Osteoarthritis is one of the most common conditions I see in clinic, and also one of the most misunderstood.
For a long time, osteoarthritis was framed as a condition where joints simply wore out over time and activity needed to be limited to avoid making things worse. That idea still sits with a lot of people, and understandably so. When joints are painful and stiff, the instinct is often to protect them by doing less.
What we now know is that this approach can actually accelerate problems rather than slow them down.
Modern osteoarthritis guidelines consistently recommend exercise as a first line treatment, not just to manage symptoms, but to improve function and quality of life and, in many cases, slow functional decline. This shift is based on a growing body of evidence showing that appropriately prescribed exercise is safe, effective, and one of the most powerful tools we have for managing osteoarthritis.
International guidance, including recommendations from organisations such as the National Institute for Health and Care Excellence, clearly outlines that exercise should be offered to everyone with osteoarthritis, regardless of age, disease severity, or joint affected. The focus is not on avoiding load, but on applying the right type of load, in the right way, at the right time.
In practice, this is where many people get stuck.
They are told exercise is important, but not what kind, how much, or how to progress safely when pain is already present. Others try generic programs that are either too easy to be effective or too aggressive to be sustainable.
The aim of this article is to explain the role of exercise in osteoarthritis management in a clear and practical way. I want to walk through why exercise is recommended in every major guideline, what types of exercise are most helpful, and when professional guidance can make a meaningful difference.
When exercise is prescribed properly, osteoarthritis does not have to mean a steady decline. In many cases, it can be managed proactively and confidently.
Table of contents
- What is osteoarthritis
- Can osteoarthritis stop progressing
- Key takeaways
- Why exercise is recommended in osteoarthritis guidelines
- How exercise helps joints affected by osteoarthritis
- What types of exercise are best for osteoarthritis
- How exercise should be prescribed safely
- When professional guidance makes a difference
Key takeaways
If you are living with osteoarthritis, or supporting someone who is, the most important thing to understand is this: exercise is not harmful to osteoarthritic joints when it is prescribed appropriately.
Every major osteoarthritis guideline now recommends exercise as a core treatment. This applies to osteoarthritis of the knee, hip, hand, and other joints, and it applies across all age groups.
The key principles behind these recommendations are consistent:
- Osteoarthritis is not simply a wear and tear condition that worsens with movement
- Avoiding activity often leads to increased pain, stiffness, and loss of function
- Strengthening muscles around a joint reduces joint stress during daily activities
- Aerobic exercise improves overall health, weight management, and pain tolerance
- Exercise improves confidence in movement and reduces fear related to joint pain
Importantly, exercise does not need to be extreme to be effective. The benefits come from regular, progressive, and well matched loading, not from pushing through high levels of pain.
International guidance, including recommendations from the National Institute for Health and Care Excellence, supports exercise as a first line treatment for osteoarthritis and highlights that benefits are seen regardless of disease severity when programs are appropriately designed.
From my perspective, the biggest barrier is not whether exercise works. It is whether people are given the right information and support to exercise safely and consistently.
When exercise is approached with a clear plan and realistic expectations, it becomes a powerful tool for managing osteoarthritis rather than something to fear or avoid.
What is osteoarthritis
Osteoarthritis is a condition that affects the whole joint, not just the cartilage.
This is an important point, because osteoarthritis is often described as a simple case of joints wearing out over time. While changes to cartilage are part of the picture, they are only one component of what is actually happening.
In osteoarthritis, changes can occur in the cartilage, the bone underneath it, the joint lining, the surrounding ligaments, and the muscles that support the joint. Pain and stiffness are influenced by how all of these structures interact, as well as by how the nervous system processes pain.
This helps explain why two people with similar looking joints on an X ray can experience very different symptoms.
It also explains why pain does not always match what imaging shows. Some people with significant structural changes have minimal pain, while others with mild changes experience persistent symptoms. Osteoarthritis is not a straightforward mechanical problem, and it is not simply a one way path of decline.
From a clinical perspective, this matters because it shifts the focus away from trying to protect the joint from movement and toward improving how the joint functions as a system.
Another common misconception is that osteoarthritis only affects older people. While age is a risk factor, osteoarthritis can affect younger adults as well, particularly following joint injury, surgery, repetitive loading, or long periods of reduced activity.
The joints most commonly affected include the knees, hips, hands, feet, and spine, but the principles of management are consistent regardless of location.
What we now understand is that joints adapt to load. When load is appropriate and progressive, joints can become more resilient. When load is too high, too sudden, or absent altogether, symptoms are more likely to persist.
