Exercise guide
Chronic pain is pain that lasts, or keeps coming back, for more than 3 months. It affects about 4 in 10 adults in the UK, and it can make exercise feel like the last thing you should do. In fact, exercise is one of the main treatments that NICE (the National Institute for Health and Care Excellence) recommends. It won't usually make pain disappear, but it can help you do more and feel better, and some pain while you exercise is usually fine: hurt doesn't necessarily mean harm.
If your pain has a name, such as fibromyalgia, chronic back pain or arthritis, start with the guide for your condition. This page covers what they share: what exercise can and can't do, how much pain is OK during and after exercise, how to start and build up, pacing, flare-ups, and the warning signs that need a doctor, with 3D demos and a short routine for bad days.
NICE recommends offering a supervised group exercise programme for chronic pain with no clear underlying cause, and encouraging people to stay active for the long term. In its review, exercise reduced pain and improved quality of life, in the short and long term, whatever the type.
Exercise mostly improves how much you can do, with smaller and less consistent effects on pain, and it eases anxiety and low mood. The evidence is low quality, so expect steady, modest gains rather than a cure.
The rule our pain guides use, borrowed from osteoarthritis research: pain no higher than about 5 out of 10 during and after exercise, settling within an hour or so and back to your usual by the next morning. If it isn't, do less next time, not nothing.
A few minutes on most days, adding a little each week. Pacing means a steady, planned amount, rather than doing a lot on good days and paying for it afterwards.
Keep moving gently rather than stopping, cut the load before you cut the sets, then build back up more slowly. See a GP (general practitioner) if a flare brings new symptoms.
See a doctor about new or changed pain, pain with a fever or feeling unwell, weight loss you can't explain, or new numbness or weakness. Call 999 for back pain with loss of feeling around your genitals or bottom, or new problems peeing or pooing.
NICE sends pain caused by a condition to that condition's own guidance, and so do we. If no guide fits, or your pain has no clear cause, this page is the place to start.
NICE defines chronic pain as pain that persists or recurs for more than 3 months; it's also called persistent or long-term pain. Chronic primary pain has no clear underlying condition, or the pain is out of proportion to any injury or disease: fibromyalgia is one type. Chronic secondary pain is explained by a condition, such as osteoarthritis or rheumatoid arthritis. The two can happen together.
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In 19 UK studies with 139,933 adults, about 4 in 10 had chronic pain (between 35% and 51%), and between 1 in 10 and 1 in 7 had pain that was moderately or severely disabling. It becomes more common with age, from 14% at 18 to 25 to 62% over 75, and it's more common in women.
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The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage".
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Pain in an arm or leg, often after an injury, that is far worse than expected and comes with changes in skin colour, temperature or sensitivity may be complex regional pain syndrome. We don't have a guide for it: see a GP. The NHS (National Health Service) lists physiotherapy exercises, pain relief and psychological support among the treatments.
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In long-term pain, the nerves, spinal cord and brain can become over-sensitised, so the body's warning system produces more pain even though there may no longer be any ongoing damage. Not knowing the cause doesn't mean the pain isn't real. The British Pain Society puts it this way: pain is never just in the mind or just in the body.
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Pain signals are processed alongside the parts of the brain that deal with anxiety, emotions, sleep, appetite and memory. That's why pain can make you tired, anxious and low, and why low mood and poor sleep can make pain worse.
The British Pain Society says hurt does not mean that harm is taking place, and the NHS says that if you become more active gradually, it's unlikely you'll cause any damage. Aches when you start are common and usually settle as you get fitter.
In people without pain, a bout of exercise usually dampens pain for a while afterwards. In long-term pain that effect is less reliable, and pain can rise for a while, which can put people off. Across 17 trials, though, a single session on average neither raised nor lowered pain over the next hour.
On its own, learning about pain made no clinically important difference to quality of life in NICE's review, though it may help pain and does no harm. Reviews find it helps more when it's added to exercise, and a 2026 review of 12 trials found a small reduction in pain.
Most trials are small and short, and most were in people with osteoarthritis, fibromyalgia, back pain or neck pain, so the size of the benefit is uncertain.
