Exercise guide
Exercise is the first treatment for osteoarthritis in every major guideline, whichever joint it affects. On average it eases pain and makes everyday tasks easier by a modest amount, and some people improve much more. It won't rebuild cartilage, it works for as long as you keep it up, and it doesn't wear your joints out.
The core is strengthening the muscles around your joints on 2 or 3 days a week, and walking, cycling or swimming on most days, built up gradually. Some pain is allowed: up to 5 out of 10 that settles by the next morning. Get help the same day for a hot, swollen joint with a fever, or severe pain and swelling that came on suddenly in one joint.
This guide gives the honest numbers, how much to do, what to do in a flare, moves with 3D demos, a follow-along routine and a plan for each joint.
NICE (the National Institute for Health and Care Excellence) tells clinicians to offer everyone with osteoarthritis exercise tailored to them: strengthening for the muscles around the joint and general aerobic fitness, alongside weight loss if it's needed. The international, American and European guidelines agree.
Modestly, on average. In knee osteoarthritis, pain was about 9 points better on a 0 to 100 scale than with a placebo or comparison treatment, and about 13 points better than usual care; in the hip, about 8 points. Hand exercise helped a little, for a short time. Some people improve much more than the average, and the benefit lasts only while you keep going.
NICE's experts wanted to reassure people that exercise is not harmful to joints with osteoarthritis. In studies lasting up to 30 months, exercise didn't make knees worse on scans or lead to more joint replacements. X-ray changes and pain often don't match, so pain is not a measure of damage.
Joint pain may rise a little when you start, and regular exercise still helps. The rule used in trials: 0 to 2 out of 10 is safe, up to 5 is acceptable, and the joint should be back to its usual level by the next morning. If it isn't, do less next time, not nothing.
No type is clearly best. Strengthening, walking, cycling, tai chi and water exercise all help, so choose what you'll keep doing, with some strength work for the muscles around your joint. Water exercise is a gentle way in if exercise on land hurts.
If you carry extra weight, any loss helps, and 10% helps more than 5%; diet plus exercise beat either alone in an 18-month trial. Walking is linked with less new knee pain, and recreational runners had less hip and knee osteoarthritis than people who didn't run.
Joints are exposed to a constant low level of damage that the body normally repairs. In osteoarthritis the cartilage on the ends of the bones thins and roughens, bony growths form and the joint can swell, because it can no longer repair itself as well as it once could. Almost everyone has some of these changes with age, often without knowing.
Pain and stiffness, often worse after rest, that come and go. Knees, hips and the small joints of the hands are most often affected, then the spine and the big toe. NICE diagnoses it from your symptoms, without an X-ray, if you're 45 or over with joint pain on activity and either no morning stiffness or stiffness that lasts 30 minutes or less. It doesn't necessarily get worse over time, and it can improve.
About 595 million people worldwide had osteoarthritis in 2020, 7.6% of the population, with the knee the most common joint. In the UK about 10 million adults have it, about 6 million women and 4 million men. It is more common in women but common in men too, and no guideline gives different exercise advice by sex.
People with weaker thigh muscles were more likely to develop knee osteoarthritis (5 studies, 5,707 people), one reason strengthening is central. Body weight loads the knees and hips: each kilo lost took about 4 kg of load off the knee with every step. Pain and X-rays often disagree: depending on the study, 15 to 76% of people with knee pain had osteoarthritis on X-ray, and 15 to 81% of people with X-ray changes had pain.
NICE's core treatments are therapeutic exercise and weight management, with information and support. OARSI (the Osteoarthritis Research Society International) makes structured land-based exercise a core treatment for knee, hip and widespread osteoarthritis. The American College of Rheumatology strongly recommends exercise, weight loss if needed, tai chi and self-management programmes, and EULAR (the European Alliance of Associations for Rheumatology) includes exercise in its knee, hip and hand recommendations.
In 2018, EULAR concluded that the activity guidelines for everyone, covering aerobic, strength, flexibility and balance work, are feasible and safe for people with hip or knee osteoarthritis and inflammatory arthritis, and that promoting them should be part of standard care. Its 2025 update, published in 2026, keeps activity promotion as standard care and puts more weight on sitting less and on support to change habits, including through technology.
The 2024 Cochrane review (139 trials, 12,468 people) found pain about 9 points better on a 0 to 100 scale than placebo or attention control (low certainty), and about 13 points better than usual care; function was about 11 to 13 points better (moderate certainty). The authors judged these gains of uncertain clinical importance, because they didn't clearly reach the change most people notice (12 points for pain, 13 for function). Types of exercise didn't differ, and exercise may increase side effects (low certainty).
