Training with arthritis: how to lift and move when joints hurt

A concrete arthritis training plan: keep pain at or below 5/10, lift twice a week, 150 minutes of cardio, and the signs that mean you see a doctor.

Arthritis doesn't end training, it changes how you train. For knee and hip osteoarthritis, regular strength work cuts pain and improves function as much as most conservative treatments on offer; for rheumatoid arthritis, it protects the muscle you lose fastest during flares. What follows is a concrete plan — sets, reps, minutes, and the point where you stop.

The pain rule: a 0 to 10 scale

Learn this before you touch a weight. Pain up to 5/10 during exercise is acceptable and does not damage the joint — trials in knee osteoarthritis show people training in that zone progress at least as well as those who avoid all discomfort. Above 5/10, cut the load, the range of motion, or the reps.

The real test is the next morning. If pain is back to your normal baseline within 24 hours, the dose was right. If the joint still hurts on the second morning, or is swollen and warm to the touch, drop 20–30% of the load next session and build back up.

Gone by tomorrow morning: good session. Still there: too much.

Warm-up: 8 to 10 minutes, every time

An arthritic joint does not loosen on its own. Cartilage needs movement to take on fluid before it tolerates load, so never start on a working set.

4–5 minutes on a stationary bike with no resistance, or walking at a pace where you can still speak in full sentences
2 x 15 controlled full-range movements for whatever you are about to load: seated knee bends and extensions, shoulder circles, opening and closing the hand
1–2 sets of each main lift at 40–50% of your working weight, 8 reps each

Strength: two to three times a week

This is the part that changes daily life most. People with knee osteoarthritis average 20–30% weaker quadriceps than their peers, and a weak quad means the joint absorbs impact the muscle should have taken. Leave at least 48 hours between sessions for the same body part.

Sit-to-stand squat — 3 sets of 8–12. Three seconds down, touch the seat, stand. When it gets easy, hold 4–8 kg at your chest.
Leg press or short-range split squat — 3 x 10. If the knee complains at depth, work only the top half of the range.
Seated knee extension — 3 x 12–15, from 90 to 45 degrees. That arc puts the least pressure on the kneecap surface.
Hip bridge — 3 x 12 with a 2-second hold at the top.
Seated row or band row — 3 x 10.
Overhead or incline press — 2–3 x 8–12; widen the grip slightly if the shoulder objects.
Loaded carries — 3 x 30 seconds, up to 20–30% of body weight in total if your hands allow it.

Pick loads that leave 2–3 reps in reserve at the end of each set. To progress, add one rep per set per week; when you reach the top of the range, add 1–2 kg on upper-body lifts and 2.5–5 kg on leg work, then start again at the bottom of the rep range.

If your hands are involved, add a soft-ball squeeze: 10 x 5 seconds per hand daily, each rep followed by opening the hand to full finger extension.

Cardio: 150 minutes a week, in small doses

Aim for 150 minutes of moderate activity weekly, but not in two long outings. Three to five sessions of 20–30 minutes, or even 3 x 10 minutes in a single day, counts the same and is far kinder to the joint.

Stationary bike — raise the saddle so the knee stays slightly bent, about 25–30 degrees, at the bottom of the stroke; light resistance, 60–80 rpm
Water — a pool at 28–31 °C takes roughly 80% of body weight off knees and hips; 30 minutes walking in chest-deep water works well
Walking — flat ground, thicker-soled shoes, uphill rather than downhill when you get to choose, since descending loads the knee harder

Bad days and flares

When a joint is swollen and hot, you scale down rather than stop. Keep full range of motion unloaded, 10–15 reps per joint twice a day, and skip the exercises that load that joint directly until the swelling settles. Ice for 10–15 minutes after training helps swelling; a warm shower before training helps morning stiffness. Complete rest beyond 5–7 days measurably costs strength, so come back as soon as you can, even with an empty bar.

Weight and food

Every kilogram of body weight puts 3–4 kg of extra load through the knee with each step. Losing 5% of body mass noticeably reduces pain, and about 10% combined with strength training produced the largest improvements recorded in knee osteoarthritis trials. Keep the deficit modest — 300–500 kcal a day, no more, so you don't lose muscle along with the fat.

Protein: 1.2–1.6 g per kilogram of body weight daily, split across 3–4 meals of 25–35 g each. That is roughly 120 g of chicken, two handfuls of legumes, or 200 g of yoghurt per meal. Vitamin D runs low in many people over 65, but that is something you confirm with a blood test, not something you assume.

When to see a doctor

Don't wait if any of this shows up:

morning stiffness lasting more than 45–60 minutes, especially in several joints symmetrically
a joint that is swollen, red and hot alongside a fever — that is not training overload
pain that wakes you at night or does not settle after 2–3 weeks of reduced load
a knee that locks, gives way, or will not straighten fully
new medication (corticosteroids, methotrexate, biologics) or a planned joint replacement — the training plan needs adjusting around both

If you have never trained with resistance, two or three sessions with a physiotherapist will save you months of trial and error.

The short version

Pain up to 5/10 during exercise is fine; if it is still there on the second morning, drop 20–30% of the load.
Strength work 2–3 times a week, 6–7 exercises, 2–3 sets of 8–15 reps, always with 2–3 reps in reserve.
150 minutes of cardio a week in 10–30 minute doses; cycling and water are gentlest on the joint.
1.2–1.6 g of protein per kilogram daily, and lose 5–10% of body weight if you are carrying extra.
Swelling with redness, fever, stiffness over an hour, or a joint that locks — doctor first, gym later.