Exercise guide
Gout is a type of arthritis in which uric acid forms crystals in and around a joint, causing sudden, severe flares of pain, most often in the big toe. During a flare, rest the joint: raise it, cool it with an ice pack wrapped in a towel, keep pressure off it and take your treatment early. Between flares, keep moving: the NHS advises regular exercise, and people who are more active and fitter develop gout less often.
The research on exercise itself is thin. Guidelines found almost no exercise research in gout, and we found no study showing exercise triggers flares. In small studies, very hard exercise briefly raised uric acid, and dehydration is a recognised trigger, so how you build up matters.
This guide covers why a gout flare is rested when an arthritis flare isn't, getting going again afterwards, how hard to exercise between flares, water and weight, and why the medicine that lowers uric acid matters more than any workout. It ends with joint-friendly moves in 3D, and workouts and plans to follow.
In a flare, the NHS advises taking your treatment as soon as possible, resting and raising the limb, cooling the joint with an ice pack wrapped in a towel for up to 20 minutes at a time, and keeping pressure off it. Arthritis UK says to avoid exercising during a flare, as it could make the pain worse, and to start again once the pain and swelling have gone down.
Sudden pain and swelling in a joint that is getting worse, with a very high temperature, or with feeling sick or being unable to eat, needs an urgent GP appointment or NHS 111 the same day: it could be an infection inside the joint.
The NHS advises regular exercise but not intense exercise, while Arthritis UK says exercise that leaves you out of breath is particularly good. In large studies, people who were more active and fitter developed gout less often. Our editorial reading of both: moderate to brisk exercise, built up gradually, with hard sessions kept short and plenty to drink.
Guidelines found almost no exercise research in gout, and we found no study showing exercise triggers flares. In small studies, very hard exercise briefly raised uric acid, and dehydration is a recognised trigger, so build up gradually and drink well.
Drink plenty of fluids: the UK Gout Society suggests about 8 large glasses (1.5 litres) a day. If you need to lose weight, do it gradually, because crash diets and long spells without food can raise uric acid and trigger attacks.
Urate-lowering medicine, such as allopurinol, is what prevents flares, and it's usually taken for life. Take it every day, even when you feel fine, and don't stop it during an attack.
Gout is a type of arthritis that causes sudden, severe joint pain. Too much uric acid (urate) in the blood forms crystals in and around joints, causing flares of severe pain, heat and swelling. It most often affects the big toe, but also the feet, ankles, knees, hands, wrists and elbows, with hot, swollen, red skin over the joint (redness can be harder to see on black or brown skin). The NHS says an untreated attack usually lasts 1 to 2 weeks; Arthritis UK says attacks usually last 5 to 7 days.
About 2 to 3 in 100 people in the UK have gout, and about 9.2 million adults in the US. It usually starts in men over 30 and in women after the menopause, and it's about four times more common in men, partly because oestrogen helps the kidneys clear urate. The risk rises with a family history, being overweight, alcohol, diuretics (water tablets) and some blood pressure medicines, high blood pressure, kidney problems and diabetes.
About three-quarters of the urate in the body comes from breaking down the body's own purines, and only about a quarter from food and drink, so diet is not the whole story.
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A knock or injury to the joint, an illness with a fever, an operation, an unusually large meal, too much alcohol, dehydration, and starting urate-lowering medicine or not taking it regularly.
Repeated attacks can damage joints and cause tophi (hard lumps of crystals under the skin) and kidney stones. Most people have further flares, and almost a quarter of people with gout have moderate to severe chronic kidney disease (stages 3 to 5).
The exercise evidence is almost all in men: the runners' study was men only, and a weight-loss trial and a treatment study were 95% to 97% men. Women with gout are under-studied, not shown to need different advice.