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In 9 trials (549 people), exercise reduced hip pain by about 8 points and improved function by about 7 points on 0 to 100 scales, with high-quality evidence: about 1 in 6 people improved who otherwise wouldn't have. The benefit lasted 3 to 6 months after supervised sessions ended.
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In 5 trials (381 people), hand exercise reduced pain by about half a point on a 0 to 10 scale, with small gains in function and stiffness. The evidence was low quality, and the benefit had faded at 6 and 12 months.
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There are almost no exercise trials for osteoarthritis in these joints. The advice is borrowed from NICE's guidance, which covers osteoarthritis in any joint, and our joint guides say so.
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In 13 trials (1,190 people, average age 68), exercise in water gave a small short-term improvement in pain and disability, about 5 points on a 0 to 100 scale, with no serious side effects. OARSI recommends it for knee osteoarthritis but not for the hip or for many joints at once.
In Denmark's GLA:D programme (Good Life with osteoArthritis in Denmark), 9,825 people did two education sessions and 12 supervised exercise sessions over 6 weeks. Knee pain fell from 48 to 34 out of 100 and hip pain from 47 to 36 at 3 months, it held at a year, and fewer people took painkillers; there was no comparison group, so the true effect is smaller.
In the UK, a trial of 418 people with long-term knee pain found that ESCAPE-pain, a group programme of exercise and self-management, improved function a little more than usual GP care. More than 20,000 people have now done the programme.
The reviews disagree. The Cochrane review found no difference between types for the knee. A meta-regression of 48 knee trials found aerobic, strengthening and functional exercise similar, with thigh-focused programmes and supervised sessions at least 3 times a week doing better. A network analysis of 103 trials ranked aerobic and mind-body exercise (tai chi, yoga) highest for pain, and an earlier one of 60 trials favoured combining strength, flexibility and aerobic work.
Tai chi twice a week for 12 weeks matched physiotherapy in a trial of 204 people with knee osteoarthritis, and the American College of Rheumatology strongly recommends it.
Across 49 studies of exercise lasting 3 to 30 months in older adults with knee pain, there were no serious side effects, no increase in pain, no worsening on scans and no increase in knee replacements. In the 66 trials behind EULAR's recommendations, most trials that reported side effects found none, and the rest found only minor ones such as temporary joint or muscle pain. Loading exercise didn't seem to harm knee cartilage, though that evidence is low quality, and NICE's experts wanted to reassure people that exercise is not harmful to osteoarthritic joints.
No guideline sets a separate dose for osteoarthritis: EULAR found the general activity guidelines suitable. Doses name their source or say they're our suggestion.
Work the major muscle groups on 2 to 3 days a week. EULAR's table suggests 8 to 12 repetitions for most adults, or 10 to 15 at a light effort for older people starting out, and a single set can work for older people and beginners; the GLA:D sessions used 2 to 3 sets of 10 to 15. Enough matters: hip programmes that met the recommended dose reduced pain, while those of uncertain dose didn't, and in knee trials, strength gains of about 30 to 40% were needed before pain and function were likely to improve.
About 150 minutes a week of moderate activity (you can talk but not sing), or 75 minutes of vigorous activity, spread over the week. If you've been inactive, light to moderate activity still helps, and 20 minutes a day can make a difference. Build up how long first, then how often, then how hard. Walking, cycling, swimming and water aerobics all count.
EULAR suggests balance and coordination work such as tai chi on 2 to 3 days a week, and stretching on 2 to 3 days (daily is best), holding each stretch for 10 to 30 seconds, or 30 to 60 seconds for older people. From 65, the NHS advises strength, balance and flexibility work on at least 2 days a week. Break up long spells of sitting: the World Health Organization recommends sitting less at every age, and EULAR's 2025 update puts more weight on it.
NICE suggests considering supervised exercise sessions: the evidence that they beat exercising alone is limited, but its experts thought supervision helps people keep going. GLA:D and ESCAPE-pain both run twice a week for 6 weeks, and an ESCAPE-pain class is a 20-minute discussion and a 40-minute exercise circuit. In many areas you can refer yourself to NHS physiotherapy without seeing a GP, and Arthritis UK has free follow-along exercise programmes.
Our editorial starting point for knee, hip or general osteoarthritis without warning signs: the arthritis exercise routine below, or a local class, twice a week for 6 weeks, with walking, cycling or swimming on most other days, starting at 10 minutes and adding a few minutes a week towards 150. Then keep two strength sessions a week going for good. The shape copies GLA:D and ESCAPE-pain; the exact numbers are ours.
