Range-of-motion exercises

To help relieve their pain and discomfort during early stages of arthritis, people often keep affected joints bent – especially in the knees, hands, and fingers. While this may temporarily relieve discomfort, holding a joint in the same position for too long can cause permanent loss of mobility and interfere with daily activities.

Range-of-motion exercises (also called stretching or flexibility exercises) help maintain normal joint function by increasing and preserving mobility and flexibility. In this group of exercises, affected joints are conditioned by gently straightening and bending the joints in a controlled manner as far as they comfortably will go. During the course of a range-of-motion exercise program, the joints are stretched progressively farther, maintaining comfort levels, until normal or near-normal range is achieved and maintained.

In addition to preserving joint function, range-of-motion exercises are an important form of warm-up and stretching. They should be done prior to performing strengthening or endurance exercises or engaging in any other physical activity.

A doctor or physical therapist can provide you with instructions on how to perform range-of-motion exercises for the fingers, shoulders and back, chin and neck, hips, knees, and ankles.

Strengthening exercises

Strong muscles help keep weak joints stable, more comfortable, and protected against further damage. A program of strength-conditioning exercises that target specific muscle groups can be beneficial as part of your arthritis treatment program. There are several types of strengthening exercises that, when performed properly, can maintain or increase supportive muscle tissue without aggravating affected joints.

  • Isometrics: Some people with arthritis avoid exercise because of joint pain. However, a group of exercises called isometrics are designed to strengthen targeted muscle groups without bending painful joints. Isometrics involve no joint movement, but rather strengthen muscle groups by using an alternating series of isolated muscle flexes and periods of relaxation.
  • Isotonics: Another group of exercises, isotonics, are similar to range-of-motion exercises because they involve joint mobility. However, this group of exercises is more intensive, achieving strength development through increased repetitions or speed of repetitions, or by introducing light-weight resistance with small dumbbells or stretch bands.

A physical therapist or fitness instructor (preferably one with experience working with arthritis patients) can provide you with instruction on how to correctly and effectively perform isometric and isotonic exercises.

  • Aquatic therapy is a program of exercises performed in a large pool. Aquatic therapy may be easier on painful joints. The water creates buoyancy that reduces the load on the joint which makes resistance training more comfortable. Warm water temperatures, along with hydrostatic pressure, help with pain control and mobility.

Endurance exercises

The foundation of endurance training is aerobic exercise. Aerobics include any activity that uses large muscle groups, can be maintained continuously for a long period of time, and is rhythmic in nature. Aerobic activity conditions the heart, lungs, and cardiovascular system to:

  • Use oxygen more efficiently.
  • Supply the entire body with larger amounts of oxygen-rich blood.
  • Build stronger muscle tissue.

When paired with a healthy diet, aerobic activity also is fundamental for weight control (which reduces excess pressure on affected joints) and improving overall general health.

People with arthritis should perform about 15 minutes of aerobic activity at least three times a week at first, then gradually build up to 30 minutes daily. The activity also should include at least 5 to 10 minutes of warm up, plus 5 to 10 minutes of cool down.

While peak benefits are achieved when an aerobic activity is performed continuously for at least 30 minutes, aerobic exercise can be spread out in smaller segments throughout the day to suit your comfort level, without overexerting yourself. Aerobic exercise should be performed at a comfortable, steady pace that allows you to talk normally and easily during the activity. Ask your therapist what intensity of exercise is right for your fitness level.

Intensity is how hard you are exercising. During exercise, your heart's "training range," or training heart rate, should be closely monitored. To improve your body's aerobic condition, you need to exercise at an intensity between 60% and 80% of your maximum heart rate.

Examples of aerobic activities include:

  • Walking.
  • Swimming.
  • Low-impact aerobic dance.
  • Biking.
  • Daily activities such as mowing the lawn, raking leaves, or playing golf.

Walking is one of the easiest aerobic exercise programs to begin because it requires no special skills or equipment other than a good pair of supportive walking shoes. It is less stressful on joints than running or jogging.

Biking also may be better for people with arthritis than other aerobic activities because it places less stress on knee, foot, and ankle joints.

Appropriate recreational exercise, including sports, can be helpful to most people with arthritis, but only if it is preceded by a program of range-of-motion, strength, and aerobic exercise to reduce the chance of injury.

How do I begin a new exercise program?

Regardless of your condition, discuss exercise options with a doctor before beginning any new exercise program. Also, begin new exercise programs under the supervision of a physical or occupational therapist, preferably one with experience working with arthritis patients.

People with arthritis who are beginning a new exercise program should spend some time conditioning. Use a program that consists only of range-of-motion and strengthening exercises, depending on your physical and athletic condition. Endurance exercises should be added gradually, and only after you feel comfortable with your current fitness level.

As with any change in lifestyle, your body will have to take time to adapt to your new program. During the first few weeks, you may notice changes in the way your muscles feel, changes in your sleep patterns or different energy levels. These changes are to be expected with increased activity levels. However, improper exercise levels or programs may be harmful, making symptoms of arthritis worse.

Consult your physician or therapist and adjust your program if you experience any of the following:

  • Unusual or persistent fatigue.
  • Sharp or increased pain.
  • Increased weakness.
  • Decreased range of motion.
  • Increased joint swelling.
  • Continuing pain (lasting greater than 24 hours).

Effective treatment of arthritis should include a comfortable balance of range-of- motion, strengthening, and endurance exercises. Whichever exercise program you select, it's important to begin slowly and choose a program you enjoy so that you keep at it. Make exercise part of your weekly routine so that it becomes a lifetime commitment.

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