The NHS advises regular exercise but not intense exercise or lots of pressure on the joints. Arthritis UK says staying active reduces your chances of an attack, and that exercise leaving you out of breath is particularly good. The Austrian rheumatology society recommends 150 to 300 minutes a week of moderate cardio, and the UK Gout Society suggests aerobic exercise that gets your heart pumping for 20 minutes at least 3 times a week. The National Institute for Health and Care Excellence (NICE) and the American College of Rheumatology (ACR) make no recommendation on exercise.
The grade reflects that this is consistent guidance; it rests on studies that follow people over time, not on trials.
Guidelines found almost no exercise research in gout, and we found no study showing exercise triggers flares. NICE looked for lifestyle trials, including exercise, and the 7 it found were all about diet or supplements. A review for the European Alliance of Associations for Rheumatology (EULAR) found "little research on the effect of physical activity in gout": one study linking 150 minutes a week of exercise with fewer tophi, and one trial comparing yoga with an Ayurvedic bloodletting treatment. A Chinese trial of aerobic exercise in people with gout is registered, but we found no results.
In 28,990 male runners followed for nearly 8 years, those running 8 km a day or more had about half the risk of gout of the least active, and the fittest 65% less; lower body weight explained part of this. In 97,387 UK adults who wore activity monitors for a week, regular activity of at least 150 minutes a week was linked with 21% lower risk over 8 years, allowing for uric acid, while cramming it into 1 or 2 days was not. In 416,481 UK adults, a healthy lifestyle that included activity was linked with 37% lower risk, whatever their genes, and a genetic study linked moderate activity with less gout.
These studies show links, not cause and effect, and they're about getting gout in the first place, not about flares.
In 6 untrained young men, repeated 1-minute cycling sprints raised uric acid by 40%, and it was still higher the next morning, while in 7 others 2 hours of moderate cycling didn't raise it. In 7 people, adding arm exercise to intense leg exercise raised uric acid further, to a peak of 585 against 355 micromol per litre. A single moderate session didn't raise uric acid in 18 young men with high levels. None of these small studies measured flares.
In 33 people with gout who wore activity trackers, daily steps fell in weeks with a flare (5,900 against 6,972).
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In UK Biobank, heart and circulatory disease was about twice as common in people with gout (11.38 against 5.49 events per 1,000 person-years), and a healthier lifestyle, including activity, was linked with lower risk at every uric acid level. Across 26 studies, 63.9% of people with gout had high blood pressure, and across 11 cohorts, death rates were 23% higher. In 467,976 Taiwanese adults with high uric acid, but not necessarily gout, being active for 30 minutes on 5 days a week was linked with 4 to 6 years longer life than being inactive.
A review of 10 mostly observational studies favoured weight loss, but the evidence for fewer attacks was low quality, and uric acid and attacks rose for a while after weight-loss surgery. In a 16-week trial in 61 people with gout and obesity, a low-energy diet took off 15.4 kg against 7.7 kg without changing uric acid, flares or pain. The ACR rates weight loss as very low certainty, though it reports that a fall in body mass index (BMI) of more than 5% was linked with 40% lower odds of further flares in one study.
In a rabbit model of acute gout, moving the joint through its range made the inflammation worse, while static muscle work across the joint didn't. It's an animal study, but it fits the advice to rest a flaring joint.
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In interviews with 25 people with gout, people described stigma, losing independence during flares, and uncertainty about whether exercise could trigger flares or damage joints, especially without advice written for gout.
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Do these, and don't put pressure on the joint, which can make the pain feel worse:
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NICE recommends an anti-inflammatory, colchicine or a short course of steroid tablets as first treatments, and says an ice pack alongside your medicine may help the pain, though the evidence for ice is one small study. The ACR also suggests ice, on low-certainty evidence.
Arthritis UK says: "You should avoid exercising during a flare-up of gout, as it could make your pain worse. It's important to rest and recover and begin exercising after the pain and swelling have gone down." Don't stretch or massage the hot joint either.