Each guide has a staged plan and warning signs for that joint. For arthritis in the lower back, the long-term back pain guide has the plan.
2 to 3 days a week: 2 sets of 10 to 15, building to 3, as in the GLA:D programme. Use a higher chair, a smaller range or a lower step if a joint complains, and keep the goblet squat for when the chair and step work feel easy.
3D demoSit to stand from a chairBeginner · A bench or box
3D demoSeated knee extension (chair)Beginner · A bench or box + Something with weight
3D demoQuad set (static quads)Beginner · No equipment
3D demoGlute bridgeBeginner · No equipment
3D demoLow step-upBeginner · A step
3D demoSide-lying leg raiseBeginner · No equipment
3D demoSlow calf raiseBeginner · A wall
3D demoDumbbell goblet squatIntermediate · A dumbbellWall push-ups and band rows: 2 sets of 10 to 15 (our starting point); wrap the band round your palm if gripping hurts. Tendon glides and ball squeezes come from hand arthritis programmes, and the pendulum keeps a sore shoulder moving: the hand and shoulder guides have the full plans.
2 to 3 days a week, next to a counter: 3 holds of 20 to 30 seconds on each leg, 10 heel-to-toe steps, and 10 side-steps each way.
Build towards 150 minutes a week: start with 10 minutes at a pace where you can talk but not sing, and add a few minutes a week (our suggestion). Walking outdoors, swimming, pool walking and aqua aerobics count too.
The arthritis exercise routine twice a week, with walking or cycling on other days. The chair workout suits flare days or limited mobility, and the strength and balance workout is the next step once the routine feels easy.
A 30-minute joint-friendly circuit built like the GLA:D and ESCAPE-pain programmes: a gentle warm-up, chair, step and band strength moves, balance, then stretches.
30 minBeginner14 movesA bench or box, A stepA gentle leg strength routine with no jumping: sit-to-stands, step-ups, wall sits, bridges and calf raises.
20 minBeginner7 movesA bench or box, A stepBalance practice in 10 minutes: tandem stance, single-leg stands, marches, heel walks, tree pose and floor transfers.
10 minBeginner7 movesA wall, A bench or boxA 25-minute standing cardio circuit with no jumping: marching, step jacks, sit-to-stands, punches, step-ups and wall push-ups, with a seated option for most moves.
25 minBeginner9 movesA bench or box, A stepA steady 30 to 45 minute cardio session at talk-but-not-sing pace: walk, cycle, row or cross-train, counting toward weekly activity guidelines.
40 minBeginner3 movesCardio machine, A wallA 20-minute seated workout for older adults who cannot stand for long: marching, leg and arm strength, posture, and sit-to-stands that lead back to standing.
20 minBeginner11 movesA bench or box, Something with weightA 10-minute session for low-energy days: marching, sit-to-stands, wall push-ups, step-ups and bridges, then a short walk. Doing a little counts.
10 minBeginner7 movesA bench or box, A wallStrength and balance in one session: squats, Romanian deadlifts, push-ups, rows, step-ups, back extensions, carries and single-leg balance.
45 minBeginner14 movesA wall, A dumbbellNew to exercise? Start with the beginner plan. The plan for women over 50 and the 3-day home plan suit you once the routine above feels comfortable.
Your first four weeks: two, then three short strength sessions a week at home plus walks, building gently to a full routine.
2 training days20 minBeginner3 days a weekA weekly plan for women over 50: strength, bone-loading and balance on 3 days plus walking, built on UK osteoporosis consensus advice.
3 training days45 minBeginner3 days a weekThree full-body home workouts a week with dumbbells or no equipment at all, plus walks and an 8-week plan to keep progressing.
3 training days35 minBeginnerRate your pain from 0 to 10 during and after exercise. In the pain-monitoring model used in knee and hip trials, 0 to 2 counts as safe, up to 5 as acceptable and above 5 as too much. By the next morning the joint should be back to its usual level; if it isn't, drop back one step next time (fewer sets, a smaller range, a lower step), not to nothing.
In 76 people with severe hip or knee osteoarthritis who trained this way, pain after sessions was usually about 2 out of 10, it fell over the weeks, and nobody stopped because of joint pain. Across trials in long-term muscle and joint pain, exercising into some pain did no worse than keeping it pain-free.
NICE asks clinicians to explain that joint pain may increase when you start exercising, that regular, consistent exercise will still help even if it causes some discomfort at first, and that keeping going long term increases the benefit.
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A flare is a temporary worsening of pain, swelling and stiffness, worse than your normal, that can disturb sleep and activity. The NHS says flares can last several days.
