For osteoarthritis, the most common type of arthritis, exercise is a core treatment, not something to avoid. NICE recommends therapeutic exercise for everyone with osteoarthritis, and a Cochrane review of 54 studies found exercise reduced knee pain by about as much as anti-inflammatory painkillers. Even for people waiting for a knee replacement, most of those who tried a 12-week programme of exercise, education and diet advice didn't have surgery within a year. Physiotherapy helps you find the right type and amount of exercise for your joints.
Key takeaways
- "Wear and tear" is misleading. Joints with osteoarthritis still respond to load, and the right exercise reduces pain and improves function.
- NICE (2022) recommends therapeutic exercise for everyone with osteoarthritis, supervised where possible, and weight loss support where relevant.
- Cochrane (2015): exercise reduced knee pain by about 12 points on a 100-point scale, an effect similar to anti-inflammatories.
- Some extra discomfort when you start is normal. Consistency over months is what brings the benefit.
- Inflammatory arthritis, such as rheumatoid arthritis, needs medical care from a rheumatology team, but exercise is still important.
What is arthritis?
"Arthritis" covers more than 100 conditions that affect the joints. The two you'll hear about most are:
- Osteoarthritis (OA): by far the most common. It affects the whole joint, including cartilage, bone and the tissues around it. It's most common in the knees, hips, hands and feet, usually from middle age.
- Inflammatory arthritis, such as rheumatoid arthritis or psoriatic arthritis: the immune system attacks the joints. It often causes several hot, swollen, stiff joints, with morning stiffness lasting more than 30 minutes. It needs diagnosis and treatment by a GP and rheumatology team.
This article focuses on osteoarthritis. If you think you might have inflammatory arthritis, see your GP.
The myth: "It's wear and tear, so exercise will wear it out faster"
"Wear and tear" makes joints sound like car tyres: the more you use them, the faster they wear out. But living joints aren't tyres. Cartilage, bone and muscle all respond to load, and the muscles around a joint help protect it.
A 2015 Cochrane review of 54 studies on exercise for knee osteoarthritis found high-quality evidence that exercise reduced pain by about 12 points on a 0–100 scale straight after treatment, with moderate-quality evidence for better physical function. The benefits lasted at least 2–6 months after formal treatment ended. The size of the effect was comparable to anti-inflammatory painkillers (NSAIDs).
Reading this critically: most people in the trials knew they were exercising, which can boost results, and the effect is moderate rather than dramatic. But the authors judged that more research was unlikely to change the conclusion. Exercise also has wider benefits for your heart, weight, mood and sleep.
What does NICE recommend for osteoarthritis?
NICE's 2022 guideline says to:
- offer therapeutic exercise to everyone with osteoarthritis, tailored to their needs, such as muscle strengthening and general aerobic fitness
- consider supervised exercise sessions
- explain that joint pain may increase when you start exercising, but regular, consistent exercise will benefit your joints, and sticking with it long term increases the benefit
- support weight loss for people living with overweight, as it improves pain, function and quality of life
- diagnose osteoarthritis clinically, without routine imaging, in people aged 45 or over with typical symptoms
- not offer arthroscopic washouts, glucosamine or strong opioids
Exercise or surgery?
For severe knee osteoarthritis, a joint replacement can be very effective. But exercise-based care is worth trying first, even for people who've been told they need surgery.
A Danish trial (NEJM, 2015) randomised 100 people with moderate-to-severe knee osteoarthritis who were eligible for a knee replacement. One group had surgery plus a 12-week programme; the other had only the 12-week programme of exercise, education, diet advice, insoles and pain medication.
- After a year, the surgery group had bigger improvements in pain and function (32.5 vs 16.0 points).
- But they also had more serious adverse events (24 vs 6).
- And 74% of the non-surgical group hadn't had a knee replacement a year later.
What this means: surgery works well for many people, but it isn't the only option, and many people do well enough with non-surgical care to delay or avoid it. NICE suggests considering referral for joint replacement when symptoms substantially affect your quality of life and non-surgical treatment hasn't worked.
A simple exercise plan for knee or hip osteoarthritis
Start gently and build gradually. Do the strengthening exercises 2–3 times a week, and some form of aerobic exercise most days. Discomfort up to 3–4/10 that settles by the next morning is fine. If pain is still raised the next day, ease back.
| Exercise | Sets × reps | Progress by |
|---|---|---|
| Sit-to-stand from a chair | 3 × 10 | Using a lower chair or holding a weight |
| Step-ups onto a low step | 3 × 10 each leg | A higher step |
| Bridges | 3 × 12 | Single-leg bridges |
| Side-lying leg lifts (hip) | 3 × 12 each side | An ankle weight or band |
| Calf raises | 3 × 15 | One leg at a time |
| Walking, cycling or swimming | 20–30 minutes | Gradually adding time |
Tips: warm up with 5 minutes of easy movement; spread activity through the day rather than one long session; and remember that a flare-up isn't a sign you've caused damage.
When to see a physio, GP or get urgent help
See your GP promptly if you have:
- several hot, swollen, stiff joints, especially with morning stiffness lasting over 30 minutes
- a joint that's suddenly hot, red and swollen, especially with a fever (go to A&E or call 111 urgently, as this can be a joint infection)
- unexplained weight loss or feeling generally unwell
- a joint that gives way or locks repeatedly
See a physio if arthritis pain is stopping you walking, working, exercising or sleeping well, or you're not sure how much exercise is safe for you.
Arthritis physio at Athos Physio
Our clinic is inside F45 Manchester NQ, at 77 Piccadilly in Manchester city centre. We'll assess your joints, explain what's going on, and build a custom rehab and strengthening plan that fits your level and goals, whether that's walking further, managing stairs or getting back to the gym. If getting into town is difficult, we also offer home visits. You don't need a GP referral, and we work with Bupa, WPA, Vitality and Aviva. Book an appointment, or read about arthritis physio in Manchester.
FAQs
Is walking good for arthritis?
Yes, for most people with knee or hip osteoarthritis. Walking is a good form of aerobic exercise. Start with a distance that's comfortable and build up gradually. Supportive shoes and spreading walks through the day can help.
Does exercise make arthritis worse?
Not usually. Joint pain may increase a little when you start, but NICE advises that regular, consistent exercise benefits your joints. Build up gradually and adjust if pain is still raised the next day.
Do I need an X-ray to diagnose arthritis?
Often not. NICE says osteoarthritis can be diagnosed without imaging in people aged 45 or over with typical activity-related joint pain and short morning stiffness. Imaging is used if something doesn't fit the typical picture.
Can physiotherapy help rheumatoid arthritis?
Yes, alongside medical treatment from your rheumatology team. Physio can help with exercise, joint protection, managing fatigue and staying active. Inflammatory arthritis needs diagnosis and medicines from a doctor first.
This article is general information, not a substitute for an individual assessment.
Sources
- NICE. Osteoarthritis in over 16s: diagnosis and management (NG226), 2022. https://www.nice.org.uk/guidance/ng226
- Fransen M, et al. Exercise for osteoarthritis of the knee. Cochrane Database Syst Rev 2015;1:CD004376. https://doi.org/10.1002/14651858.CD004376.pub3
- Skou ST, et al. A randomized, controlled trial of total knee replacement. N Engl J Med 2015;373(17):1597–1606. https://doi.org/10.1056/NEJMoa1505467
Related: Arthritis physio · Knee and hip osteoarthritis · Rheumatoid arthritis physio · Knee pain when bending · Hip pain at night · All conditions we treat
Reviewed by Nick Chatziviltsos, PgDip, HCPC-registered physiotherapist (PH114351).