Exercise guide
Polymyalgia rheumatica (PMR) makes the muscles around the shoulders, neck and hips stiff and achy, worst in the morning, mostly in people over 65. Moving usually eases it, and the 2026 UK guideline says everyone with PMR should get advice on physical activity and pacing. No trial has tested exercise in PMR yet, so the advice here comes from guidelines, a self-help booklet written with patients, and research in other conditions.
Steroid tablets ease PMR quickly, but they can weaken muscles and bones, so gentle stretches come first, then strength, balance and walking, built up slowly. PMR is linked to giant cell arteritis (GCA), which needs urgent care: a new headache, jaw pain when eating or any change in your sight means contacting a GP (general practitioner) or NHS 111 immediately, and suddenly losing your sight means calling 999.
This guide starts with those warning signs, then covers how much to do, daily stretches and strength moves with 3D demos, steroids and bones, flares and tapering, and a follow-along routine. Your GP and rheumatology team come first: use this to understand and remember their advice.
This is general information, not a diagnosis. A&E means accident and emergency. In the US, call 911 where this page says 999, and get same-day medical care where it says NHS 111.
Call 999 or go to A&E if any of these happen. Don't drive yourself: ask someone to drive you, or call 999 for an ambulance.
The NHS says to contact a GP or call NHS 111 immediately if you've been diagnosed with polymyalgia rheumatica, or it's suspected, and you have:
In the NHS's words: "Unlike polymyalgia rheumatica, temporal arteritis requires immediate medical attention. It can lead to serious problems like stroke or blindness if not treated quickly." Temporal arteritis is another name for giant cell arteritis. If it affects your sight, the NHS says you should have a same-day appointment with an eye specialist at a hospital eye department, and treatment starts before the diagnosis is confirmed.
The charity PMRGCAuk says sudden changes in your sight need a doctor the same day even if they only last a few minutes, and if you can't see your doctor, go to A&E. Arthritis UK says that if you can't get an immediate appointment, contact an out-of-hours doctor or go to A&E straight away. Less often, giant cell arteritis causes pain in the arm muscles when you use them, or in the calves when you walk. In Scotland, NHS inform says to phone 111 or your GP practice urgently, and for sudden changes in your vision, to contact an optician immediately or phone 111.
Sources give different figures. The NHS says up to 1 in 5 people with PMR develop giant cell arteritis. The 2026 guideline from the British Society for Rheumatology (BSR) and PMRGCAuk say 5% to 10% later develop it, and a 2025 review says 15% to 20% have it at some point. Whatever the figure, the signs above always need urgent help.
Activity usually eases the pain and stiffness of PMR, while doing too much tends to make it worse. The 2026 UK guideline says everyone with PMR should get advice on physical activity and pacing, and the 2015 European and American recommendations say to consider an exercise programme to keep muscle strength and function and cut the risk of falls.
A booklet written by PMRGCAuk with patients, Keele University and the University of Leeds suggests stretches for the neck, shoulders and hips, held for up to 20 seconds, 5 of each, at least twice a day, and getting up to move every half hour. This is expert and patient advice: no trial has tested exercise in PMR.
Steroids can cause painless weakness in the thigh and shoulder muscles. Light strength work, such as arm curls with a water bottle and standing up from a chair, plus balance practice and walking, helps keep you strong and steady and helps your bones.
PMRGCAuk's helpline suggests thinking of your earlier level of activity and doing about half of that. If you ache afterwards, halve it, then build back up over a week. These are rules of thumb from experience, not trial results.
The risk of breaking a bone is higher with PMR, and steroids are one reason; it's highest in the first year of treatment. Most people are offered bone-protecting medicine when they start steroids, with weight-bearing exercise such as walking, and strength work, alongside it.
Never stop or change your steroid dose yourself. If your PMR symptoms come back as the dose comes down, contact your GP or rheumatology team, and keep moving gently in the meantime.
Polymyalgia rheumatica causes pain, stiffness and inflammation in the muscles around the shoulders, neck and hips. The main symptom is stiffness in the morning that lasts longer than 45 minutes, and people often feel very tired, lose their appetite or feel low. It often comes on over a week or two, sometimes after a flu-like illness, and the stiffness can make dressing, washing, climbing stairs or getting out of bed hard. Unlike the ache after exercise your body isn't used to, it's worse after rest and eases with activity and as the day goes on.
Most people diagnosed are over 65, and it's very rare under 50. It's more common in women. About 1% of people in the UK have it, and the lifetime risk is 2.4% for women and 1.7% for men.
