Exercise and Osteoarthritis: Can Exercise Help Joint Pain?

If you've been diagnosed with osteoarthritis (OA), you may have been told that your joints are simply "wearing out" and that you should avoid too much activity. It's an understandable belief, and one that many people have heard over the years. However, our understanding of OA has changed considerably.

Current UK guidance recommends exercise as one of the main treatments for OA. Rather than causing further damage, appropriate exercise can help reduce pain, improve strength, make everyday activities easier and support your long-term joint health.

Whether your OA affects your knees, hips, hands or other joints, staying active can play an important role in managing your symptoms and maintaining your independence.

In this article, we'll explore what OA is, why exercise helps, and what the latest UK guidance recommends.

What is Osteoarthritis?

OA is the most common type of arthritis in the UK and affects millions of people worldwide. Although it becomes more common as we get older, it isn't simply an inevitable part of ageing, and not everyone develops symptoms to the same degree.

Many people still think of OA as a condition caused by the gradual "wearing away" of joint cartilage. While changes to the cartilage do occur, we now know that osteoarthritis affects the whole joint. The underlying bone, joint lining (synovium), ligaments and surrounding muscles can all be involved.

Several factors can increase the likelihood of developing OA, including:

• Increasing age

• Previous joint injuries

• Genetics

• Carrying excess body weight

• Repetitive heavy loading in some occupations or sports

It's also important to remember that the amount of OA seen on an X-ray doesn't always match the amount of pain someone experiences. Some people have significant changes on imaging with very few symptoms, while others have considerable pain despite relatively minor changes.

This is one of the reasons why healthcare professionals now focus less on scan results and more on improving pain, strength, movement and overall function.

Should You Exercise if You Have Osteoarthritis?

The simple answer is yes.

Current UK guidance recommends exercise as one of the main treatments for people with OA, regardless of their age or the severity of their condition. Rather than avoiding movement, healthcare professionals are encouraged to help people find safe and enjoyable ways to stay active.

Current UK guidelines recommend regular exercise to help reduce pain, improve function and keep you moving.

Research has consistently shown that regular exercise can help to:

• Reduce pain

• Improve joint function

• Increase muscle strength

• Improve balance and confidence

• Make everyday activities easier

• Enhance overall quality of life

  
  

Exercise isn't about "curing" OA or reversing the changes within a joint. Instead, it's about improving how well your joints function, reducing symptoms and helping you stay active and independent.

Importantly, there isn't one single "best" type of exercise. Current guidance recommends choosing activities that you enjoy and can continue long term. This may include strength training, walking, swimming, cycling, Pilates or other forms of regular physical activity.

As a physiotherapist, one of the most common concerns I hear is, "Won't exercise make my arthritis worse?" It's an understandable question, particularly if movement is already painful. However, the evidence tells us that appropriately prescribed exercise is both safe and beneficial for the vast majority of people with OA.

Why does exercise help?

There isn't one single reason why exercise helps people with OA. Instead, it has a number of positive effects on your joints, muscles and overall health that work together to improve symptoms and function.

Exercise helps in many ways. Stronger muscles, healthier joints, better balance and less stiffness all contribute to improved movement and confidence.

Stronger muscles help support your joints

The muscles surrounding a joint act as natural shock absorbers. When they are stronger, they can better support and stabilise the joint during everyday activities such as walking, climbing stairs or getting up from a chair.

For example, strengthening the muscles around the knee and hip can reduce the load placed on the joint itself and make movement feel easier and more comfortable.

Movement helps nourish your joints

Unlike many other tissues in the body, joint cartilage doesn't have its own blood supply. Instead, it receives nutrients from the synovial fluid that surrounds the joint.

When you move a joint through a comfortable range of motion, the cartilage is gently compressed and released. This helps circulate synovial fluid across the joint surface, delivering nutrients to the cartilage and removing waste products. You can think of it as a gentle pumping action that helps keep the joint healthy.

This is one of the reasons why joints often feel stiff after long periods of sitting and why gentle movement can help them feel more comfortable again.

Exercise can help reduce pain

It might seem surprising that exercise can reduce pain, particularly if movement has become uncomfortable. However, regular physical activity has been shown to reduce pain in many people with OA.

This is likely due to a combination of factors, including stronger muscles, improved joint function, better circulation and changes in the way the nervous system processes pain, helping some people become less sensitive to painful stimuli over time.

While exercise won't remove the structural changes associated with OA, it can often reduce the impact those changes have on daily life.

Better balance and confidence

OA doesn't just affect joints—it can also affect confidence in movement. People who are worried about pain or losing their balance often become less active, which can lead to further weakness and reduced mobility.

Exercises that improve strength and balance can help people feel more confident walking, using stairs and carrying out everyday activities, making it easier to stay independent.

