Exercising with Osteoarthritis: Why Movement Helps and How to Start

The biggest myth about rest with osteoarthritis

If you have osteoarthritis in your knee or hip, you have probably heard the advice to protect the joint by taking it easy. Rest seems logical: it hurts, so moving less feels like the safe choice. Yet this is one of the most persistent misunderstandings in physiotherapy. Prolonged rest weakens the muscles around the joint, and those muscles normally carry a large share of the load that would otherwise land on the cartilage.

Research suggests that exercise therapy can be effective for osteoarthritis symptoms in the knee and hip, particularly for reducing pain and improving day-to-day function. That doesn't mean any type of movement is automatically fine, but it does mean that complete rest usually isn't the best route. Moving in a way that matches your joint and your current capacity is generally a wiser starting point than giving up sport altogether.

This article is meant as general information. Every situation is different, and if symptoms persist or worsen, it's worth getting assessed by a physiotherapist or GP.

What happens in your joint when you train?

A joint affected by osteoarthritis has cartilage that has thinned or become uneven. Cartilage has no blood supply of its own and gets most of its nutrition through movement: loading and unloading the joint essentially pumps joint fluid through the tissue. Complete inactivity deprives the joint of that nutrition, while measured loading can support it.

The muscles around the joint also play a key role. Stronger quadriceps around the knee or stronger hip muscles help distribute forces more evenly, which can reduce the load landing directly on the joint itself. Training doesn't just change how strong you are, it can also contribute to how your joint copes with load.

Important to know: more pain during or after exercise doesn't automatically mean more damage. Joints with osteoarthritis are often more sensitive to loading, even when nothing is getting worse. That distinction between 'pain' and 'damage' is exactly why guidance often helps people keep moving with confidence.

Strength training for knee and hip osteoarthritis: what does the evidence say?

Strength training is widely used in physiotherapy for knee and hip osteoarthritis, and research indicates it can contribute to less pain and better function. The idea isn't that muscles 'repair' cartilage, but that stronger muscles can distribute load on the joint more favourably and improve stability.

Where do you start?

For most people with osteoarthritis, it makes sense to start with exercises that move the joint through a comfortable range with light to moderate resistance. For example:

• Seated leg extension (for the knee): sit upright, slowly straighten one leg to nearly full extension, hold briefly, then lower with control. If you feel sharp pain, reduce the range of motion.
• Half squat against a wall or holding a chair: bend the knees to an angle that feels comfortable, often no more than 45 degrees when symptoms are new, then rise back up.
• Side-lying leg raise (for the hip): lying on your side, lift the top leg straight without tilting the pelvis.
• Bridge: lying on your back with bent knees, slowly lift and lower the hips to activate the glutes and lower back.

Build up repetitions before increasing resistance, and allow at least a day of rest for the same muscle group between sessions. If you're unsure about technique or progression, a physiotherapist can help tailor this to your joint and symptom pattern.

Which sports work well (and which need a careful build-up)?

Low-impact sports are generally well tolerated with osteoarthritis, because they load the joint without repeated jarring impact. Examples include:

• Cycling, outdoors or on a stationary bike, with the saddle height set so the knee stays slightly bent at the lowest pedal position.
• Swimming and aqua jogging, where the water supports body weight.
• Walking, at a pace and distance you can comfortably sustain, using walking poles for extra stability if helpful.
• Strength training at the gym or under guidance, focused on the leg and hip muscles.

Sports with lots of direction changes, jumping, or direct impact, such as running on hard surfaces, football, or tennis, don't necessarily need to be avoided, but deserve a more gradual build-up and closer attention to how the joint responds. Where possible, alternate with low-impact movement, and increase volume and intensity step by step rather than all at once.

What works best for you depends on the nature and duration of your symptoms, your fitness level, and your sport preferences. A physiotherapist can help you think through which adjustments keep your sport realistic to continue.

A training week with osteoarthritis: a practical example schedule

The schedule below is a general example, not a substitute for personal advice. Adjust it to your own capacity and check with a physiotherapist if you're unsure.

• Monday: 20 to 30 minutes of walking or cycling at an easy pace.
• Tuesday: strength exercises for the leg or hip, 2 to 3 sets of 10 to 15 reps per exercise.
• Wednesday: rest day or light mobility exercises.
• Thursday: swimming, aqua jogging, or cycling.
• Friday: strength exercises, with slightly more resistance than Tuesday if that felt fine.
• Weekend: one active day of your choice (a walk, sport, or bike ride) and one rest day.

Build this up over several weeks and avoid increasing multiple variables at once. Add repetitions before increasing resistance, for example, or extend the duration of a walk before picking up the pace.

Pain during movement: when is it okay, and when isn't it?

A mild, dull ache during or shortly after exercise that settles within a day is generally considered acceptable with osteoarthritis. In physiotherapy this is sometimes summarised as a rule of thumb: a slight, temporary increase in symptoms that returns to normal by the next day isn't a reason to stop moving.

Scale back the intensity or adjust the exercise if you notice:

• the pain is sharp or stabbing rather than dull
• the pain clearly worsens during the exercise itself
• symptoms last longer than a day, or increase further after activity
• the joint becomes noticeably warmer, more swollen, or redder

Seek assessment from your GP if you notice a strongly swollen or red joint, fever, sudden and severe pain, a joint that seems to lock, or a serious feeling of instability while walking. These signals fall outside typical osteoarthritis symptoms and deserve a medical assessment.

Guided exercise and education programmes: what physiotherapy adds

For people with knee or hip osteoarthritis, similar guided exercise and education programmes exist, such as the internationally used GLA:D (Good Life with osteoArthritis in Denmark), offered by physiotherapists. Programmes like this combine education about osteoarthritis with a structured training programme, aiming to help participants move more independently and with more confidence.

A guided programme adds a few things that are harder to arrange on your own:

• A focused assessment of your joint, movement pattern, and muscle strength as a starting point.
• Exercises matched precisely to your capacity, using ultrasound imaging or force testing (such as VALD Force Decks) as an objective measure of progress.
• Adjustments when an exercise doesn't feel right, so you can keep moving with confidence instead of stopping when in doubt.
• Education about what pain does and doesn't mean with osteoarthritis, so you can better judge for yourself when it's fine to continue.

At Physical Studio, our physiotherapists are also qualified personal trainers, which means a training programme and an assessment of your joint symptoms come together in the same appointment. For physiotherapy, we work with all Dutch health insurers, typically through supplementary (aanvullende) coverage. What's covered depends on your individual policy, so check your policy or use the insurance checker on the website to see what applies to your situation.

Dealing with knee or hip symptoms and wondering what a programme could look like for you? Our physiotherapists are happy to think it through with you, even if you're not yet sure whether exercising with osteoarthritis is a good fit. You don't need a referral to book an appointment.