A steroid medicine, prednisolone, is the main treatment, and symptoms usually improve within a few days. The dose is reduced slowly, usually every 1 to 2 months, and most people take it for about 2 years. About half of people have a flare as the dose comes down, and in a review of studies, about half were still taking steroids after 2 years and a quarter after 5 years. In the UK, most people are treated by their GP, with a rheumatologist's help when needed.
In an Australian study, 36 people with PMR were compared with 32 people of the same age and sex. People with PMR had more difficulty with everyday tasks, and 18 months on, women with PMR took about 3 seconds longer to stand up from a chair 5 times and walked more slowly. More people with PMR were on the way to becoming frail (71% against 34% at the first visit). A US study of 41 people found similar results. Both studies are small.
In the same Australian study, about a third of people with PMR had severe fatigue, against 3% of the comparison group, and most slept poorly, almost 2 years after starting treatment. In a UK survey of 550 people with PMR, about 1 in 7 had symptoms of depression. Prednisolone can affect mood too: about 1 in 20 people notice changes.
The 2026 UK guideline says people with PMR should have information on self-care, including physical activity and pacing, which 97% of its panel agreed with. The 2015 recommendations from EULAR (the European Alliance of Associations for Rheumatology) and the American College of Rheumatology say to consider an individual exercise programme to keep muscle mass and function and cut the risk of falls. A physiotherapist can tailor one.
No trial has tested exercise in people with PMR, and a 2026 review for the European guidelines found none in PMR or giant cell arteritis. The UK guideline expects research in arthritis and other conditions to apply to PMR, and calls for trials. So the amounts in this guide are expert and patient advice, not trial results.
In a 1985 study of 12 people taking prednisone, a similar steroid (about 12.6 mg a day, and not people with PMR), the thigh muscles were 20% smaller than in people not taking it, and 50 days of training on a strength machine increased the muscle and brought strength back to normal. The UK guideline expects resistance and weight-bearing exercise to counteract steroid muscle weakness, but this hasn't been tested in PMR.
In 59 trials of older people living at home, exercise cut the rate of falls by 23%, and the review rated this high-certainty evidence. These weren't PMR trials, but falls matter more when steroids have thinned the bones, which is why the UK guideline wants falls reviewed soon after diagnosis.
In UK records of 12,136 people with PMR, the risk of breaking a bone was 63% higher than in people without it, and fewer than 13% of those on steroids were prescribed bone medicine. The 2026 UK guideline now recommends bone-protecting medicine (bisphosphonates) for everyone starting steroids for PMR unless there's a reason not to, and the UK osteoporosis guideline recommends regular weight-bearing and muscle-strengthening exercise alongside.
In a 2015 survey of 1,072 UK physiotherapists, 80% saw a role for physiotherapy in PMR, and 89% prescribed individual exercise that builds up gradually. Yet in a UK study of 197 people with PMR, only 35 used exercise to manage it, and a 2025 review says only about a quarter had been given exercise advice by their doctor.
Steroids treat PMR and usually work within days. Bone protection and, for some people, other medicines such as methotrexate are your team's decisions. Exercise works alongside them for strength, balance, bones, weight and mood, never instead of them.
These are starting points to discuss with your GP or a physiotherapist. The booklet's amounts are expert and patient advice from PMRGCAuk, Keele University and the University of Leeds; they haven't been tested in a trial.
Get up, stretch and move every half hour, even if it's only walking to your front door. On long journeys, stop now and then to stretch your shoulders, arms and legs.
Go as far as is comfortable and hold for up to 20 seconds. Start with 5 of each, at least twice a day, and with just a few minutes in total, building up to about a minute for each exercise.
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Start with 5 of each move and build up over a month to 20 a day. A tin of beans or a small bottle of water works as a weight. Step-ups: 30 seconds, or until you're moderately breathless, building to a few minutes, twice a day. Wall squat: hold for 10 seconds, building to 60 seconds, 3 times, once a day. PMRGCAuk says steroids can reduce your muscle, so some resistance exercise matters.
The NHS advises older adults to do activities that improve strength, balance and flexibility on at least 2 days a week. Our editorial starting points are side-stepping, 10 steps each way, as in our older adults guide, and standing with one foot half in front of the other, up to 10 seconds each side building to 30 seconds, with your fingertips on a kitchen counter.
Walking is usually the most suitable weight-bearing exercise for PMR. Start with a few minutes, and when you can, walk at a brisker pace for a few minutes. Many people find swimming particularly good, though it doesn't load your bones. Over time, build towards the NHS guideline of 150 minutes of moderate activity a week.
Steroids can ease symptoms so quickly that it's tempting to go straight back to your old routine, and PMRGCAuk says almost everyone who does feels rough the next day. Its helpline's rule of thumb is to think of your earlier activity or sport and do about half of that. If you ache afterwards, halve what you did, then build back up over the next week.