In osteoarthritis, a flare is managed by keeping gently moving, as our arthritis guide explains. A gout flare is an acute inflammation driven by crystals, treated with medicine, rest, raising the limb and ice. If repeated attacks have damaged a joint, Arthritis UK says that damage is treated like osteoarthritis: regular exercise, less strain on the joint and a healthy weight.
If you feel well, gentle movement that doesn't jar or load the painful joint, such as seated upper-body work, is reasonable; there's no evidence either way. Keep drinking fluids.
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The NHS and the arthritis charities put it differently:
Moderate to brisk exercise, built up gradually, with hard sessions kept short and plenty to drink. That fits all three sources and the small studies, in which very hard efforts raised uric acid for a day or so and moderate exercise didn't. If you enjoy hard training, build up to it over weeks and avoid stacking hard days back to back. This is our reading; no study has tested it.
Start once the pain and swelling have gone down. Begin with gentle movement of the joint, such as ankle circles and easy toe or knee bends, then cycling, swimming or short walks on the flat, and build back to your usual activity over 1 to 2 weeks. After a big-toe flare, our big toe arthritis guide has a staged routine; skip its toe exercises while the joint is hot and swollen.
Aim for at least 150 minutes of moderate activity a week (the Austrian guideline says 150 to 300), plus strength work on 2 days, as the NHS advises for all adults. Spread it through the week: in the UK monitor study, a regular pattern was linked with lower risk, and cramming it into 1 or 2 days was not.
Cycling, swimming, rowing and walking on the flat are kind to sore feet. If a joint has been damaged by past attacks, treat it like osteoarthritis: our arthritis guide's pain rule applies to that joint, but not to a flare.
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Very hard exercise breaks down energy stores in muscle faster than they can be rebuilt, and the leftovers are turned into uric acid. In small studies, repeated sprints raised uric acid by 40% into the next morning, adding arm exercise to intense leg exercise raised it further, and long or single moderate sessions didn't raise it. A genetic study linked moderate activity with less gout but not with lower uric acid, and in 71 men with obesity, moderate activity (not light or vigorous) went with lower uric acid.
Exercise isn't a reliable way to lower uric acid; medicine is. If you train hard, drink well before and after, keep the hardest sessions short and build up over weeks (our suggestion). No study has measured whether this prevents flares.
The NHS says to drink plenty of fluids to avoid getting dehydrated, and lots of water during an attack unless a doctor says otherwise. The UK Gout Society suggests about 8 large glasses (1.5 litres) of fluid a day, and all drinks except alcohol count. Arthritis UK suggests at least 2 litres of water a day if you've had kidney stones, and the NHS allopurinol advice is to drink plenty of fluids too. Drink more on hot days and around long or sweaty sessions (our suggestion). In US survey data, people who drank more water had lower uric acid, though a snapshot can't show cause.
Avoid lots of sugary drinks, which raise the risk of gout. Have some alcohol-free days each week and keep within 14 units a week; the ACR reports that more than 1 or 2 drinks in 24 hours was linked with a 40% higher risk of a flare.
If you need to lose weight, do it gradually and avoid crash diets. The UK Gout Society says going without food for long periods and losing weight quickly can raise uric acid and trigger attacks, and that balanced eating with regular activity is the best way to lose weight safely. Arthritis UK says daytime fasting, such as during Ramadan, should be OK. In 211 people on treatment, a larger waist predicted a lower chance of reaching the uric acid target, so your waist is worth watching.
Gout comes with more high blood pressure, heart attacks, heart failure and strokes, and almost a quarter of people with gout have moderate to severe kidney disease. NICE suggests a follow-up after a flare that checks heart risk factors and kidney disease. That's the strongest reason to stay active between flares: see our guides to exercise for high blood pressure, heart disease and kidney disease.
Build towards 150 minutes a week, spread through the week. After a foot flare, start with the bike; swimming counts too.
