow a dose of any medicine

Any of these needs an assessment that is urgent, on the same day, from your GP or NHS 111:

• A joint that is hot and swollen, with a fever or feeling unwell, since an infected joint has to be ruled out at once, at A&E or through NHS 111
• A joint that has become hot and very swollen suddenly, or is worsening quickly, even without a fever, since an infected joint does not always announce itself with one
• Joint pain with a fever, or feeling hot, cold or shivery, or generally unwell, since an infection in or around a joint has to be found the same day
• Joint pain that has suddenly become severe, without a fall or injury, since a sudden change like this can point to another problem in the joint, which should be checked that day; a joint you cannot put weight on or move is in the first list instead
• New chest pain, new palpitations, or breathlessness that is new or getting worse, since breathlessness or a racing heart beyond what the effort explains can point to a problem with the heart or the lungs; palpitations happening now that do not stop, or that come with chest pain, breathlessness, feeling faint or fainting, belong to the first list; in pregnancy, breathlessness that comes on suddenly, or when you lie down, or with dizziness, is for your midwife or maternity unit straight away
• Chest pain brought on by exercise that eases within a few minutes once you stop, or known angina that now comes more often, lasts longer, is worse or starts at rest, since the arteries feeding the heart may be narrowing; stop exercising until it has been checked, and call NHS 111, who can direct you to the right service that day; chest pain still there after a few minutes' rest, or after your angina spray or tablets, belongs to the first list

An activity that seems to be making your joints worse is a reason to ease back and to ask a physiotherapist or your GP how to adjust your programme; a joint whose pain keeps getting in the way of everyday activities or sleep is for a GP appointment. Very bad pain after a fall or injury, or a joint you cannot put weight on, belongs to the first list, and pain that turns severe all at once, with no fall or injury behind it, to the same-day list. No referral is needed to be seen here; next-working-day appointments can almost always be arranged, and same-day appointments are sometimes possible. If you cannot tell how urgent something is, asking is never a mistake.

Activity adds to your treatment; it does not stand in for it. If you have inflammatory arthritis, the medicines that control the disease still need taking as prescribed, and a physiotherapist can design exercise around the joints you have and the goals you set. More on each condition is in rheumatoid arthritis and osteoarthritis, while fatigue and arthritis explains how activity eases tiredness, and diet and arthritis turns to food, the other side of looking after your joints.

Can exercise wear out a joint with arthritis?

Not when it is done at the right level. Regular, sensible exercise does not wear out joints with arthritis: in osteoarthritis it keeps the joint working better and can ease pain, and in a two-year trial of intensive exercise in rheumatoid arthritis, damage to the large joints seen on X-ray did not increase, except perhaps in people who already had a lot of damage there, whose programme is best tailored with a physiotherapist or their specialist. What can harm a joint is doing too much too soon, or the wrong kind of exercise, which is why a plan from your GP or a physiotherapist is worth having. The muscles that exercise builds steady and shield the joint.

Is it all right to exercise if it hurts?

Feeling a little more discomfort as you take up something new is expected: NICE's guidance on osteoarthritis says joint pain may increase at first, and that keeping going brings the benefit. It tends to fade as your fitness builds. If a new activity seems to make your joints worse rather than better, do it less often and do less of it for a while, then build up more slowly; a physiotherapist or your GP can help you pitch it. A joint that is hot and swollen with a fever, or suddenly hot and very swollen, joint pain that turns severe all at once, a joint you cannot put weight on, and chest pain or a faint during exercise are different matters, each with its route under When to seek help.

Which kind of exercise should I choose?

Variety helps most. Combine activity that raises your heart rate, such as walking, swimming or cycling, with work that builds muscle and stretches that keep the joints supple. Low-impact activities are the easiest place to begin. Exercise in water is gentle on sore joints, and a warmer hydrotherapy pool suits some people. The exercise you enjoy enough to keep up will do you more good than a better one you abandon.

How much exercise should I aim for?

Work towards the UK target for adults: at least 150 minutes of moderate activity a week, with strengthening activities on at least two days. That is a goal to build up to, not a place to start, so begin with what you can manage and add a little at a time. If you have not exercised for a while, or have other health conditions or concerns, speak to your GP before you start.

What about exercise during a flare?

Keep moving, gently. When joints are swollen and tender, let them settle and keep them moving with gentle range-of-movement exercises rather than strength work, then build back up to your normal routine once the flare has settled. A bad flare, or one still not settling after several days, needs your rheumatology team or GP within the next few days, as managing a flare explains; a joint that turns hot and swollen with a fever or feeling unwell needs seeing that day, at A&E or through NHS 111, and one that turns suddenly hot and very swollen without either needs checking by your GP or NHS 111 that day.