Is It Safe to Exercise With Osteoarthritis?

This is one of the most common questions we hear, and the underlying fear makes sense: if a joint is already showing wear, won't loading it through exercise make things worse? The evidence points the other way.

What the Evidence Shows

Exercise therapy is a core treatment for osteoarthritis (OA) in major clinical guidelines, including NICE and OARSI, with therapeutic exercise recommended for people with OA regardless of which joint is affected. A systematic review examining long-term exercise therapy in knee OA found no treatment effect on tibiofemoral radiographic disease severity, cartilage morphology, synovitis or joint effusion. The same review did find low-quality evidence of greater odds of worsening bone marrow lesions, an area that warrants some caution and further research, but the overall picture does not support the idea that appropriately dosed exercise accelerates joint damage (Van Ginckel et al., 2019).

In practice, appropriately dosed exercise reduces pain, improves function, and builds the muscular capacity that helps the joint tolerate everyday load more effectively.

Some Discomfort During Exercise Is Not the Same as Damage

A modest and temporary increase in symptoms during or after exercise can be acceptable, particularly when starting or progressing a programme. The important question is not whether you feel anything at all, but whether symptoms settle afterwards and whether the overall trend over time is improving rather than progressively worsening. This is very different from pushing through severe or persistent pain, which is not the goal.

Understanding Flares

Osteoarthritis is not a steady, linear condition. Periods of increased symptoms, or flares, are a common feature of OA and are not, by themselves, evidence that the condition is rapidly worsening or a reason to stop exercising altogether. Learning to distinguish an ordinary flare from a signal that genuinely needs clinical review is one of the more useful skills a person with OA can develop, and it's something we help patients build confidence in during rehabilitation.

What Type of Exercise Helps

Both strengthening and aerobic exercise can improve symptoms and function, and combining different forms of activity is often a practical way to build fitness, strength and confidence together. Strength training should target the muscles relevant to the affected joint and the person's functional goals, for example the quadriceps and hip musculature for knee OA. Aerobic activity, such as walking, cycling, swimming or aquatic exercise, supports cardiovascular fitness and weight management. Aquatic exercise in particular can make movement more comfortable when land-based exercise is difficult because of pain.

Starting Point

The right starting point is whatever you can currently manage consistently, not the most intense programme you can tolerate for a week or two. Meaningful improvements usually require consistency over several weeks, with the programme progressed gradually according to symptoms, capacity and goals.

Read More

• Osteoarthritis: How Exercise, Strength and Weight Management Can Help
• Osteoarthritis FAQ

References

• National Institute for Health and Care Excellence (NICE). Osteoarthritis in over 16s: diagnosis and management (NG226). 2022.
• Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthr Cartil. 2019;27(11):1578–1589.
• Fransen M, McConnell S, Harmer AR, et al. Exercise for osteoarthritis of the knee: a Cochrane systematic review. Br J Sports Med. 2015;49(24):1554–1557. doi:10.1136/bjsports-2015-095424.
• Van Ginckel A, Hall M, Dobson F, Calders P. Effects of long-term exercise therapy on knee joint structure in people with knee osteoarthritis: a systematic review and meta-analysis. Semin Arthritis Rheum. 2019;48(6):941–949. doi:10.1016/j.semarthrit.2018.10.014.

Get in touch with us today if fear of making things worse is what's keeping you from being active. A structured, guided programme can help you build confidence as well as capacity.