Keep a diary of your activity and how you feel, to find what you can manage even on a bad day. Don't do more than you planned on a good day, still do some activity on a down day, and look at your progress over a month rather than a week. Housework, work and seeing friends count as activity too.
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A hot bath or shower first thing in the morning or after exercise can ease pain and stiffness.
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The booklet's beginner set: go as far as is comfortable and hold up to 20 seconds, 5 of each, at least twice a day. Turn your head left and right only, stopping if you feel dizzy, and do the knee to chest sitting if lying down is hard.
3D demoNeck CARs (controlled articular rotations)Beginner · No equipment
3D demoSingle knee-to-chest stretchBeginner · No equipment
3D demoShoulder rollsBeginner · No equipment
3D demoStanding overhead reachBeginner · No equipment
Elbow opening with hands behind the headBeginner · No equipment
Hand up the back (back scratch reach)Beginner · No equipment
3D demoTable slide (seated forward reach)Beginner · A bench or box
3D demoSeated upper-back lift (sit tall, shoulders back)Beginner · A bench or boxThe booklet's set: 5 of each, building over a month to 20 a day, with a water bottle or tin of beans as a weight; hold side raises and hip extensions for 5 to 10 seconds. The knee extension and band row are our additions: 1 set of 8 to 12 to start (editorial).
3D demoSeated dumbbell curlBeginner · A dumbbell + A bench or box
3D demoSeated dumbbell lateral raiseBeginner · A dumbbell + A bench or box
3D demoStanding band hip extensionBeginner · A band + An anchor point
3D demoSit to stand from a chairBeginner · A bench or box
3D demoLow step-upBeginner · A step
3D demoWall sitBeginner · A wall
3D demoSeated knee extension (chair)Beginner · A bench or box + Something with weight
3D demoBand rowBeginner · A band + An anchor pointOn at least 2 days a week, easiest first, with your fingertips on the counter. Our editorial starting points: march for 1 to 2 minutes, side-step 10 steps each way, and hold each stance for up to 10 seconds, building to 30 seconds.
Walk most days, starting with a few minutes. Seated marching breaks up long spells of sitting. Heel drops add impact for your bones only if you've had no spinal fractures: read our osteoporosis guide first.
Steroids can cause painless weakness and wasting in the muscles of the thighs, hips and shoulders, so climbing stairs, getting up from a chair and lifting get harder. It can be hard to tell apart from PMR itself, so tell your team about new weakness. Strength work for these muscles is the exercise answer.
Broken bones are most common in the first year of treatment, and the extra risk lasts at least 5 years: in one UK study, about 1 in 10 people with PMR had broken a bone by 5 years. Bone protection usually starts with the steroids. Walking, strength work and balance practice help too, and our osteoporosis guide explains safe bending and impact.
Prednisolone increases appetite and can raise blood pressure and blood sugar. The NHS says regular exercise helps keep your weight stable and helps lower high blood sugar, and the UK guideline lists aerobic exercise for blood sugar, weight and blood pressure.
Stopping suddenly can make you very unwell. If you take steroids for more than 3 weeks, your GP or pharmacist should give you a steroid card to carry. If you're ill and being sick, follow the steroid sick day rules your team gave you.
Living with PMR can be unpredictable, and setbacks are normal. You may ache after activity, especially in muscles you haven't used for a while. If so, halve what you did, then build back up over the next week.
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Some people's energy dips as their steroids are reduced. Cut back your planned activity for a while, for example with a shorter walk, rather than stopping, and build up again.
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Some of your old symptoms may return as the dose comes down. If you think it's your PMR coming back rather than soreness from doing more, contact your GP or rheumatology team: a flare may need a change of dose, which only your team should make. Keep moving gently in the meantime.
As the dose comes down, some aches may come from osteoarthritis that the steroids were hiding, which doesn't need steroids. After long-term steroids, some people develop tendon problems such as rotator cuff trouble in the shoulder, where a physiotherapist can help.
Start with the PMR routine's stretches, and add its strength block once your symptoms are controlled. The chair workout suits stiff mornings, the strength and balance workout is a next step, and the flare-up routine suits a bad day.
The stretches and light strength moves from a polymyalgia rheumatica self-help booklet written with patients, plus balance practice, built up slowly.
15 minBeginner15 movesA dumbbell, A bench or boxA 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 wallA 40-minute strength and balance session for over-65s, built from the Otago home programme and NHS exercises, using a chair, a counter and a step.
40 minBeginner18 movesA bench or box, Something with weightEight gentle neck and shoulder stretches for desk stiffness, done standing or seated in ten minutes.
