Exercises that will help a person with osteoarthritis include:

• Aerobic exercise that builds cardiovascular endurance, such as walking, biking, or swimming.
• Strength exercise, such as lifting weights.
• Range-of-motion (flexibility) exercise, such as stretching or joint-specific exercises.

Exercises to avoid

If you have osteoarthritis in your hands, try to avoid exercises or sports that require a tight grip, such as bicycling. If you have osteoarthritis in your knees, try to avoid exercises that stress the knees, such as tennis.

Also, try to avoid overexercising. Joint pain that lasts longer than 2 hours after exercise may be a sign of overexercising. ¹ Studies show that exercising harder does not necessarily lead to further improvement in osteoarthritis pain or your ability to do your daily activities, so exercise within your tolerance. If an activity makes you feel sore, try something different. You can also change how you do the activity by trying any of the following:

• Rest between repetitions or between activities.
• Decrease your speed.
• If you're walking or swimming, go a shorter distance. You may be able to take two or three short walks in a day rather than one long walk.
• Spend a shorter time exercising, then rest and do a little more later.
• Lift less weight.

Joints and muscles need to be exercised to prevent stiffness and weakness. Also, exercise will make you feel better and help you maintain a healthy weight. Excess body weight places extra force and pressure on arthritic joints and causes osteoarthritis to progress more rapidly.

Without exercise, not only will you lose muscle strength but your osteoarthritis will progress faster. Exercising will not "wear out" a damaged joint. ² But newer research also suggests that if your joint is unusually loose or does not line up normally, some kinds of exercise may not be as effective or may even increase the progression of osteoarthritis. ³ Your doctor can help you determine what exercise is best for you.

Stretching exercises will help prevent the stiffness associated with osteoarthritis and help prevent injury. Strengthening exercises will help strengthen the muscles and ligaments surrounding a joint, which in turn will protect and reduce stress on the joint. For example, stronger thigh muscles take some of the stress off of weight-bearing joints such as the knees and hips.

Several studies have shown the benefits of exercise for people with osteoarthritis. Exercise can help to:

• Improve hip and knee joint function and movement. ²
• Improve function in a person with knee osteoarthritis, and perhaps delay or prevent the need for surgery. ⁴
• Improve posture and balance in older adults with osteoarthritis, thus reducing the chance of falls. ⁵

Motivation to exercise Sometimes it is hard to get motivated to exercise, even though we understand the benefits of exercise. These suggestions may be helpful:

• Try to find a friend to exercise with you, or join a support group. People are more likely to stay with their exercise program if they exercise with a friend. Also, people with osteoarthritis who attend classes or support groups have less pain, less depression, and better joint activity than people who do not. ⁶
• Try a class at your local health club or with your local arthritis chapter that is specifically designed for people with arthritis. People who participate in an exercise class in addition to their home exercise program have shown added improvement in function. And they are more likely to keep doing their exercise even after the class ends. ⁷
• You can exercise without spending a lot of money at a health club or on equipment. You can do many exercises, such as walking, almost anywhere at no cost. At a local health club such as the YMCA, you can enroll in a class (rather than pay for a complete registration) that is inexpensive and designed specifically for people with arthritis.
• Record your efforts. Some people are motivated by seeing their progress written down.
• Reward your efforts. When you reach a step toward your goal, reward yourself by doing a special activity or buying something.

