Arthritis and exercise: why movement helps

For osteoarthritis, the UK's NICE guidance makes therapeutic exercise a core treatment, alongside weight management, rather than an optional extra. For rheumatoid and other inflammatory arthritis, regular exercise is both safe and beneficial. Whichever type you have, being active is one of the most effective things you can do for your joints, and it is firmly evidence-based rather than wishful thinking.

This is the worry that stops many people, and it is worth answering plainly: no. Regular, sensible exercise does not wear out or damage arthritic joints.

• In osteoarthritis, NICE notes that joint pain may increase a little when you first start, but that consistent exercise reduces pain and improves function over time and is good for the joint, not bad for it.
• In rheumatoid arthritis, studies including long-term, higher-intensity programmes have found that exercise does not increase joint damage on x-rays for most people. If you already have significant joint damage, it is worth having your programme tailored with your specialist or physiotherapist.

If anything, the muscles you build by exercising support and protect the joint. Standing still is the bigger risk.

The benefits are wide-ranging:

• Less pain and better function. In knee osteoarthritis, exercise can reduce pain and improve how well the joint works. In rheumatoid arthritis, aerobic exercise improves fitness and function and eases pain, safely.
• Beyond the joints. Activity lifts energy and mood, helps sleep, reduces fatigue, and lowers cardiovascular risk, which matters because inflammatory arthritis carries a higher risk of heart disease. It also helps with weight, which in turn helps osteoarthritis.

A balanced mix is ideal, and none of it needs to be punishing:

• Aerobic activity that gets you slightly out of breath, such as brisk walking, cycling or swimming.
• Muscle strengthening, which builds the support around your joints.
• Flexibility and range-of-movement work to keep joints supple.

Water-based exercise is especially gentle and a good place to start if your joints are sore.

UK guidance suggests aiming for around 150 minutes of moderate activity a week, plus strengthening activities on two days. That is a target to work towards, not a starting line: begin with what you can manage and build up gradually, because something is always far better than nothing.

A little extra discomfort when you start is normal and settles as you get fitter. Ease back if pain is sharp, severe or lingers well beyond the session. During a flare, keep moving gently within your comfort rather than stopping completely, and return to your usual level as it settles.

Exercise works best alongside the rest of your care, not instead of it: for inflammatory arthritis, keep taking your prescribed medication, which controls the disease itself. A physiotherapist can tailor a programme to your joints and goals. Our guides to osteoarthritis and rheumatoid arthritis explain the conditions in more detail, and diet and arthritis covers the other half of staying well.

Will exercise damage or wear out my arthritic joints?

No. This is a very common worry, but the evidence is clear: regular exercise does not wear out or damage arthritic joints. In osteoarthritis it helps reduce pain and improve function, and in rheumatoid arthritis even higher-intensity programmes have been shown not to increase joint damage for most people (if you already have significant joint damage, it is worth having your programme tailored with your specialist). Strong muscles around a joint actually help to protect it.

It hurts when I exercise. Should I stop?

A little extra discomfort when you start something new is normal and not a sign of harm, and it usually settles as you get fitter. Ease back if the pain is sharp, severe, or lasts well beyond the session, and build up gradually. If you are unsure, a physiotherapist can help you pitch it right.

What type of exercise is best?

A mix works best: aerobic activity such as walking, cycling or swimming; muscle strengthening; and movements that keep the joints flexible. There is no single best exercise, the best one is the one you will keep doing. Water-based exercise is gentle and useful if your joints are sore.

How much should I do?

Aim towards about 150 minutes of moderate activity a week, plus muscle-strengthening on two days, in line with UK guidance. But start where you are: something is always better than nothing, and you can build up over time.

Should I still exercise during a flare?

Usually yes, gently. Rather than stopping altogether, keep the joints moving within your comfort with gentle range-of-movement exercises, and return to your usual level as the flare settles. If a flare is severe, ease off and seek advice.