When someone suffers from stiff, aching joints due to arthritis, the last thing they likely want is to get up and move. Yet consistent physical activity may be their best bet-more so than temporary solutions like anti-inflammatory drugs or steroid injections.
Experts now say that physical activity should be a first-line treatment for osteoarthritis, reducing pain and improving mobility. Exercise helps protect the joints from future inflammation flare-ups, so long as it doesn't cause too much pain.
Despite this, emerging evidence from the U.S., Europe, and the U.K. finds that most osteoarthritis patients are not referred to a physical therapist. Some instead receive surgery referrals first.
Physiotherapist Clodagh Toomey from the University of Limerick in Ireland wrote in a 2025 piece for The Conversation: "The best medicine isn't found in a pill bottle or an operating theatre." Toomey noted that too few patients are guided toward the one therapy proven to protect their joints: exercise.
Osteoarthritis was once thought to be due to "wear and tear" from overuse. Today, we know it involves the entire joint and systemic inflammatory processes. Unlike drugs, exercise can strengthen bones, ligaments, muscles, cartilage, and nerves, and may reduce systemic inflammation.
A review of 217 randomized controlled trials, with more than 15,000 participants, found that aerobic exercise-brisk walking, swimming, or cycling-likely produces the largest pain improvements after 12 weeks, and boosts joint function for up to 24 weeks.
In severe cases, surgery or joint replacement may be more effective for some patients. But these procedures aren't necessary for everyone. Physical therapy is significantly less risky, expensive, and invasive.
What kind of exercise is best? As exercise scientist Hunter Bennett and physiotherapist Lewis Ingram from Adelaide University concluded: "The best type of exercise is the one that gets done."