3D demoStationary cyclingBeginner · Cardio machine
3D demoRecumbent exercise bikeBeginner · Cardio machine
3D demoIndoor Rowing (Rowing Machine)Beginner · Cardio machine
3D demoTreadmill walkingBeginner · Cardio machine
3D demoElliptical trainerBeginner · Cardio machine
3D demoStanding marchBeginner · No equipment2 days a week: 10 to 15 repetitions, 2 rounds, as in our arthritis exercise routine.
3D demoSit to stand from a chairBeginner · A bench or box
3D demoGlute bridgeBeginner · No equipment
3D demoSeated knee extension (chair)Beginner · A bench or box + Something with weight
3D demoWall push-upBeginner · A wall
3D demoBand rowBeginner · A band + An anchor point
3D demoLow step-upBeginner · A step
3D demoDumbbell goblet squatIntermediate · A dumbbellOnly once the pain and swelling have gone down, never on a hot, swollen joint. The two big-toe moves have no 3D demo.
3D demoAnkle circlesBeginner · No equipment
Big toe joint self-mobilisationBeginner · A bench or boxBig toe press (seated toe-flexor hold)Beginner · A bench or box
3D demoTowel toe curlBeginner · Other / check instructions + A bench or box
3D demoSeated bent-knee calf raise (soleus raise)Beginner · A bench or box
3D demoSlow calf raiseBeginner · A wall
3D demoWall calf stretch (gastrocnemius)Beginner · A wall
3D demoSingle-leg standBeginner · A wallOnce the knee has settled: 10 slow repetitions, or 10 holds of 5 seconds for the quad set (our suggestion).
Seated upper-body work keeps you training without loading the foot (our suggestion).
Between flares only. After a foot flare, leave out the foot and ankle routine's spring block for a couple of weeks (our suggestion).
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 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 10-minute routine for straight after a meal: an easy walk, a few simple standing moves from blood sugar trials, then a short walk to finish.
10 minBeginner6 movesCardio machine, A bench or boxA 15-minute barefoot routine for stronger toes, arches, calves and ankles, finishing with balance. You need only a towel, a wall and a resistance band.
15 minBeginner11 movesA wall, Other / check instructionsA 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 stepAn upper body workout at home with no gym: push-ups, band rows, pike push-ups, face pulls, close-grip push-ups and Y-T-W raises, with dumbbell options.
30 minIntermediate13 movesA band, An anchor pointA 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 weightLose weight gradually alongside the plan, without crash diets.
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 minBeginner5 days a weekA 12-week workout plan for weight loss: three strength days, two cardio days and daily steps, building to 200 minutes a week, with honest results.
3 training days45 minBeginner3 days a weekA 12-week exercise plan for over-65s: strength and balance three times a week, short balance sessions and daily walks, based on falls-prevention trials.
3 training days40 minBeginnerNICE recommends offering urate-lowering therapy (ULT), with the dose adjusted to reach a target, to people with frequent or troublesome flares, moderate to severe kidney disease, diuretic treatment, tophi or long-term gouty arthritis, and discussing it with anyone who has had a flare. It usually starts at least 2 to 4 weeks after a flare settles, aims for uric acid below 360 micromol per litre (below 300 with tophi or ongoing flares) and is usually lifelong. Only a third of people with gout take it, and only a third of those reach the target.
Take it regularly, even when you have no symptoms, and never stop allopurinol during an attack. Starting it can set off a flare, so NICE suggests discussing medicine to prevent flares, usually colchicine, while the dose is being adjusted. Allopurinol won't usually affect your ability to ride a bike, but wait if it makes you drowsy, dizzy or unsteady.
Diuretics (water tablets) and some blood pressure tablets raise the chance of gout, but don't stop them without medical advice.
If you have sudden pain and swelling in a joint and:
These can be signs of an infection inside the joint (septic arthritis), which usually needs treatment in hospital.
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If you get a rash or other skin reaction. For any other serious side effect, call NHS 111.
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Speak to a GP first if you haven't exercised for some time, or if you have a medical condition such as heart or kidney disease.