For chronic primary pain, NICE says to offer a supervised group exercise programme, suited to each person's needs and abilities, and to encourage staying active for the long term. It's the only treatment NICE says to offer rather than consider. In its review, exercise reduced pain (23 studies) and improved quality of life (22 studies) compared with usual care, in the short and long term, whatever the type. The only downside was more people dropping out. Most of the evidence came from supervised groups of women with fibromyalgia and people with chronic neck pain.
A Cochrane overview of 21 reviews (381 studies, 37,143 people) found that exercise improved physical function, mostly by a small to moderate amount, and sometimes pain, though not consistently. Side effects were few, mostly soreness that settled within a few weeks. The evidence was low quality: small studies, with follow-up rarely beyond 3 to 6 months.
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In 79 trials of chronic musculoskeletal pain, exercise beat no treatment and usual care, but in the 4 trials that compared it with a placebo treatment, it wasn't clearly better. The evidence was very low quality, and part of the benefit may come from the care and attention that comes with an exercise programme.
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In 28 trials with 2,265 people with chronic pain, exercise reduced anxiety and depression by a small to moderate amount.
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NICE found benefits from cardiovascular, mind-body, strength and combined exercise. Walking improved pain by about 5 to 8 points on a 100-point scale, and function for up to the long term (26 studies, 2,384 people). Aerobic exercise reduced pain slightly (27 studies). Tai chi reduced pain and disability in the short term (15 trials, mostly osteoarthritis), and tai chi, yoga and qigong reduced pain in middle-aged and older people (17 trials, low certainty). Pick what you enjoy and can keep doing.
There's no clear dose: a reanalysis of 75 studies found no strong dose effect, though more sessions a week looked most likely to help. Most trials used 2 to 3 sessions a week.
Cognitive behavioural therapy (CBT) gave small benefits over usual care for pain, disability and distress (75 studies, 9,401 people). NICE says to consider acceptance and commitment therapy (ACT) or CBT.
For chronic primary pain, NICE says to consider an antidepressant, and not to start opioids, anti-inflammatory painkillers, paracetamol, gabapentinoids or several others; if you already take them, review them with your doctor. It says not to offer TENS (transcutaneous electrical nerve stimulation), ultrasound or interferential therapy, and to consider a single course of acupuncture. The NHS says painkillers aren't the main way to manage long-term pain. Keep taking your medicines as prescribed, and talk to your GP or pharmacist before changing them, because some need to be reduced slowly.
These group programmes, run by a team over about 6 weeks, aim to improve quality of life rather than remove pain, with gentle exercise, relaxation, help with emotions and pacing. NICE made no recommendation for or against them for chronic primary pain (8 studies found no difference in quality of life); the NHS and the British Pain Society describe them as helpful. Ask your GP about a referral.
This is the rule our pain guides use, borrowed from osteoarthritis research:
The rule comes from an exercise programme for severe hip and knee osteoarthritis that counted pain of 0 to 2 out of 10 as safe and up to 5 as acceptable, with pain back to usual by the next day. In 76 people using it, median pain after sessions was 2 out of 10, pain stayed the same or fell over the weeks, and nobody stopped because of joint pain. Across 7 trials in chronic musculoskeletal pain, exercise that allowed some pain gave a small short-term benefit over pain-free exercise, and no difference later. It hasn't been tested across all kinds of long-term pain.
Stop or shrink any move that sends pain, pins and needles or numbness down an arm or leg, and get advice. Sharp pain, a joint giving way or new swelling aren't the acceptable kind either (our reading, as on our arthritis and hypermobility guides).
The British Pain Society: it pays to start gently and build up slowly. The NHS: the pain you feel when you start gentle exercise is your muscles and joints getting fitter, and in the long term the benefits of exercise far outweigh any increase in pain.
Our editorial starting point, the same as on our fibromyalgia guide, not a tested programme. Weeks 1 and 2: 5 to 10 minutes of walking, marching or cycling on 3 days, at a pace where you can talk easily, plus one round of 3 light strength moves (sit-to-stands, wall push-ups and band rows) on 2 days, and a few minutes of slow breathing each day.
