Exercise With Arthritis: Moving Without Aggravating Joints

Different arthritis, different care

Osteoarthritis (OA): wear and tear, often in the knees, hips, hands and spine. Exercise is a central treatment; see knee osteoarthritis at home.

Rheumatoid arthritis and other inflammatory arthritis: the immune system attacks the joints, causing swelling, warmth and morning stiffness. Exercise helps, but during active flares joints need rest and gentle range-of-motion only; medical treatment is essential. See osteoarthritis vs rheumatoid arthritis and arthritis home care guide.

Gout: acute attacks need rest and medical treatment; exercise between attacks; see gout in older adults.

A hot, red, very swollen joint, especially with fever, is not a time for exercise; it needs a doctor, as it may be infection.

Why exercise helps

• Stronger muscles take pressure off joints and improve stability.
• Movement lubricates the joint and eases stiffness.
• Better balance reduces falls.
• Weight control reduces load on the knees and hips.
• Better sleep and mood, and less pain in many people.
• Better function: easier walking, dressing, stairs, chairs.

Exercise does not wear out joints in people with arthritis when done sensibly; inactivity is more harmful.

The key question: how much pain is acceptable?

A simple rule used by therapists:

• Mild discomfort during exercise, a stretch or ache that stays at about 3 out of 10 or less, and settles within an hour or so afterwards, is acceptable.
• Sharp, stabbing or increasing pain during exercise means stop that movement.
• Pain that is worse the next day, or swelling or heat in the joint, means you did too much; cut back by about a third next time.
• Joint pain that lasts more than two hours after exercise also suggests overdoing.
• Morning stiffness lasting more than about an hour suggests inflammation that needs medical review.

Use a pain diary to see patterns; see keeping a pain diary and talking to the doctor.

Types of exercise that suit arthritic joints

Range-of-motion and flexibility. Gently moving each joint through its comfortable range daily keeps it supple. Examples in words: make a gentle fist and open the fingers wide; circle the wrists; bend and straighten the elbows; roll the shoulders; slowly bend and straighten the knees seated; circle the ankles. Hold stretches 15 to 30 seconds without bouncing; see stretching for stiff older bodies.

Strengthening. Muscles around the knee, hip, shoulder and spine. Use bodyweight in a chair, resistance bands or light weights, with slow controlled movements, within pain-free ranges; see chair exercises for seniors, resistance band routine for seniors and exercises for knee and hip pain. Do two or three days a week, with a rest day between sessions for the same muscles.

Low-impact aerobic activity. Walking on level ground, cycling (stationary or pedal exerciser), swimming or water exercise (warm water is soothing), gentle dancing, chair aerobics. Build towards about 150 minutes a week as ability allows; see walking programme for older adults and pedal exerciser guide.

Balance training, to reduce falls; see balance exercises for seniors.

Mind-body activities. Tai chi and gentle yoga, taught by an instructor experienced with arthritis, may reduce pain and improve balance; see learn how tai chi can help manage osteoarthritis pain. Choose supported versions and avoid forcing the knees or spine into deep bends, full lotus, deep squats or sitting on the heels.

Hand exercises for hand arthritis; see grip strength and hand exercises.

Pacing: the secret of living well with arthritis

Pacing means spreading activity through the day and balancing activity with rest, so that you do not oscillate between overdoing it on good days and being laid out on bad days.

• Break tasks into chunks: 10 minutes of sweeping, rest, then another 10.
• Alternate heavy and light tasks, and sitting and standing.
• Plan the day with the hardest tasks when you feel best, often after morning stiffness has eased.
• Rest before you are exhausted, not after.
• Do a little every day, rather than a lot occasionally.
• Increase gradually, by about 10 per cent a week, if comfortable.
• Set realistic goals, such as walking to the park gate, then the bench, then around.

Warm-up, heat and cold

• Warm up before exercise with 5 to 10 minutes of gentle movement, and a warm shower, a warm bath or a warm pack on stiff joints for 10 to 15 minutes, with skin protection; see heat or cold for joint pain and hot pack safety for older skin.
• Cool down gently afterwards.
• Cold packs (wrapped in cloth) for 10 minutes after exercise if a joint is sore or swollen.
• Do not apply heat to a hot, swollen joint.
• TENS may help some people exercise more comfortably; ask a doctor first; see TENS units for pain.

Managing a flare

During a flare, pain, swelling and stiffness increase.

• Reduce the load, not stop altogether: continue gentle range-of-motion movements for the affected joint, within comfort, several times a day.
• Rest the joint for short periods, using a support or splint only if advised; see knee support buying guide and wrist supports.
• Use cold or heat as feels better.
• Do not do strong stretches or heavy strengthening of the flared joint.
• Keep other joints and the general fitness moving with seated or lower-body exercises.
• Take medicines as prescribed; see painkillers and older adults for cautions.
• Call the doctor for a hot, red, very swollen joint, fever, new severe pain or a flare that does not settle within a few days, or for the first time.
• Restart gradually at about two-thirds of your previous level when it settles.

Protect your joints in daily life

• Use larger, stronger joints for tasks, such as carrying with forearms and pushing doors with the body.
• Avoid prolonged gripping, and use built-up handles and tools; see arthritis daily living gadgets.
• Avoid staying in one position for long; change position every 30 minutes.
• Avoid deep squatting, cross-legged floor sitting and kneeling for long if they hurt, using chairs and stools; see raised toilet seat guide and choosing a chair for an older person.
• Use a walking stick in the hand opposite a painful knee or hip; see how to choose a walking stick.
• Wear supportive footwear; see choosing shoes for older feet.
• Maintain a healthy weight, where appropriate.

Safety and when to check first

Ask a doctor before starting if you also have heart disease, uncontrolled blood pressure, breathlessness, a recent surgery or fracture, osteoporosis with fractures, or dizziness. See exercise at home for seniors: a safe starter guide, exercise with heart disease and exercise for osteoporosis. Stop and seek help for chest pain, severe breathlessness, dizziness, a sudden severe joint pain, a joint that gives way, a swollen calf or signs of stroke; call 112 for emergencies.

If you take steroids or immune-suppressing medicines, ask about infection risk, bone health and exercise in crowded places.

Indian home and climate notes

• Exercise in the cool hours; warm water soothes joints in winter.
• Joint pain often worsens in cold, damp weather; warm up longer and wear warm clothes; see cold weather health risks for seniors.
• Floor sitting and squatting strain knees and hips; use chairs where possible, and a firm stool for prayers.
• Marble floors are slippery; wear grippy footwear.
• Choose a seated routine on high-pain days; see exercising indoors in Indian summer and monsoon.
• Pace through festivals and weddings, with sitting breaks; see mobility aids for temples and weddings.

When to ask a professional

Ask a doctor if you have new or worsening joint symptoms, swelling or morning stiffness, to confirm the diagnosis and discuss treatment. A physiotherapist can assess joints, set a safe programme and teach pacing. An occupational therapist can advise on joint protection and aids. A dietician can help with weight. A rheumatologist can manage inflammatory arthritis. In an emergency, call 112.