Exercises that will help a person with osteoarthritis reduce joint stiffness and pain include the following:

• Aerobic exercise to strengthen your heart and lungs and increase your endurance. Aerobic exercises include:
  • Walking outdoors, which you can do through your neighborhood or along city paths, for example.
  • Walking indoors, which you can do on a treadmill or at the mall, for example.
  • Walking in water that is up to your waist or your chest (if walking outdoors or indoors is not comfortable). The water helps take the weight off painful joints, and also provides some resistance.
  • Swimming, which you can do at your local health club or YMCA. Many locations offer classes specifically for people with arthritis. Swimming is an excellent choice for people with hip or knee osteoarthritis, because water takes weight off the joints while also providing some resistance.
  • Cycling, which you can do outdoors or indoors on a stationary exercise bicycle.
  Note: Start slowly. For example, do 10 minutes of exercise at a time, two times a day. Then increase your time gradually. Aim for at least 2½ hours of moderate exercise a week. One way to do this is to be active 30 minutes a day, at least 5 days a week.
• Strength exercises to improve and maintain strength in your muscles. Strength exercises include:
  • Simple, safe, and effective exercises such as chin-ups, push-ups, side leg-lifts, and other exercises that improve abdominal, neck, arm, shoulder, and leg strength. Many exercise books and videotapes can show you how to do these exercises properly.
  • Lifting light weights or dumbbells, or using elastic tubing. You can use these at your local health club, or you can buy them yourself to use at home.
  • Using an exercise machine at home or at your local health club.
  Note: Before starting strength exercises, ask a physical therapist, a trainer from a health club, or your doctor which exercises would be best for you. And ask how to do strength exercises safely so you don't get hurt.
• Range-of-motion exercise to improve flexibility and help prevent further joint damage. Range-of-motion exercises include:
  • General stretching exercises, which will move your joints through their entire range of motion. For example, stretching exercises for the legs include calf stretch, quadriceps (thigh) stretch, and hamstring (tendons in the back of the knee) stretch. See a picture of several stretches.
  • Joint-specific exercises, which target a particular joint such as the knee in order to improve motion in that joint and prevent further damage. An example of this is a quadriceps (thigh) stretch to keep your knees flexible.
  Note: Stretching exercises, along with strengthening, can also be helpful for older adults in maintaining balance, which will help prevent falls.

Exercises for osteoarthritis of the knee Specific exercises that are helpful for people who have knee osteoarthritis include:

• Quadriceps (thigh) strengthening exercises . While sitting in a chair, straighten your leg and hold for 5 to 10 seconds. Lower your foot back to the floor very slowly. Repeat 5 to 10 times with each leg. Do up to 3 times every day.
• Straight-leg raise. Lie on your back on the floor or a firm bed. Keep the leg you will be exercising straight, and bend your other knee comfortably, resting your foot on the floor or bed. Keeping your kneecap pointing to the ceiling, tighten the thigh muscle of your straight leg and lift your left straight up as high as you can. You should feel a pull on the back of your leg, but not pain. Slowly lower your leg back down. Repeat 10 times with each leg. Do up to 3 times every day.
• Knee-to-chest stretch. Lie on your back on the floor or a firm bed. Bend both knees, and place your feet on the floor or bed. Hold one knee with your hands and pull that leg slowly toward your chest. You should feel a gentle pull in your knee, but not pain. Hold the stretch for 5 to 10 seconds, then relax. Repeat 10 times with each knee. Do up to 3 times every day.
• Bridging. Lie on your back on the floor or a firm bed. Bend both knees and place your feet on the floor or bed. Push your feet into the floor or bed and lift your hips up as high as you can. Hold 5 to 10 seconds, then lower your hips back down. Repeat 10 times. Do up to 3 times every day.
• Quarter squat. Stand behind a chair, holding the back of the chair for balance. With your feet shoulder-width apart, slowly bend your knees and then slowly straighten them. Keep your heels on the floor throughout the exercise. Repeat 10 times. You can do this exercise several times each day, for example while you are standing at the kitchen sink.

If you have osteoarthritis of the knee, wearing shock-absorbing footwear, wedged insoles, or cushioned shoes may help redistribute weight and reduce joint stress. Taping the kneecap in a certain position has also been shown to help decrease pain. ⁸ If you and your doctor find that taping helps you, you can learn to do this simple technique yourself.

