Is Strength Training Safe For Arthritis

For many people living with osteoarthritis, strength training can feel intimidating.

If a joint is already stiff, painful, or unpredictable, the idea of adding load to it can seem counterintuitive. A common thought is: “If it hurts, surely I should rest it.” That reaction is understandable. But it isn’t the full picture.

To understand why the opposite approach is actually more effective, we have to understand what a joint really needs and what an arthritic joint lacks. Arthritis is usually a slow, progressive change to a joint over time. It can come on quicker as a result of things like injury or occupational stresses but it usually takes a lot of time. Damage to the structures of the joint over time results in the following; instability, reduced proprioception and balance, compensation patterns affecting other regions of the body and reduced muscle.

These resulting factors move a joint from being healthy and robust, to weak, painful and susceptible to further damage through giving way and falling.

How Strength Training Helps Osteoarthritis

Strength training or resistance training, addresses all of these arthritic joint issues, it also prevents and slows down the onset of arthritis in the first place. It was long thought that movement and weightbearing exercises had a negative effect on joints. In fact, high-quality research shows the opposite. A large 2015 meta-analysis published in the Annals of Internal Medicine found that resistance training significantly reduced pain and improved physical function in people with knee osteoarthritis compared to non-exercise controls.

More recently, clinical guidelines from the American College of Rheumatology strongly recommend strengthening exercises as a core treatment for osteoarthritis of the knee, hip and hand.

Strengthening the tissues around a joint and the movement patterns that determine what a joint does contributes to all of the following;

Instability reduces due to the proprioceptive feedback that increases as the joints ligaments are put through regular strength and balance movements.

Muscle bulk increases through hypertrophy which refers to the process of breaking down muscle tissue through strength training and allowing the body to naturally build an extra amount of muscle in order to protect for future activities. This matters because research consistently shows that quadriceps weakness is strongly associated with increased pain and functional limitation in knee osteoarthritis. Strengthening these muscles improves joint stability and reduces compressive stress within the joint. In controlled trials, even moderate resistance training performed two to three times per week has been shown to significantly increase muscle strength in adults with osteoarthritis within 8–12 weeks.

Compensation patterns reduce as the affected joint is able to take more of the load during normal day to day activities, slowing the process of arthritis taking hold in other weightbearing joints or that of the opposite limb.

Pain and stiffness reduces as the joint becomes lubricated through synovial fluid, the bodies natural lubricant which is only produced adequately when moving under load. Movement under load also stimulates cartilage metabolism. Laboratory and imaging studies have shown that articular cartilage responds positively to cyclic loading, improving nutrient exchange within the joint. Importantly, long-term observational data show no increased rate of structural joint deterioration in people with osteoarthritis who engage in appropriately prescribed strength training compared to those who remain inactive.

What “Safe” Strength Training Looks Like

Safe strength training with osteoarthritis does not mean:

• Heavy lifting through sharp pain

• Fast, uncontrolled movements

• Pushing through flare-ups

• Ignoring symptoms

  
  

Instead, it involves:

• Controlled, steady movements

• Moderate resistance

• Gradual progression

• Clear structure

• Adjustments during flare-ups

  
  

Many people benefit from starting with chair-based exercises or supported positions as prescribed in OsteoFit's Light programme before progressing to more demanding movements like that of the Intermediate programme.

What about pain during exercise?

Some mild discomfort during strength work can be normal, particularly if a joint has been underused. New exercise programmes regardless of intensity often resulting in pain the following day due to a process known as DOMS (Delayed onset muscle soreness). This should feel like an ache when moving and shouldn't be painful at rest.

However, sharp pain, pain that worsens significantly the next day or swelling that increases are signs that the load may need adjusting. A helpful rule of thumb is that symptoms should settle within 48 hours. If they don’t, the programme may be too aggressive. Listening to the body, without fearing it is part of the process.

Ensuring that your strength training has 'active recovery days' built in is absolutely crucial. These allow you to gain the movement that arthritis so craves, whilst removing most of the added load that your training days provide. This benefits muscle, tendon and joint recovery processes.

Rest vs Strength: Finding the Balance

Rest has a role, especially during flare-ups and particularly if you suffer with an autoimmune variety of arthritis like rheumatoid or psoriatic arthritis.

But long-term joint health usually benefits more from structured, progressive movement than from avoidance. In fact, systematic reviews comparing exercise therapy to minimal care consistently show that structured strengthening programmes produce moderate reductions in pain and meaningful improvements in walking speed, stair climbing and overall quality of life. For many individuals, these benefits rival those seen with common pain medications, without the side effects.

A structured approach makes a difference

One of the biggest challenges people face is not knowing; which exercises are suitable, how much weight to use, how often to train and when to progress. Having a clear plan removes guesswork and builds confidence. Whether that structure comes from a clinician, a class, or a guided programme, consistency tends to matter more than intensity.

For many people, having that structure makes the difference between starting and sticking with their training. If you’d prefer guided, joint-friendly strength sessions with clear weekly structure, you can learn more about OsteoFit programmes here.

All OsteoFit programmes are written and include video instruction by a registered allied health care practitioner.

View OsteoFit plans

References

Fransen, M., McConnell, S., Harmer, A.R., Van der Esch, M., Simic, M. & Bennell, K.L. (2015).Exercise for osteoarthritis of the knee. Cochrane Database of Systematic Reviews, (1), CD004376.– Found that exercise significantly reduces pain and improves physical function in knee osteoarthritis.

Bannuru, R.R., Osani, M.C., Vaysbrot, E.E., et al. (2019).OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis and Cartilage, 27(11), 1578–1589.– Recommends exercise, particularly strengthening, as a core treatment for osteoarthritis.

Kolasinski, S.L., Neogi, T., Hochberg, M.C., et al. (2020).2020 American College of Rheumatology Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care & Research, 72(2), 149–162.– Strong recommendation for exercise (including resistance training) for knee, hip, and hand osteoarthritis.

Øiestad, B.E., Juhl, C.B., Eitzen, I. & Thorlund, J.B. (2015).Knee extensor muscle weakness is a risk factor for development and progression of knee osteoarthritis: a systematic review and meta-analysis. Osteoarthritis and Cartilage, 23(2), 171–177.– Demonstrates the association between quadriceps weakness and knee OA progression.

Hurley, M.V., Dickson, K., Hallett, R., et al. (2018).Exercise interventions and patient beliefs for people with hip, knee or hip and knee osteoarthritis: a mixed-methods review. BMC Musculoskeletal Disorders, 19, 351.– Shows long-term improvements in pain and function following structured exercise therapy.