Arthritis UK's physiotherapists advise slow, gentle movement during a flare rather than stopping altogether; even exercises in bed help. High-intensity, high-impact or high-volume exercise is the most likely to aggravate it, so swap a 30-minute walk for a 15-minute stroll, reduce the load before the number of sets, and never force a movement into pain. Swimming and walking on the flat are usually tolerated. This is expert advice: flare strategies haven't been tested in trials.
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Mild discomfort and some muscle soreness are normal when you start. For a hot, swollen joint after exercise, try a wrapped ice pack for 15 to 20 minutes, and contact your GP or healthcare team if pain, heat and swelling last more than a few days. Pace yourself rather than doing too much on a good day: if you're wiped out and in agony the day after, go shorter and gentler next time.
Gentle range of movement with little load, as Arthritis UK's physiotherapists suggest in a flare: 5 to 10 slow repetitions within a comfortable range, never forced into pain (our starting point).
3D demoSupine heel slideBeginner · No equipment
3D demoHip Windshield WipersBeginner · No equipment
3D demoSingle knee-to-chest stretchBeginner · No equipment
3D demoSupine isometric hip abduction (belt press)Beginner · A band3D demoQuad set (static quads)Beginner · No equipment
3D demoAnkle CARsBeginner · No equipment
3D demoTendon glides (hand tendon gliding exercises)Beginner · No equipment
3D demoWrist & forearm flowBeginner · No equipmentFor people living with overweight or obesity, NICE says losing weight improves quality of life, function and pain. Any amount helps, and losing 10% of your body weight is likely to help more than 5%. Most of the evidence is in knees, but NICE applies it to every joint.
In an 18-month trial of 454 older adults with knee osteoarthritis, diet plus exercise (11.4% weight loss) eased pain and improved function more than diet alone or exercise alone. A community version in 823 people (8% weight loss) gave only a small pain benefit, of uncertain importance, and a few more falls and strains in the exercise group. Losing more than about 5% of body weight improved disability in pooled trials.
In 142 older adults with knee osteoarthritis, each kilo of weight lost took about 4 kg of load off the knee with every step. Our weight loss guide covers how to lose weight.
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In 1,212 people aged 50 and over with knee osteoarthritis, those who walked for exercise were less likely to develop new frequent knee pain and had less narrowing of the joint space on X-ray. This was an observational study, so walkers may differ in other ways.
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In 25 studies (125,810 people), 3.5% of recreational runners had hip or knee osteoarthritis, against 10.2% of people who didn't run and 13.3% of competitive runners. These are associations, and past injuries and other factors may explain some of the difference.
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In 1,203 people with knee osteoarthritis, those who chose to run had no more X-ray worsening or new knee pain than those who didn't, and their pain went away more often. The authors concluded that running need not be discouraged.
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Recreational running doesn't cause arthritis, and many people with mild knee osteoarthritis can keep running if it stays within the pain rule (our view). With a painful, flaring or badly arthritic joint, build strength and fitness first with walking, cycling or swimming. Arthritis UK suggests strengthening your legs before you start running, with the NHS Couch to 5K app as a way in. The risk sits with very high training loads and jobs that put heavy strain on the joints, not with ordinary running.
Exercise and weight management are the core; NICE's other options support them. Talk to your GP or pharmacist about medicines.
NICE recommends an anti-inflammatory gel or cream (a topical NSAID) first for knee osteoarthritis, and suggests considering one for other joints. It advises against routinely offering paracetamol or weak opioids, and against glucosamine and strong opioids. Steroid injections give short-term relief, 2 to 10 weeks, and can help you keep exercising.
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Acupuncture, dry needling, TENS (electrical nerve stimulation), ultrasound and other electrotherapy, and keyhole washout of the knee. Manual therapy (hands-on treatment) is only for use alongside exercise, for the hip or knee. Walking aids can help; braces, insoles and supports are not offered routinely.
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NICE suggests considering referral for a joint replacement when symptoms substantially affect your quality of life and non-surgical treatment isn't working, without ruling people out for age or weight. In a trial of 100 people eligible for a knee replacement, surgery plus 12 weeks of non-surgical care did better at a year than non-surgical care alone, but with more serious complications (24 against 6), and only 26% of the non-surgical group had the operation within the year.
Stop exercising and call 999 for:
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Ask for an urgent GP appointment or get help from NHS 111 if:
Speak to a GP first if you haven't exercised for some time, or have a medical condition or concerns. Many people don't need to see a professional to get started, as long as they start slowly and listen to their body. In many areas you can refer yourself to NHS physiotherapy. After a fall or an injury to a joint, our joint guides list the signs that need a same-day check.