Each week, if you haven't had a flare lasting more than a day or two, add a few minutes or one round. If you have, go back to the last week that felt manageable. Over 2 to 3 months, build towards 20 to 30 minutes on 2 to 3 days and strength work twice a week.
The NHS guidelines for adults: 150 minutes of moderate activity a week and strength work on 2 days, reached gradually. The NHS suggests speaking to a GP first if you haven't exercised for some time or have a medical condition.
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NICE recommends a supervised group programme, so ask your GP or physiotherapist what's available locally, including pain clinics and pain management programmes.
Across 40 studies, pain, other health conditions, not knowing the benefits and lack of time held people back; an approach suited to the person, support from others and knowing the benefits helped.
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Start with 5 to 10 minutes on 3 days at an easy pace, and build towards 20 to 30 minutes on 2 to 3 days over 2 to 3 months (our editorial starting point). Marching on the spot or stepping on your bottom stair work at home.
Twice a week: start with 1 set of 8 of each and build to 2 or 3 sets over the weeks (our editorial starting point), keeping to the pain rule.
Gentle movement and yoga poses. Stretching on its own helps least, so pair these with walking and strength work, and hold the tree pose near a wall.
3D demoCat-cowBeginner · No equipment
3D demoThoracic rotationBeginner · No equipment
3D demoHip windshield wipersBeginner · No equipment
3D demoSupine spinal twist (Supta Matsyendrasana)Beginner · No equipment
3D demoMountain pose (Tadasana)Beginner · No equipment
3D demoTree pose (Vrksasana)Beginner · No equipmentA few minutes of slow breathing or rest each day: the NHS suggests breathing slowly and deeply to ease pain.
Start with the 10-minute starter workout: one round is a full session at first. Add the low-impact or easy cardio workouts once 10 minutes feels manageable, and a yoga, Pilates or breathing session if you enjoy it. The chair workouts suit bad days. Our back pain, arthritis and hypermobility guides have routines for those conditions.
A 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 wallA 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 25-minute gentle yoga class for complete beginners and over-50s: slow breathing, a warm-up, supported standing poses, floor poses and a closing rest.
25 minBeginner14 movesNo equipmentA 20-minute mat Pilates workout for complete beginners. It covers breathing, spine position and the foundation moves, each with an easier option.
20 minBeginner13 movesNo equipmentA free 20-minute chair yoga class for older adults: slow breathing, gentle seated stretches and twists, standing poses holding the chair, and a calm finish.
20 minBeginner18 movesA bench or box, Something with weightA 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 6-minute breathing routine: slow breathing, crocodile breathing, alternate nostril breathing, box breathing and 4-7-8 breathing.
6 minBeginner5 movesNo equipmentA slow, 10-minute floor routine to unwind before sleep: child's pose, twists, happy baby and slow breathing.
10 minBeginner7 movesFirm cushion, A wallFollow a plan at a slower pace than written, repeating a week whenever you need to (our suggestion).
A free 8-week walking plan for beginners: build to 150 minutes of brisk walking a week, with intervals, hills and two short strength sessions.
6 training days40 minBeginner2 days a weekYour 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 free 4-week, 3-day Pilates plan for complete beginners. Two mat days and one wall day, with clear rules for when to move each exercise to its harder version.
3 training days25 minBeginnerSetting targets for each day and for the longer term, broken into small, manageable steps. The British Pain Society says carrying on to the point of unmanageable pain or exhaustion is rarely helpful, and that pushing through usually makes pain or tiredness worse. NHS pain management programmes teach pacing to avoid flare-ups.
Plan your day or week, break jobs into chunks, switch between activities and positions, and take planned rests. Do a set amount (a time, a distance or a number of reps) and build it up gradually, rather than stopping only when pain forces you to. On a good day, stop while you could still do more; on a bad day, do a shorter, gentler version rather than nothing (our suggestion).
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In a 2026 review of 9 studies (873 people), how much people could do tended to improve with this kind of pacing, but results for pain and tiredness were mixed, and confidence in the evidence was very low. An NHS pain service's pacing programme was workable, though about 4 in 10 people had dropped out by the end.
