Exercise and Strength Training With Arthritis

By Linda Rath | April 30, 2024

If you have arthritis, you may be wary of exercise. The truth is physical activity is among the most uniformly successful of all arthritis treatments. Among other benefits, exercise can:

• Reduce pain, fatigue and inflammation
• Strengthen muscles, joints and bones
• Reduce heart disease risk and improve heart outcomes
• Reduce the chance of diabetes,  lowering blood sugar about as well as diabetes drugs
• Improve thinking and mood
• Improve balance
• Lead to more restful sleep

Exercise is now considered an essential part of any arthritis treatment plan and the American College of Rheumatology (ACR), Arthritis Foundation, Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) consider it crucial for everyone with arthritis.

Slow and Steady Wins the Race

Making exercise a regular part of your life can be easier said than done, though, especially if like many people with arthritis you tend to move less and have less muscle strength and a lower aerobic capacity. Don’t be discouraged or give up if you can’t meet a goal right away. It can take six to eight weeks before you begin to notice fitness gains, although pain, fatigue and mood may start to improve almost immediately.

The key is not to push yourself too hard too soon, says James Wyss, MD. Dr. Wyss is a physiatrist — a doctor specializing in nonsurgical treatment of orthopedic conditions — at Hospital for Special Surgery in New York City and Long Island.

“Everyone, including those with arthritis, can make progress, but they need to start slow. We advise people to make small gains, such as a 10% or 20% increase in their exercise intensity or duration or in [the amount of] weight if strength training, rather than trying to double everything,” he says.

If you worry about exercise safety, you’re not along. Many who have arthritis do. But experts say the real concern is not exercising at all, which makes your joints more stiff, painful and prone to injury. Exercise strengthens the muscles, ligaments and tendons around the joints, which act like a brace to protect them.

Another problem: Arthritis patients have traditionally been told to exercise but without much guidance about what or how to do it. That’s where this article comes in. It will give you a range of exercises and ways to do them safely. (If you have questions beyond the scope of this article, reach out to the Arthritis Foundation Helpline or consult your doctor or physical therapist.)

Options are important because there’s no best exercise for arthritis, Dr. Wyss says. “Individuals may find certain choices are best for them because they enjoy them and are more likely to develop a good routine and stick with it. They may find that their body responds well to certain exercises [and] that they feel better afterward with minimal soreness.”

Mild muscle soreness and stiffness — often referred to as delayed onset muscle soreness and often delayed by a day or two after exercising — are common after a workout, especially if you’re a beginner or trying something new. Sometimes distinguishing post-exercise soreness from joint pain can be challenging. If you’re unsure, ask a trainer or physical therapist for help.

Exercise Round-Up

You’ll get the most benefit from a well-rounded exercise program that includes cardio and strength training along with mobility and balance work. For example, you might walk or jog one day (yes, some people with arthritis can jog), bike on another, lift weights or perform other types of resistance training twice a week and set aside at least one day for balance and flexibility exercises like yoga, Tai chi or Pilates.

Warm up for at least five minutes before any type of exercise, but avoid stretching, which can injure cold muscles. Instead, try a quick walk or a few range-of-motion exercises, like arm, neck and ankle circles. Range-of-motion exercises are crucial for people with arthritis because they keep joints strong and flexible.

Cardio

Cardio or aerobic exercise is anything that raises your heart rate. An effective cardio session gets your blood pumping, delivering oxygen and nutrients to every part of your body, including your joints and brain. It improves thinking and endurance, relieves fatigue, burns calories and for some people, releases natural cannabinoids that help relieve anxiety and depression — problems common in people with arthritis.

Authors of a 2023 systematic review and meta-analysis of 12 studies found that 30 to 40 minutes of exercise at least three to five times a week significantly relieved pandemic-related anxiety, depression and stress. A similar analysis of 23 studies found that people who didn’t exercise during the pandemic were more likely to be anxious, depressed and have trouble sleeping. And a study of patients with rheumatoid arthritis (RA) found that those who exercised regularly during the pandemic fared better psychologically than those who didn’t. There are many reasons why mental health plummeted during the pandemic. One may be that a lot of people simply stopped moving.

Here's a closer look at some cardio exercises.

Walking. This is probably the easiest and least expensive form of exercise. You don’t need special equipment — just comfortable walking shoes or running shoes with a wide toe box and good support. If you have trouble with shoe selection, a podiatrist can help you find the right shoes or fit you with custom ones.

Walking has dozens of benefits, including stronger joints and bones and a reduced risk of fractures and even dementia. A walking program may help you stick with your routine and can help you track your progress. The Arthritis Foundation’s Walk With Ease Program is a six-week walk program that scientifically proven to improve arthritis symptoms and can be adapted for a lifetime as your fitness level improves. But if your normal gait has changed due to pain and stiffness, a walking program should not be your first step. Instead, consider a session or two with a physical therapist, who can help you relearn to walk in a healthier way so you get the most from your exercise program and don’t make imbalances you already have worse.

Walking outside has lots of benefits — fresh air, nature, more balanced circadian rhythms — but if that’s not possible, treadmill walking is a good, if potentially less cost-effective alternative. Contrary to what you may have heard or think, walking on a treadmill is not dangerous for people who have arthritis. The key is not to hang onto the siderails; they’re mainly there to help you get on and off the machine. Holding on while you exercise reduces the effectiveness of your workout. It also worsens your posture and throws off your stride and balance, setting you up for injury. Trainers say the best approach for beginners is to start at a slow pace with no incline and gradually increase both as you get stronger and more comfortable with the machine.