This is where exercise plays such a critical role. It is not about reversing osteoarthritis changes, but about improving joint tolerance, strength, movement confidence, and day to day function.
Understanding osteoarthritis as a manageable condition rather than an inevitable deterioration changes how people approach treatment. It opens the door to proactive strategies rather than passive ones.
Why exercise is recommended in osteoarthritis guidelines
Exercise is not recommended for osteoarthritis because it is a nice add on. It is recommended because it consistently delivers better outcomes than almost any other single intervention.
Across international and Australian guidelines, exercise is positioned as first line treatment for osteoarthritis. This recommendation is not based on opinion. It is based on decades of research showing that people who remain active and follow structured exercise programs report less pain, better function, and higher quality of life than those who rely on rest or passive treatments alone.
One of the clearest examples of this comes from guidance published by the National Institute for Health and Care Excellence, which states that exercise should be offered to everyone with osteoarthritis, regardless of age, joint affected, or severity of symptoms. The emphasis is not on protecting joints from load, but on improving their capacity to tolerate it.
From a clinical point of view, this makes sense.
Joints are designed to move and respond to load. When load is removed or avoided, muscles weaken, joint control declines, and sensitivity to movement increases. Over time, this can lead to more pain with less activity, which reinforces fear and avoidance.
Exercise works in the opposite direction.
Strength training improves the ability of muscles to absorb and distribute forces that would otherwise be transferred directly through joint surfaces. Aerobic exercise improves circulation, metabolic health, and pain modulation. Regular movement also improves confidence in the joint, which is a critical factor in long term symptom management.
Importantly, the benefits of exercise are not limited to the joint itself. Osteoarthritis often exists alongside other health conditions such as cardiovascular disease, diabetes, or reduced bone density. Exercise positively influences all of these, which is why it is often described as medicine rather than simply rehabilitation.
What the guidelines also make clear is that exercise should be individualised. There is no single program that works for everyone. The right exercise is one that matches the person’s current capacity, goals, and health status, and can be progressed safely over time.
This is where the gap often exists. People are told exercise is important, but not how to start, how to progress, or how to adapt when pain fluctuates.
Understanding why exercise is recommended is the first step. Knowing how to apply it safely and effectively is where outcomes are truly shaped.
How exercise helps joints affected by osteoarthritis
When people hear that exercise helps osteoarthritis, the natural question is how. If a joint is already painful or stiff, it can seem counterintuitive that loading it would improve symptoms rather than make them worse.
The key is understanding that exercise changes how the joint behaves, not just how it looks on a scan.
One of the most important effects of exercise is improved muscle strength around the joint. Stronger muscles act as shock absorbers. They reduce the amount of force that is transferred directly through joint surfaces during everyday activities like walking, climbing stairs, or getting up from a chair. When muscles are weak, joints are asked to do more work than they are designed to handle.
Exercise also improves joint control. Many people with osteoarthritis develop altered movement patterns without realising it. These changes are often protective responses to pain, but over time they can increase stress on sensitive areas of the joint. Targeted exercise helps retrain movement so that load is distributed more evenly.
Another benefit is improved joint mobility and circulation. Movement helps circulate synovial fluid within the joint, which plays a role in joint nutrition and lubrication. While exercise does not regenerate cartilage, regular movement supports joint health and reduces stiffness.
There is also a significant effect on the nervous system. Persistent joint pain can increase sensitivity to movement, even when tissue damage is minimal. Exercise has been shown to improve pain modulation, meaning the body becomes better at dampening pain signals rather than amplifying them.
Beyond the joint itself, exercise improves balance, coordination, and confidence. This is particularly important for people who have reduced activity due to fear of pain or instability. As confidence improves, people tend to move more naturally, which further reduces unnecessary joint stress.
From a clinical perspective, these changes explain why people often report improvements in pain and function even when imaging findings remain unchanged. Exercise does not cure osteoarthritis, but it can significantly improve how the joint performs and how the person feels day to day.
This is why consistency matters more than intensity. Small, regular amounts of appropriate exercise create meaningful change over time.
What types of exercise are best for osteoarthritis
One of the biggest misconceptions about exercise and osteoarthritis is that it has to look a certain way to be effective. In reality, there is no single best exercise. What matters most is that the exercise is appropriate, achievable, and progressed gradually.
Most osteoarthritis guidelines recommend a combination of strengthening and aerobic exercise.
Strengthening exercise is essential because it improves the ability of muscles to support and protect joints. This can include resistance training using weights, resistance bands, bodyweight exercises, or structured programs such as Pilates or yoga when appropriately modified. The aim is to build strength around the affected joint so that everyday movements place less strain on sensitive structures.
