How to Exercise Safely With Arthritis | Physio to Home
Should you exercise with arthritis? Yes — and the evidence is clear on how. North Tasmania's home physiotherapist explains the exact principles, the exercises that help most, and the common mistakes that make arthritis pain worse.
Should you exercise with arthritis? Yes — and the evidence is clear on how. North Tasmania's home physiotherapist explains the exact principles, the exercises that help most, and the common mistakes that make arthritis pain worse.
Micheal Ghattas
3/6/2026 · 7 min read
How to Exercise Safely With Arthritis: A Practical Guide
By Michael Ghattas, DPT | AHPRA Registered Physiotherapist | 18 Years Experience
Physio to Home, North Tasmania | Last reviewed: March 2026
If you have arthritis — osteoarthritis in particular — you have almost certainly been told to rest when it hurts, to take it easy, to avoid exercise that causes pain. This advice is wrong. Not unhelpful — wrong. It is contradicted by decades of research showing that appropriate exercise is one of the most effective treatments for arthritis pain and function, and that rest and inactivity make arthritis worse over time.
This guide explains how to exercise safely with arthritis — including which exercises are most effective, how to manage pain during and after exercise, and how to tell the difference between normal exercise discomfort and a warning sign worth paying attention to.
Why Exercise Is the Right Treatment for Arthritis
The muscles surrounding arthritic joints — hips, knees, shoulders — are the joint's primary shock absorbers. When those muscles are strong, they absorb the forces of daily movement before they reach the joint surface. When they are weak — as they almost always are in people with chronic arthritis — the joint bears the load directly.
This is why rest is counterproductive. Rest weakens the muscles. Weaker muscles mean more load on the joint. More load on the joint means more pain and accelerating cartilage stress. The cycle produces exactly the outcome that rest was meant to prevent.
Exercise reverses the cycle. It strengthens the muscles that protect the joint, improves the lubrication of the joint through synovial fluid movement, reduces the central nervous system sensitisation that amplifies arthritis pain, and produces meaningful improvements in pain and function that the research consistently shows are equivalent in effect size to non-steroidal anti-inflammatory drugs.
The 2019 OARSI guidelines for osteoarthritis management — the most authoritative international guidelines in this field — recommend exercise as a core treatment for all patients with hip and knee osteoarthritis, regardless of severity, age, or pain level. There is no imaging finding, no X-ray grade, and no age at which exercise becomes contraindicated in osteoarthritis.
The Three Principles of Safe Exercise With Arthritis
Principle 1: Distinguish between hurt and harm
The most important distinction in exercising with arthritis is between pain that is unpleasant (uncomfortable, effortful, temporarily worse than resting) and pain that signals damage (structural harm to the joint). In arthritis, the great majority of exercise-related discomfort falls into the first category.
A clinically useful rule of thumb: pain during exercise that stays within a 4/10 intensity and resolves within 30 minutes of stopping is normal exercise discomfort — not a signal to stop. Pain that reaches 7–8/10 during exercise, or that takes more than 30–60 minutes to settle after exercise, suggests the load was too high and should be reduced, not stopped entirely.
Principle 2: Progress gradually
The joint — and more importantly, the muscles, tendons, and ligaments surrounding it — needs time to adapt to increasing loads. Doing too much too soon is the most common cause of arthritis flares during exercise. Beginning with lower-resistance, lower-repetition exercises and increasing the demand by no more than 10% per week gives the tissues time to adapt.
Principle 3: Be consistent above all else
The research on arthritis and exercise consistently shows that consistency is the most important predictor of outcomes — more important than the specific exercises chosen, more important than the intensity, more important than the mode. An exercise programme done three times per week, every week, for three months will produce dramatically better outcomes than a programme done intensively for two weeks and then abandoned.
The Best Exercises for Arthritis — By Joint
Hip arthritis
Clamshell: Lying on your side, knees bent, feet together — lift the top knee without moving the pelvis. 15 repetitions, 2 sets. Targets the gluteus medius, the most important hip stabiliser.
Bridging: Lying on your back, knees bent, feet flat — push through your heels and lift your hips. Hold 3 seconds. 15 repetitions. Targets gluteus maximus.
Sit-to-stand: Stand up from your chair and sit back down slowly. 10–15 repetitions. One of the most functional exercises for hip arthritis.
Standing hip abduction: At the kitchen bench for support — lift one leg out to the side, hold, lower slowly. 15 repetitions each side.
