From the Guidelines
For optimal joint health and mobility, I strongly recommend a combination of low-impact aerobic exercises, strength training, flexibility work, and range-of-motion exercises, as supported by the most recent and highest quality study 1.
Key Recommendations
- Start with walking, swimming, or cycling for 20-30 minutes, 3-5 times weekly to improve circulation to joints without excessive stress.
- Add strength training 2-3 times weekly focusing on muscles around problematic joints using light weights or resistance bands with 10-15 repetitions per set.
- Daily stretching exercises should be performed when muscles are warm, holding each stretch for 20-30 seconds, as recommended by the 2018 EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis 1.
- Include specific joint mobility exercises like gentle arm circles for shoulders, knee bends for knees, and ankle rotations.
- Tai chi and yoga are excellent complementary practices that combine strength and flexibility while being gentle on joints, as conditionally recommended by the 2022 American College of Rheumatology guideline for exercise, rehabilitation, diet, and additional integrative interventions for rheumatoid arthritis 1.
Importance of Gradual Progression
Always begin with a 5-10 minute warm-up and progress gradually, increasing duration and intensity by no more than 10% weekly.
Benefits of Exercise
These exercises work by strengthening supporting muscles around joints, improving synovial fluid circulation for better lubrication, enhancing flexibility, and maintaining cartilage health through regular movement, as supported by the 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee 1.
From the Research
Recommended Joint Exercises
The following joint exercises are recommended based on the available evidence:
- Aerobic exercise, resistive exercise, and aquatic therapy, which have strong evidence supporting their use 2
- Dynamic exercise, Tai Chi, and yoga, which have mixed to limited evidence supporting their use 2
- Exercise therapy, which provides at least as effective pain relief as pharmacological pain medications, without serious adverse effects 3
- Therapeutic exercise, which has sufficient evidence to support its use for pain, inflammation, and grip strength 4
Key Considerations
When recommending joint exercises, the following key considerations should be taken into account:
- Exercise therapy should be individualised to the preferences and needs of the individual patient 3
- At least 12 supervised sessions, 2 sessions per week, are required initially to obtain sufficient clinical benefit 3
- Structured patient education concerning joint protection and self-management is important to retain motivation and adherence to an exercise programme 3, 4, 5
- Instruction on joint protection has strong evidence supporting its efficacy, with an absolute benefit of 17.5 to 22.5 and a relative benefit of 100% 5
Additional Interventions
Additional interventions that may be recommended in conjunction with joint exercises include:
- Patient education and self-management, which have strong evidence supporting their use 2
- Cognitive-behavioral approaches and multidisciplinary approaches, which have strong evidence supporting their use 2
- Joint protection and energy conservation, which have sufficient evidence to support their use 4, 5
- Provision of splints, which has indicative findings for evidence that it decreases pain 5