If activity is regularly followed by a delayed crash, out of proportion to what you did, that takes days or longer to recover from, see a GP. That pattern (post-exertional malaise) suggests ME/CFS, and NICE advises against graded exercise therapy and general exercise programmes for ME/CFS. Our ME/CFS and long COVID guides explain the different approach.
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Planned, gradually increasing amounts of activity reduced disability a little in chronic low back pain (13 trials), but did no better than other exercise.
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Gradually doing movements you've come to fear reduced fear of movement and catastrophising and improved disability (8 trials, 554 people), though its effect on pain was inconsistent and certainty was very low to moderate. If you avoid some movements because you fear damage, building up to them step by step, ideally with a physiotherapist, can help, as our back pain guide says for bending and lifting.
NICE describes a flare-up as a sudden, temporary worsening of symptoms, usually more intense pain, sometimes with tiredness or stiffness. It's unpredictable, how long it lasts varies, and a cause may not be found.
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Arthritis UK's physiotherapists advise slow, gentle movement during a flare rather than stopping altogether; even exercises in bed help, and simple stretches for a few minutes, then rest and repeat. High-intensity, high-impact or high-volume exercise is most likely to aggravate symptoms, so swap a 30-minute walk for a 15-minute stroll, and reduce the load before the number of sets. Never force a movement. This is expert advice: it hasn't been tested in trials.
Drop back to an easier level for a few days, then build up again more slowly than before (our suggestion).
NICE asks clinicians to reassess you in a flare-up, review your care plan and look into any new symptoms. Agree in advance what helps, what you'll cut back and when to get help (our suggestion).
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Arthritis UK's flare moves and other gentle ones: 5 to 10 slow repetitions in a comfortable range, then rest and repeat later (our editorial starting point). Leave out the knee hug if it sends pain down a leg.
3D demoSupine heel slideBeginner · No equipment3D demoHip windshield wipersBeginner · No equipment
3D demoSingle knee-to-chest stretchBeginner · No equipment
3D demoSupine isometric hip abduction (belt press)Beginner · A band
3D demoAnkle circlesBeginner · No equipment
3D demoShoulder rollsBeginner · No equipment
3D demoSeated marchBeginner · A bench or boxA 10-minute routine for bad days, mostly lying and sitting. Repeat it 2 or 3 times through the day if it helps, and see a GP if the flare brings new symptoms.
A 10-minute routine for a pain flare-up: slow breathing, small gentle moves lying and sitting, a short stroll if you can, then rest. Repeat later in the day.
10 minBeginner10 movesA band, A bench or boxA free 20-minute chair yoga class for older adults: slow breathing, gentle seated stretches and twists, standing poses holding the chair, and a calm finish.
20 minBeginner18 movesA bench or box, Something with weightKeep regular bed and getting-up times, let in daylight, keep daytime naps short (about 20 minutes, early in the afternoon) and try relaxation. See a GP if sleep problems keep going.
Pain can make you tired, anxious, low and grumpy, which can make pain worse. Exercise eased anxiety and depression in people with chronic pain, and talking therapies help too. Our depression, anxiety and sleep guides cover more.
If you are thinking about suicide or can't keep yourself safe, call 999 or go to A&E (accident and emergency). For urgent help, call Samaritans free on 116 123, any time, or in England call 111 and select the mental health option. In the US, call or text 988.
NICE recommends exercise firmly; a Cochrane overview rates the evidence low quality; and one meta-analysis found exercise no better than placebo treatments in 4 trials. Our reading: exercise helps most people a little, mostly with what they can do and with mood, and it's safe.
Older advice was to keep exercise pain-free. Trials that allowed some pain found a small short-term benefit, so we use the pain rule above.
NICE makes no recommendation for chronic primary pain; the NHS describes them as helpful. Both can be true: they aim at quality of life rather than pain.
Don't drive yourself to A&E.
Your GP first. In many areas you can refer yourself to NHS physiotherapy without seeing a GP. A GP can refer you to a pain clinic or a pain management programme, and the NHS names support groups such as Pain Concern and Action on Pain.