Joints are constantly repairing everyday wear; in osteoarthritis that repair falls behind. Long-term exercise studies found no worsening on scans and no increase in joint replacements, loading exercise didn't harm knee cartilage, and NICE's experts wanted to reassure people that exercise is not harmful to osteoarthritic joints. Build up gradually because it's more comfortable and you're more likely to stick with it, not because your joints will wear out.
NICE says pain may increase when you start and that regular exercise still helps. In trials, pain up to 5 out of 10 that settled by the next morning was acceptable, and exercising into some pain did no worse than pain-free exercise. Pain and X-ray damage often don't match.
Resting a painful joint may feel better at first, but too much rest can increase stiffness and weaken the muscles that support it. Even in a flare, Arthritis UK's physiotherapists advise gentle movement rather than stopping.
Recreational runners had less hip and knee osteoarthritis than people who didn't run, and people with knee osteoarthritis who ran didn't get worse. The higher rates were in competitive runners.
In knee trials, exercise helped about as much whatever the X-ray looked like. In a trial of people eligible for a knee replacement, most of those given 12 weeks of exercise and other non-surgical care hadn't had surgery a year later.
Water exercise helps a little and is a good way in. But land-based strengthening and aerobic exercise are the core treatments in every guideline, and OARSI recommends water exercise for the knee only.
In 9 trials that scanned knee cartilage, exercise mostly made no difference to its thickness or volume: it didn't harm it, and there's no good evidence that it rebuilds it. Exercise reduces pain and improves function while you keep doing it.
Yes. For osteoarthritis, every major guideline puts exercise first, with weight loss if you need it. On average it reduces pain and makes daily tasks easier by a modest amount, and some people improve a lot more. The benefit lasts as long as you keep going.
The one you will keep doing. Strengthening the muscles around the joint and aerobic exercise such as walking, cycling or swimming all help, and reviews disagree on which helps most. Tai chi did as well as physiotherapy for knee arthritis in a trial. A mix of strength, aerobic and balance work covers the most.
Not in the long run. In studies lasting up to 30 months, exercise didn't worsen joints on scans or lead to more joint replacements, and NICE says exercise is not harmful to arthritic joints. Pain can rise a little when you start: up to 5 out of 10 is acceptable if it settles by the next morning.
Keep moving, but gently: shorter walks, less load and range-of-movement exercises, rather than stopping altogether. Build back to your usual routine as the flare settles. A hot, red, swollen joint with a fever, or severe pain and swelling that came on suddenly in one joint, needs help the same day.
The same as everyone: build towards 150 minutes a week of moderate activity, with strength work on 2 or more days and balance work if you're older or unsteady. European guidelines found these amounts safe and suitable for people with arthritis. Start well below that and build up gradually; group programmes such as ESCAPE-pain run twice a week for 6 weeks.
Yes. People with knee arthritis who walked for exercise were less likely to develop new frequent knee pain, and walking is one of the low-impact activities the NHS recommends. Start with short, comfortable walks and add a few minutes each week.
Recreational runners had less hip and knee arthritis than people who didn't run, and people with knee arthritis who chose to run didn't get worse. Many people with mild arthritis can keep running within the pain rule. With a painful or flaring joint, build strength and fitness with walking, cycling or swimming first.
It helps a little and is easy on the joints: exercise in water gave a small short-term improvement in pain and function in knee and hip arthritis. It's a good way in if exercise on land hurts, but add some land-based strengthening, which is the core treatment.
Yes. Strengthening is one of the two types of exercise NICE recommends, and European guidelines found the usual strength training advice safe for people with arthritis. Start light, with 10 to 15 controlled repetitions, and build up, using the pain rule to adjust the depth and the load.
No. Your joints are always repairing everyday wear, and in osteoarthritis that repair falls behind. That's why moving usually helps rather than harms, and why X-ray changes and pain often don't match.
If you carry extra weight, yes: any loss helps, and losing 10% is likely to help more than 5%. In an 18-month trial, diet plus exercise beat either alone, and each kilo lost takes about 4 kg of load off the knee with every step.
In the GLA:D programme (6 weeks of classes), pain was lower at 3 months and stayed lower at a year. Exercise won't rebuild cartilage, but it reduces pain and improves function while you keep doing it. Osteoarthritis doesn't necessarily get worse, and it can improve.
Exercise education, not a diagnosis or treatment plan, and clinical review of these guides is pending. Stop and get advice for chest pain, unusual breathlessness, dizziness or fainting, or new pain, and check with your doctor or midwife first if they have told you to limit activity. Health disclaimer.