10 minBeginner8 movesA wallA 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 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 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 wallFor building up walking and strength over several weeks, once your symptoms are controlled.
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 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 minBeginnerThe giant cell arteritis signs are at the top of this page. In the US, call 911 where this page says 999.
Call 999, and don't drive yourself to A&E, for:
The NHS lists these as serious side effects of prednisolone:
Low mood is common with PMR, so tell your team. For urgent mental health help, call NHS 111 and choose the mental health option, or call Samaritans free on 116 123, any time. If you feel you can't keep yourself safe, call 999 or go to A&E. In the US, call or text 988.
PMRGCAuk's helpline, answered by volunteers who have had PMR or giant cell arteritis, is on 0300 111 5090, Monday to Friday, 9am to 5pm; it can't give medical advice. Arthritis UK's helpline is on 0800 5200 520.
Activity usually eases PMR pain and stiffness; it's doing too much that tends to make symptoms worse. The UK guideline recommends advice on physical activity and pacing, and most UK physiotherapists surveyed prescribe gradual exercise for PMR.
PMRGCAuk says almost everyone who does this feels rough the next day, with the aching and stiffness back. Its rule of thumb is about half your earlier level, built up slowly.
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In a small study, 50 days of training restored thigh muscle and strength in people taking a similar steroid, and the UK guideline expects resistance exercise to counteract steroid muscle weakness. It hasn't been tested in PMR itself.
It might be soreness from doing more, which eases if you cut back for a few days, or your PMR returning as the dose comes down, which needs your GP or rheumatology team. Some returning aches are osteoarthritis that the steroids had hidden.
It's an inflammatory condition that steroids treat, often within days, and it carries a risk of giant cell arteritis, which needs urgent care.
Light strength work is part of the plan: the booklet uses a water bottle or a tin of beans, and PMRGCAuk says resistance exercise matters because steroids can reduce your muscle. Build up slowly, ideally with a physiotherapist's advice.
Yes. Activity usually eases PMR pain and stiffness, and the UK guideline says everyone with PMR should get advice on physical activity and pacing. Start gently with daily stretches and build up slowly, because too much too soon tends to make symptoms worse.
Doing too much can bring back the aching and stiffness for a day or so, especially if you jump back to your old routine as soon as the steroids work. PMRGCAuk suggests about half of what you used to do, halving it again if you ache, then building back up over a week. Gentle activity, built up gradually, is what UK guidance and the PMR charity recommend.
Start with gentle stretches for the neck, shoulders and hips, held for up to 20 seconds, at least twice a day. Then add light strength work, such as arm curls, side raises, standing up from a chair and step-ups, plus balance practice and walking. No single exercise has been shown to be best: the aim is moving, strength and balance.
Nothing is banned, but avoid doing too much too soon, forcing a stiff shoulder, and sitting still for long. Stop neck turns if they make you dizzy, and after a hip replacement bend only as far as you've been advised. If you've had a spinal fracture, follow our osteoporosis guide on bending.
Yes. Walking is usually the most suitable weight-bearing exercise for PMR, and it helps keep your bones strong while you take steroids. Start with a few minutes and build up; walking with others can lift your mood too.
Many people with PMR find swimming particularly good for moving their shoulders and hips. It doesn't load your bones, so add some walking and strength work for bone health.
Yes, building up gradually. Steroids can reduce your muscle, so resistance exercise matters. Start light, with 5 of each move, and build up over a month; a physiotherapist can tailor a programme for you.
Steroids can cause painless weakness in the thigh and shoulder muscles, making stairs, standing up from a chair or lifting harder. In a small study, 50 days of training restored thigh strength in people taking a similar steroid. Tell your team about new weakness, because it can be hard to tell apart from PMR.
Fatigue and poor sleep are common in PMR and can last almost 2 years after diagnosis. Pace yourself: plan your activity, rest when you need to, and still do something gentle on a down day. If you think the tiredness is your PMR coming back, contact your team.
Contact your GP or rheumatology team: flares are common and may need a change of dose, which only your team should make. Don't change your dose or stop your steroids yourself. Keep moving gently, and cut back your planned activity for a while.
The NHS says to contact a GP or call NHS 111 immediately if you have PMR and get a new or frequent headache, pain in your jaw or tongue when eating or talking, or problems with your sight, such as double vision. If you suddenly can't see from 1 or both eyes, call 999 or go to A&E. Sight changes count even if they only last a few minutes.
It helps: regular weight-bearing and muscle-strengthening exercise is recommended alongside bone-protecting medicine, which most people with PMR are offered when they start steroids. Balance practice also cuts the risk of falls. Our osteoporosis guide has more.
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.