Long periods of rest bring stiff joints, weak muscles and poor fitness, and NICE recommends exercise and staying active.
Hurt doesn't necessarily mean harm. In long-term pain the nervous system can become more sensitive, so pain can continue without ongoing damage.
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Carrying on to the point of unmanageable pain or exhaustion is rarely helpful and usually makes things worse. Aim for pain no higher than about 5 out of 10, settled by the next morning.
On average, a single session neither raises nor lowers pain over the next hour, and soreness when you start something new is common and settles within weeks.
Pain is never just in the mind or just in the body. Exercise works on the body and the nervous system together.
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The benefits are modest, mostly in what you can do and in mood. NICE notes that quality of life can improve even if the pain stays the same.
In chronic primary pain a cause may not be found, and NICE recommends exercise anyway. New or changing pain, or the warning signs above, still need a doctor.
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No type is clearly best: NICE found benefits from cardiovascular, mind-body and strength exercise. In fibromyalgia trials, stretching on its own helped least (our fibromyalgia guide has the details).
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NICE advises against starting many painkillers for chronic primary pain, including opioids and anti-inflammatories, and the NHS says painkillers aren't the main way to manage long-term pain. Never stop or change a medicine on your own: talk to your GP.
Pacing means a steady amount, broken into chunks and built up gradually, rather than doing a lot on good days and crashing. The idea is widely recommended, but the trial evidence for it is very low certainty.
Yes, for most people, though the benefit is modest. In NICE's review, exercise reduced pain and improved quality of life, short and long term, and a Cochrane overview found the clearest effect on what people could do, with smaller and less consistent effects on pain. It also eases anxiety and low mood.
No single type wins: walking, cycling, strength training, Pilates, yoga and tai chi have all helped in trials. Pick what you enjoy and can keep doing, and if your pain has a name, start with that condition's guide.
Start lower than you think: a few minutes of walking or cycling on 3 days a week, and a few light strength moves twice a week, adding a little each week if you haven't had a flare lasting more than a day or two. NICE recommends a supervised group programme, so ask your GP or physiotherapist what's available locally.
Aim for pain no higher than about 5 out of 10 during and after exercise, settling within an hour or so and back to your usual by the next morning. If it isn't, do less next time, not nothing. Sharp pain, a joint giving way, or pain, pins and needles or numbness travelling down a limb are signs to stop and get advice.
In long-term pain, the pain-damping effect exercise usually has can be weaker, and pain can rise for a while. Soreness when you start something new is common and usually settles within a few weeks. Drop back to a level that felt manageable and build up more slowly.
Pacing means doing a steady, planned amount, breaking tasks into small steps and building up gradually, rather than doing a lot on good days and paying for it afterwards. It's taught on NHS pain management programmes; the trial evidence is limited, but it's widely recommended.
Keep moving gently rather than stopping: swap long walks for short strolls, and do simple moves for a few minutes, then rest and repeat. As it settles, build back up more slowly than before. See a GP if a flare brings new symptoms.
Usually, yes. In chronic primary pain, NICE says a cause may not be found, and it still recommends exercise. See a GP first if your pain is new or has changed, or comes with weight loss, a fever, or numbness or weakness.
Exercise reduced anxiety and depression in people with chronic pain across 28 trials. Regular bed and getting-up times and short daytime naps help sleep, and talking therapies such as cognitive behavioural therapy can help with both.
Keep taking your medicines as prescribed, and talk to your GP or pharmacist before changing them, because some need to be reduced slowly. NICE advises against starting some painkillers, such as opioids, for chronic primary pain, and the NHS says painkillers aren't the main way to manage long-term pain.
Fibromyalgia is one type of chronic primary pain, where no condition fully explains the pain. Chronic pain also includes pain caused by a condition such as arthritis, and the two can happen together. Our fibromyalgia, chronic back pain and arthritis guides cover each in detail.
Not in the usual way: NICE advises against graded exercise therapy and general exercise programmes for ME/CFS. If activity is followed by a delayed crash that takes days to recover from, see a GP and read our ME/CFS guide.
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.