To up your treadmill game and relieve boredom, try interval training. You walk fast or jog for 20 or 30 seconds, then walk more slowly for 60 seconds. That’s your recovery. You can also walk at a slightly higher elevation for 30 seconds, then return to a lower elevation for recovery. If you start to feel tired or unsteady, return to a normal pace and elevation. And if you want to stop immediately, hit the emergency button.

Other great additions to a walking program — though at increased cost — include headphones and a fitness tracker that, at a minimum, counts your steps. (Many also keep track of your distance, calories, heart rate, oxygen level and sleep quality.) One study found that arthritis patients who wore a fitness tracker walked 1,520 steps more than those who didn’t. Although there’s debate about needing 10,000 daily steps for health, it can be motivating to see how you improve over time. In fact, studies show those who walked 6,000 steps received many of the same health benefits. Also motivating: working out with a buddy or walking club. Getting going first thing can help, too, experts say. A brisk walk or other early morning exercise can relieve stiffness and improve your mood.

High intensity interval training (HIIT). In this form of exercise, you alternate brief bouts of all-out effort — 85 to 95% of your maximum heart rate — with lower-intensity periods of recovery.  It can be done with any cardio workout — sprinting, jumping rope or boxing — or with a combination of exercises, such as squats, push-ups and leg lifts. Although people with arthritis have long been told to avoid high-impact exercise, newer research suggests that in some cases, impact not only doesn’t damage joints, but is actually good for them. HIIT has been shown to relieve fatigue in inflammatory forms of arthritis and to significantly reduce disease activity in RA. One small randomized controlled trial of 100 patients with axial spondyloarthritis (axSpA) found that high-intensity cardio and strength workouts  were more effective than standard treatments at reducing disease activity, relieving pain, fatigue and stiffness and improving function and cardiovascular health.  

One benefit for people who have arthritis is that HIIT can be done on non-weight-bearing equipment, such as bikes, ellipticals and rowing machines. Before starting HIIT training, talk to your doctor. Then proceed slowly, with no more than one HIIT session a week.

Dr. Wyss says you should always pay attention to your body. “Anyone experiencing increased pain and inflammation should avoid high intensity activities that involve running or twisting. [For them], we would recommend low-impact exercise, such as walking or swimming. Certain aquatic exercise classes can be great choice.”

Strength Training

You need all three major types of exercise. But if you had to choose just one, there’s a good argument to be made for strength training. That’s because it’s crucial for building the muscles that support and protect joints. Unfortunately, you lose muscle mass as you age — about 3% to 5% a decade after age 30. Men, even very fit ones, lose as much as 30% of their muscle over a lifetime. In women, muscle loss accelerates after menopause, yet 1 one in 5 women of any age trains with weights. For both women and men, strength training, along with plenty of protein – around 30 grams three times a day — is the best way to regain lost muscle and prevent future loss. Some of the latest research suggests that a healthy microbiome may also help maintain lean muscle mass, but strength training is by far the most studied option right now. Exercise machines, free weights, resistance bands and your own body weight are all effective. Here are some things to keep in mind:

• If possible, schedule a session with a physical therapist or personal trainer so they can demonstrate proper form, which is critical to avoiding injury. If that’s not in your budget, there are thousands of free, online videos that show you exactly how to perform specific strength training exercises, including the Arthritis Foundation’s Your Exercise Solution videos. You may not be lifting as heavy as the trainers in some videos, but the goal is to copy their form, not the weight they use.
• Start with light weights. Choose weights you can lift with perfect form for eight to 12 repetitions or for 60 seconds. Form is more important than the number of reps, especially when you’re first starting out.
• Challenge yourself. It’s easy to get into an exercise rut, where you stay at the same level and don’t see progress. Once working with a particular weight seems easy, try increasing your load by 2 to 5 pounds. Or, increase the number of repetitions per set instead of the weight.
• Choose compound exercises — that is, movements that use more than one joint, like squats, rows and presses. Engaging various muscle groups at the same time makes your workout more balanced and safer for your joints. And work opposing muscle groups; for example, work the front and back of the legs.
• Try bands. If you have arthritis in your hands or lack the strength to grip weights, exercise bands are a great alternative. They come in many different sizes and strengths, so it’s easy to switch them out as you get stronger.
• To protect vulnerable shoulder joints, perform shoulder exercises seated or on an incline bench at the gym.
• Always avoid locking out your joints; the goal is to stress your muscles, not your joints.
• It’s important to keep moving, even when you’re not feeling your best. If your joints are inflamed and painful, save weights for another day. Instead, Dr. Wyss recommends isometric exercises, “which produce a muscle contraction but no motion in the joint and can be performed for all muscles in the body.” Examples include holding a wall squat or plank. Wall squats are a particularly good choice because they strengthen the quadriceps, the muscles that support the knee joints. The Arthritis Foundation’s Your Exercise Solution videos offer arthritis-friendly lower-body exercises, upper-body strengthening using resistance bands, simple core workouts and more. You can also improve your hand strength and mobility with these hand exercises.

Although some people spend hours every day in the gym and spend their lives perfecting their technique, that’s not at all necessary for arthritis. What’s important, is to find exercises you enjoy and will stick with, not only to relieve pain and increase mobility but also to improve your overall health and quality of life.