Aerobic exercise plays a different but equally important role. Activities such as walking, cycling, swimming, water based exercise, and elliptical training improve cardiovascular health, assist with weight management, and have a positive effect on pain processing. Many people also find that aerobic exercise improves stiffness and overall energy levels.
Low impact options are often a good starting point, particularly during symptom flares. Water based exercise, cycling, and walking on flat ground can allow people to stay active while minimising excessive joint stress. As tolerance improves, more challenging activities can often be reintroduced safely.
Importantly, exercise selection should consider what the person enjoys and what fits into their life. A program that looks perfect on paper but is unrealistic or unenjoyable is unlikely to be maintained long term. Consistency is far more valuable than variety or intensity.
Guidance from organisations such as the Arthritis Foundation reinforces that both strengthening and aerobic exercise are beneficial for osteoarthritis, and that programs should be tailored to the individual rather than restricted based on age or diagnosis alone.
From a clinical perspective, I encourage people to think less about finding the perfect exercise and more about finding the right starting point. When exercise is matched to current ability and progressed gradually, confidence grows and symptoms often become easier to manage.
The next question then becomes how to ensure exercise is prescribed safely, particularly when pain levels fluctuate or other health conditions are present.
How exercise should be prescribed safely
While exercise is recommended for everyone with osteoarthritis, how it is prescribed matters.
Pain, stiffness, other health conditions, previous injuries, and confidence with movement all influence what is appropriate for a given person. This is why generic exercise advice often falls short. Without individualisation, programs can be either too cautious to create change or too aggressive to be sustainable.
Safe exercise prescription starts with understanding the person, not just the joint.
This includes assessing current activity levels, identifying movements that are limited or painful, considering other medical conditions, and understanding what the person wants to achieve. Someone aiming to manage daily pain and mobility will need a different approach to someone who wants to return to hiking, gym training, or recreational sport.
Progression is just as important as exercise selection. Joints affected by osteoarthritis generally respond best to gradual increases in load. Sudden changes in intensity, volume, or exercise type are a common trigger for symptom flare ups. A structured plan allows load to increase in a way that tissues can adapt to rather than react against.
Monitoring symptoms is part of this process. Some discomfort during or after exercise can be acceptable, particularly early on. What matters is how symptoms behave over time. Pain that settles within a day and does not progressively worsen is often manageable. Pain that escalates or lingers usually signals that adjustments are needed.
This is where professional guidance can be particularly valuable. Exercise Physiologists are specifically trained to design, guide, and supervise exercise programs for people with chronic conditions such as osteoarthritis. Through our exercise physiology services at Physio Club, programs are tailored to individual needs and adjusted as symptoms and capacity change.
From a clinical perspective, the goal is not to avoid pain at all costs, but to work within safe limits that build strength, confidence, and tolerance over time. When exercise is prescribed thoughtfully and progressed appropriately, people are far more likely to stick with it and see lasting benefits.
When professional guidance makes a difference
While many people can begin exercising independently, there are times when professional guidance makes a meaningful difference to outcomes.
This is particularly true when pain has been present for a long time, when confidence with movement is low, or when osteoarthritis exists alongside other health conditions. In these situations, uncertainty around what is safe or effective often becomes the biggest barrier to progress.
From a clinical perspective, this is where a coordinated approach works best.
Physiotherapists play an important role in assessing joint function, movement patterns, and pain behaviour, and in identifying factors that may be contributing to ongoing symptoms. This allows exercise to be framed within a broader management plan rather than treated as an isolated intervention. Support through physiotherapy can also help address flare ups, modify activity during difficult periods, and keep progress on track. This type of support is available through our physiotherapy services at Physio Club.
For others, particularly those looking to build long term strength, fitness, and confidence with movement, ongoing supervision and progression can be the key to consistency. Knowing that exercise is being monitored and adjusted appropriately often removes the fear of doing too much or not enough.
Professional guidance is also valuable for people who have tried exercise before without success. In many cases, it is not that exercise does not work, but that the program was not well matched to the individual or was progressed too quickly.
Osteoarthritis management works best when it is proactive rather than reactive. Exercise is most effective when it is planned, supported, and adapted over time, rather than started and stopped in response to pain.
At Physio Club, our broader services are designed to support people across different stages of osteoarthritis management, whether the goal is to reduce pain, improve daily function, or return to more demanding physical activity.
When exercise is approached as a long term strategy rather than a short term fix, osteoarthritis becomes far more manageable. With the right guidance, many people are able to stay active, independent, and confident in their movement for years to come.