Knee arthritis
Seated knee extension: Sitting in a chair, straighten one knee fully and hold 5 seconds. 15 repetitions. Targets the quadriceps with minimal joint load.
Mini squat: At the bench for support — bend your knees to no more than 30 degrees and straighten. 15 repetitions. Progress depth gradually.
Step-ups: Step onto the bottom stair, leading with the affected leg. Step down. 10–15 repetitions. Excellent functional quadriceps and glute exercise.
Calf raises: Standing at the bench — rise onto your toes, hold, lower slowly. 15 repetitions. Supports knee joint stability.
Shoulder arthritis
Pendulum: Lean forward, supporting yourself with the uninvolved arm on a table. Let the affected arm hang and swing gently in small circles. 30 seconds each direction. Low-load maintenance exercise.
Shoulder blade squeezes: Seated or standing — gently squeeze your shoulder blades together and hold 5 seconds. 15 repetitions. Improves postural support for the shoulder joint.
Wall slides: Standing facing a wall, arms at shoulder height with forearms flat against the wall — slide your arms upward as far as comfortable. 10 repetitions.
Managing Pain Before, During, and After Exercise
Before: If pain is high at the start of a session, 10–15 minutes of gentle warmup — walking, range-of-motion movements, light activity — typically reduces joint stiffness and improves tolerance.
During: Keep exercise within the 0–4/10 pain range. If pain climbs above 5/10, reduce the resistance or range rather than stopping entirely. Isometric contractions (static holds without movement) are a useful option when movement is too painful — they maintain muscle activation without joint compression.
After: Some increase in soreness following exercise — particularly after a new programme or after increasing load — is normal and typically peaks 24–48 hours later (delayed onset muscle soreness). This is not arthritis damage. Ice applied for 10–15 minutes post-exercise reduces this soreness. Heat before exercise loosens stiff joints. Both are useful in the arthritis exercise context.
The 30-minute rule: If pain has not returned to baseline within 30 minutes of completing exercise, the session was probably too hard. Reduce the load at the next session.
Common Mistakes That Make Arthritis Worse
Resting completely when pain flares. A flare is a signal to reduce load — not stop entirely. Maintain gentle movement through a flare to prevent the muscular deconditioning that will make the next flare worse.
Doing too much on good days. The boom-bust pattern — pushing hard when feeling good, then crashing for several days — is one of the most common reasons arthritis exercise programmes fail. Consistent moderate effort beats irregular intense effort every time.
Choosing high-impact over low-impact without building toward it. Running, jumping, and high-impact activities are not forbidden with arthritis — but they require a foundation of muscular strength and joint tolerance that most people with significant arthritis have not yet built. Start with low-impact exercise and build toward higher-impact activities if desired.
Stopping at the first sign of discomfort. Discomfort during exercise is normal and expected, particularly in the first weeks of a new programme. Stopping at the first twinge prevents the adaptation process from occurring.
When to See a Physiotherapist
While many people with arthritis can make meaningful progress with a self-directed exercise programme, physiotherapy provides three things that self-management cannot: an accurate assessment of which muscles are weak and which exercises are most appropriate; hands-on manual therapy that reduces joint pain and improves mobility; and expert progression of the programme as capacity improves.
A physiotherapist is particularly important if: your pain is severe and limiting engagement with exercise; you have had a recent joint replacement; you have arthritis in multiple joints; or your previous attempts at exercise have consistently produced pain flares.
Ready for a Personalised Arthritis Exercise Programme in North Tasmania?
Physio to Home provides AHPRA-registered arthritis assessment and home exercise programme prescription across North Tasmania — in your own home, using your own furniture, calibrated to your specific joints and capacity.
Book your home visit today →
About the Author
Michael Ghattas, DPT | AHPRA Registered Physiotherapist | 18 Years Experience
Founder, Physio to Home — North Tasmania's home physiotherapy service.
References
Kolasinski SL, et al. 2019 ACR/AF Guideline for the Management of Osteoarthritis. *Arthritis & Rheumatology*, 2020.
Fransen M, et al. Exercise for osteoarthritis of the knee. *Cochrane Database of Systematic Reviews*, 2015.
Bennell KL & Hinman RS. A review of the clinical evidence for exercise in osteoarthritis of the hip and knee. *Journal of Science and Medicine in Sport*, 2011.