If your knee is sore after exercise, try icing your knee. You can do this by wrapping a towel around a bag of ice or frozen vegetables and then putting the bag on your knee for 10 to 20 minutes. Also, elevating your leg or taking nonprescription pain relievers may help to relieve pain. But if you have pain or swelling that lasts more than 2 hours, either rest or reduce the amount of exercise.

Ask your physical therapist or doctor Ask your physical therapist or doctor which exercises are best for you. Also ask:

• How to exercise if a joint is sore or if a joint is swelling.
• Whether you should take anti-inflammatory drugs to make your exercising easier, or whether to use ice after exercise.

Talk to your doctor or physical therapist about starting an exercise program. He or she will help you learn the most appropriate type of exercise for you and the proper way to do it.

How to exercise with painful joints If your joints hurt, try to rest them. Use assistive devices that help you do daily activities without added stress to your joints. Your doctor may suggest nonprescription pain relievers to reduce pain in your joints.

Other steps to relieve pain and stiffness include heat or cold therapy (a type of physical therapy). You can use heat and cold therapies before or after exercise, depending on which works better for you.

Heat therapies include:

• Applying warm towels to the painful joint.
• Applying hot packs to the painful joint.
• Taking a warm bath or shower.
• Getting water therapy in a heated pool or whirlpool.

Cold therapies may relieve pain or numb an area. Use a cold pack (a bag of ice or frozen vegetables wrapped in a towel).

Other types of physical therapy that may help relieve joint stiffness and pain and allow you to exercise include transcutaneous electrical nerve stimulation (TENS) and ultrasound.

It is still important to try to exercise a little, after your pain is relieved. Walking is excellent exercise. If walking is painful, or if you would like to alternate other activities with walking as a form of exercise, try walking in waist- or chest-deep water, swimming, or riding a stationary bicycle.

For more information about exercise and osteoarthritis, talk to:

• Your doctor.
• A physical therapist.
• An occupational therapist, for regaining and building skills that are important for independent living.

Medical literature can be useful, including journals such as Current Rheumatology Reports and the Journal of the American Geriatrics Society.

For further information on exercise and osteoarthritis, the following organizations can provide information:

Organizations

American Academy of Orthopaedic Surgeons (AAOS)
6300 North River Road
Rosemont, IL  60018-4262
Phone:	1-800-346-AAOS (1-800-346-2267) (847) 823-7186
Fax:	(847) 823-8125
E-mail:	pemr@aaos.org
Web Address:	www.aaos.org
The American Academy of Orthopaedic Surgeons (AAOS) provides information and education to raise the public's awareness of musculoskeletal conditions, with an emphasis on preventive measures. The AAOS Web site contains information on orthopedic conditions and treatments, injury prevention, and wellness and exercise.
Arthritis Foundation
1330 West Peachtree Street
Suite 100
Atlanta, GA  30309
Phone:	1-800-283-7800
Web Address:	www.arthritis.org
The Arthritis Foundation provides grants to help find a cure, prevention methods, and better treatment options for arthritis. It also provides a large number of community-based services nationwide to make living with arthritis easier, including self-help courses; water- and land-based exercise classes; support groups; home study groups; instructional videotapes; public forums; free educational brochures and booklets; the national, bimonthly consumer magazine Arthritis Today; and continuing education courses and publications for health professionals.
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health
1 AMS Circle
Bethesda, MD  20892-3675
Phone:	1-877-22-NIAMS (1-877-226-4267) toll-free (301) 495-4484
Fax:	(301) 718-6366
TDD:	(301) 565-2966
E-mail:	niamsinfo@mail.nih.gov
Web Address:	www.niams.nih.gov
The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is a governmental institute that serves the public and health professionals by providing information, locating other information sources, and participating in a national federal database of health information. NIAMS supports research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases and supports the training of scientists to carry out this research. The NIAMS Web site provides health information referrals to the NIAMS Clearinghouse, which has information packages about diseases.