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True during a flare, for the affected joint. Between flares, the NHS advises regular exercise, Arthritis UK says staying active reduces your chances of an attack, and in large studies people who were more active and fitter developed gout less often. The advice is consistent; the evidence behind it comes from studies that follow people over time.
The NHS says rest and raise the limb and don't put pressure on the joint, and Arthritis UK says avoid exercising during a flare because it could make the pain worse. In an animal study, moving an inflamed gouty joint made the inflammation worse.
About three-quarters of urate comes from the body's own purines, and genes, kidneys, weight and medicines all matter. Alcohol, big meals and sugary drinks can set off attacks and raise the risk, but they're not the whole story.
Activity was linked with less gout, but in a genetic study not with lower uric acid. Urate-lowering medicine is what brings uric acid below target, and it's usually lifelong. Take it every day, even when you feel well.
Guidelines found almost no exercise research in gout, and we found no study showing exercise triggers flares. Very hard exercise does raise uric acid for a day or so in small studies, and dehydration and knocks to a joint are recognised triggers, so build up gradually and drink well.
Going without food for long periods and losing weight quickly can raise uric acid and trigger attacks, and the NHS says to avoid crash diets. Lose weight gradually, with eating changes and activity.
Not with the affected joint. The NHS advises resting and raising the limb, an ice pack wrapped in a towel for up to 20 minutes at a time, and no pressure on the joint, and Arthritis UK says to avoid exercising during a flare. Take your flare medicine as soon as possible.
Once the pain and swelling have gone down. Start gently, with cycling, swimming or short walks on the flat, and build back up over a week or two. An untreated attack usually lasts 1 to 2 weeks.
Between flares, yes: the NHS advises regular exercise, and more active people develop gout less often. Cycling and swimming are good ways back after a flare because they don't pound a sore foot. During a flare in the foot, keep weight off it and walk only as much as you need to.
Guidelines found almost no exercise research in gout, and we found no study showing exercise triggers flares; regular activity is linked with a lower risk of getting gout. Very hard exercise does raise uric acid for a day or so, and dehydration and knocks to a joint are recognised triggers. So build up gradually and drink well.
Not reliably. Very hard exercise raises it briefly, moderate exercise doesn't seem to change it, and a genetic study linked activity with less gout but not with lower uric acid. Urate-lowering medicine is what brings levels down to target.
Whatever you'll keep doing regularly: walking, cycling, swimming or dancing, plus strength work on 2 days a week. The Austrian rheumatology society recommends 150 to 300 minutes a week of moderate cardio, and regular activity spread through the week was linked with lower risk than cramming it into a weekend.
Yes, between flares, once the joint feels normal. Build up over a few weeks after a flare, drink well before and after, and keep very hard sessions short (our suggestion). If a joint has been damaged by past attacks, lower-impact options may suit it better.
Plenty: the UK Gout Society suggests about 8 large glasses (1.5 litres) of fluid a day, and Arthritis UK at least 2 litres of water if you've had kidney stones. Drink more on hot days and around long or sweaty exercise. Dehydration can set off an attack.
If you're overweight, losing weight gradually is advised, but avoid crash diets and long fasts, which can raise uric acid and trigger attacks. The evidence that weight loss reduces attacks is low quality, and one 16-week trial took off a lot of weight without changing uric acid. Gradual eating changes and activity are the safest way.
If your doctor has prescribed it, yes. Urate-lowering medicine is the treatment that prevents flares, it's usually lifelong, and the NHS says to keep taking it even when you have no symptoms. Don't stop it during a flare.
Not during a flare: the NHS says don't put pressure on the joint. Once it has settled, gentle movement such as ankle circles and big-toe movement helps you get going again. Skip toe exercises while the joint is hot and swollen.
Gout comes with more heart disease, high blood pressure and kidney disease, which is why NICE suggests checking heart risk and kidney disease after a flare. Regular exercise between flares is good for exactly those risks.
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.