Exercise benefits your overall health too

The benefits of exercise extend far beyond your joints. Regular physical activity supports heart health, bone health, weight management, sleep and mental wellbeing.

For many people living with OA, staying active is one of the most important things they can do to support their overall health and quality of life.

What types of exercise are recommended?

Current UK guidance doesn't recommend one single "best" exercise for people with OA. Instead, the aim is to find activities that you enjoy, suit your lifestyle and can continue in the long term.

A combination of different types of exercise is often the most beneficial.

Strength training

Strength training is one of the most effective forms of exercise for people with OA. Building stronger muscles helps to support your joints, improve everyday function and make activities such as climbing stairs, getting out of a chair and carrying shopping easier.

Strength training doesn't have to involve lifting heavy weights at the gym. Resistance bands, bodyweight exercises and appropriately prescribed strengthening exercises can all be effective.

Aerobic exercise

Aerobic exercise, sometimes called cardiovascular exercise, helps improve fitness, supports heart health and can reduce fatigue. Activities such as walking, cycling and swimming are all excellent options.

The best choice is often the one you enjoy enough to do regularly.

Balance exercises

People with OA can become less confident in their balance, particularly if pain has led them to move less over time. Improving balance can increase confidence, reduce the risk of falls and make everyday activities feel easier.

Simple balance exercises can often be incorporated into a regular exercise routine.

Flexibility and mobility exercises

Gentle stretching and mobility exercises can help reduce stiffness and make joints feel more comfortable. While improving flexibility alone won't change the underlying OA, maintaining a comfortable range of movement can make everyday activities easier.

Pilates

Pilates can be an excellent option for many people with OA. It combines strength, balance, flexibility and body awareness in a controlled and adaptable way.

Exercises can usually be modified to suit individual abilities and symptoms, allowing people to work at their own pace while gradually building strength and confidence.

The most important thing isn't choosing the "perfect" exercise. It's finding activities that you enjoy and can continue as part of your everyday life.

Is it normal for exercise to hurt?

It's one of the most common questions people ask after being diagnosed with OA, and the answer isn't always straightforward.

Many people worry that if an exercise causes discomfort, they must be making their arthritis worse. However, current guidance recognises that some increase in pain or discomfort when starting a new exercise programme can be normal and doesn't necessarily mean that damage is occurring.

As your muscles become stronger and your body adapts to new movements, these symptoms often improve over time.

That said, exercise should usually feel manageable rather than overwhelming. If your pain becomes severe, continues to increase during exercise or remains significantly worse for several days afterwards, it may be a sign that the exercise programme needs to be modified. Reducing the intensity, changing the exercise or allowing a little more recovery time can often help.

One of the aims of exercise is to gradually build confidence in movement. Starting gently and progressing at a pace that suits you is often more effective than trying to do too much too soon.

If you're unsure where to begin, or your symptoms are particularly severe, it's worth seeking advice from a healthcare professional who can help tailor an exercise programme to your individual needs.

Top tip: It's better to exercise regularly at a level you can maintain than to do one very demanding session and then avoid exercise for the rest of the week.

As your strength and confidence improve, your exercises may need to become slightly more challenging to continue seeing benefits.

Common myths about Osteoarthritis

Many common beliefs about osteoarthritis are outdated. Current evidence shows that staying active is one of the best ways to reduce pain and improve function.

Myth 1: "I should rest my joints."

Reality: While it may be sensible to reduce activity during a significant flare-up, prolonged rest can lead to weaker muscles, increased stiffness and reduced fitness. For most people with OA, staying as active as possible is one of the most effective ways to manage symptoms.

Myth 2: "Exercise will wear my joints out."

Reality: Current evidence does not support the idea that appropriately prescribed exercise speeds up the progression of OA. In fact, regular exercise is recommended as one of the main treatments because it helps reduce pain, improve strength and maintain joint function.

Myth 3: "My X-ray looks terrible, so exercise won't help."

Reality: The amount of OA seen on an X-ray doesn't always reflect how much pain someone experiences. Some people have significant changes on imaging with very few symptoms, while others have considerable pain despite only mild changes. Exercise can improve strength, movement and function regardless of what an X-ray shows.

Myth 4: "I'm too old to start exercising."

Reality: It's never too late to become more active. Research shows that people of all ages can improve their strength, balance and fitness through regular exercise. The key is choosing activities that are appropriate for your current ability and progressing gradually.

Perhaps the biggest myth of all is that nothing can be done.

While there isn't currently a cure for OA, there is a great deal that can be done to help manage symptoms. Regular exercise, education and healthy lifestyle choices can all make a meaningful difference to pain, movement and quality of life.

Can Pilates help if you have Osteoarthritis?

Pilates can be an excellent form of exercise for many people living with OA. While current UK guidance doesn't recommend one specific type of exercise over another, Pilates incorporates many of the components known to be beneficial, including strength, balance, flexibility and movement control.

One of the strengths of Pilates is that exercises can usually be adapted to suit different abilities and symptoms. Whether you're just starting out or have been managing OA for many years, exercises can often be modified to make them more comfortable while still providing an appropriate challenge.

As a Chartered Physiotherapist and Pilates instructor, I've worked with many people living with OA over the years. One of the things I enjoy most is helping people regain confidence in movement. It's common for people to become worried that certain movements will make their joints worse, but with the right guidance they often discover they can do far more than they expected.

Pilates isn't a cure for OA, but it can be an enjoyable and effective way to improve strength, balance, flexibility and overall function. Combined with other forms of physical activity, it can help many people stay active and continue doing the things they enjoy.

The best exercise programme is ultimately the one that you enjoy and can maintain over time. If Pilates is something you look forward to, it's far more likely to become a regular part of your routine—and consistency is where the real benefits are seen.

Key take-home messages

• Exercise is one of the main treatments recommended for people with OA.

• Strength, aerobic exercise, balance and flexibility all have an important role to play.

• Some discomfort when starting a new exercise programme can be normal and doesn't necessarily mean you're causing harm.

• The best exercise is one that you enjoy and can continue in the long term.

• Staying active can help reduce pain, improve function and support your overall health and wellbeing.

Although OA is a common condition, it doesn't mean you have to stop doing the activities you enjoy. With the right approach, regular exercise can help you stay stronger, move more confidently and continue living an active, fulfilling life.

If you're unsure where to start, seek advice from a qualified healthcare professional who can help you find an exercise programme that's right for you.

Frequently Asked Questions

Is walking good for OA?

Yes. Walking is an excellent form of exercise for many people with OA. It can help improve joint mobility, strengthen the muscles that support your joints, improve cardiovascular fitness and reduce stiffness. The key is to choose a pace and distance that feel manageable and gradually build up over time.

Can exercise make OA worse?

Current evidence shows that appropriately prescribed exercise does not make OA worse. In fact, exercise is recommended as one of the main treatments for OA. Some temporary discomfort when starting a new exercise programme can be normal, but this doesn't necessarily mean you are causing damage. If pain becomes severe or remains significantly worse for several days, your exercise programme may need to be modified.

Should I exercise if my knee hurts?

In most cases, yes. Keeping your knee moving and strengthening the surrounding muscles can help reduce pain and improve function over time. It's often sensible to start gently and gradually increase the amount or intensity of exercise as your confidence and strength improve. If you're unsure where to begin, seek advice from a healthcare professional.

Is Pilates good for OA?

Pilates can be an excellent option for many people with OA. It combines strength, balance, flexibility and body awareness, all of which are recommended as part of an active lifestyle. Exercises can usually be adapted to suit different abilities and symptoms, making Pilates accessible to many people living with OA.

Do I need an X-ray before I start exercising?

Not usually. Many people can begin an appropriate exercise programme without having an X-ray. In fact, the amount of OA seen on an X-ray doesn't always match the amount of pain or difficulty someone experiences. Your symptoms, goals and overall function are often more important than imaging when deciding how to exercise safely.

Should I avoid squats if I have knee OA?

Not necessarily. Squats are a functional movement that most of us perform every day when sitting down and standing up. When performed with good technique and at an appropriate level, they can be an excellent way to strengthen the muscles around the knee and hip. The depth of the squat and the amount of resistance can be adjusted to suit your individual ability and symptoms.

Continue reading

If you'd like to learn more or get started with Pilates at home, you may also find these helpful:

• Free Pilates Classes – Try a selection of free Pilates workouts suitable for a range of abilities.

• Online Pilates Classes – Access monthly bundles of physiotherapist-led Pilates classes to exercise at home.

• Pilates and Osteoporosis: Can You Still Do Pilates? – Read my guide to exercising safely with osteoporosis and the latest UK guidance.

Disclaimer:

This article is intended for general educational purposes only and should not be taken as individual medical advice. Exercise recommendations should always be tailored to your personal circumstances. If you have concerns about your health, are experiencing new or worsening symptoms, or are unsure which exercises are appropriate for you, seek advice from your GP or an appropriately qualified healthcare professional before starting a new exercise programme.

References

1. National Institute for Health and Care Excellence (NICE). Osteoarthritis in over 16s: diagnosis and management (NG226). Published October 2022. Available at: https://www.nice.org.uk/guidance/ng226

2. European Alliance of Associations for Rheumatology. 2025 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. Annals of the Rheumatic Diseases. 2025.

3. Osteoarthritis Research Society International. OARSI guidelines for the non-surgical management of knee, hip and polyarticular osteoarthritis. Osteoarthritis and Cartilage. 2019.

4. Versus Arthritis. Exercise and physical activity for osteoarthritis. Patient information resource.

5. National Health Service. Osteoarthritis. NHS patient information.