If you live with arthritis and the persistent pain, chances are you’ve asked yourself some version of this question: “Should I really be exercising this?”
It’s a fair concern. Pain can feel like a warning sign; something to avoid, protect, or work around. But the reality is more nuanced, and often more empowering. One of the biggest shifts in modern exercise physiology is understanding that pain isn’t always a reliable measure of harm or progress.
Pain can be influenced by:
- Sensitivity of the nervous system
- Load tolerance (what your body is currently conditioned for)
- Fear or anticipation of movement
- Knowledge, perception or understanding of a diagnosis given
- Fatigue, stress, sleep, and previous experiences
The Long and Short of Exercise With Arthritis
For most people exercise is not only safe but it’s one of the best things you can do. Where there are joint changes or degeneration is present, the symptoms of pain, stiffness, clicking and clunking don’t always directly correlate with what’s happening structurally.
- You can have pain without causing damage
- You can make progress without pain
- And sometimes, you might feel pain while still moving forward safely
Regular, well-structured exercise can improve joint health and function, reduce pain over time, and build the muscle strength needed to better support and protect your joints. It also plays a key role in increasing confidence, helping to reduce fear around movement, and improving overall quality of life while lowering the risk of chronic disease. The benefits are clear, but the real difference comes down to how you approach it.
When you visit an Exercise Physiologist this is the education you will receive, along with a program centred around some but not limited to these principles:
Gradual Adaptation (GAS Principle)
The General Adaptation Syndrome (GAS) explains how the body responds to stress:
- Alarm – a new stimulus challenges the body (exercise in this case)
- Compensation – the body adapts and becomes stronger (the muscles, bones and other tissue change)
- Fatigue – too much stress without recovery leads to setbacks (can be a flare up, weakness, etc.)
When it comes to arthritis and pain, finding the right balance is key. Adding too little load often leads to no meaningful adaptation, while too much too soon can trigger flare-ups and setbacks. The most effective approach sits in the middle; gradually and consistently exposing the body to the right level of challenge, allowing it to adapt, build tolerance, and improve over time.
Load Management, Periodisation & Pacing
Rather than doing the same thing every session or pushing hard all the time, we use periodisation; This is a planned, paced variation in training aiming to better improve exercise volume over time.
This looks like easier and harder days within your weeks and months of prescription where the intensity, weight, distance, etc. are adjusted. It allows for a building phase, while keeping in mind the above mentioned of fatigue, and then time to recover without overloading the joints, cardiac capacity and more.
This approach reduces flare-ups, improves long-term progress, and builds resilience instead of just chasing intensity.
The Fear-Avoidance Model
The Fear-Avoidance Model helps explain why pain can sometimes persist; this is not just because of tissue changes, but because of how our bodies respond to it.
In simple terms, Fear-Avoidance is present in this cycle:
- Pain occurs
- Movement is perceived as threatening
- Activity is reduced or avoided
- Strength, tolerance, and confidence decrease
- Pain becomes more sensitive and limiting over time
This is how acute pain can gradually turn into persistent pain, even when the original injury has healed or stabilised. But as an Exercise Physiologist we use the model and promote our actions and responses to pain to flow in a more positive pathway:
- Pain occurs
- Movement is approached with understanding and guidance
- Gradual exposure builds confidence
- Strength and tolerance improve
- Pain becomes less limiting
Think of it as reducing your sensitivity and expanding your tolerance to what your body can handle.
What Does Exercise Actually Look Like?
A common misconception is that pain should always dictate what you do or don’t do. In reality, pain is not always a reliable indicator of damage, and it doesn’t necessarily mean you are causing harm. Progress also doesn’t require pushing through high levels of pain. Instead, it’s about understanding your current capacity and building from there.
In the early stages, or during flare-ups, the focus is on simple, controlled movements that build confidence and tolerance. This can include:
- Sit-to-stands, supported squats, step-ups
- Light carries (suitcase or farmer’s)
- Basic balance (tandem stance, single leg)
As tolerance improves, the next step is to gradually increase load, range of motion, and movement complexity. Over time, many people can safely work toward more traditional strength exercises like deadlifts, squats, overhead pressing, and more dynamic, multi-directional movements. These aren’t just gym-based goals; they directly support everyday function, from lifting and carrying to gardening, getting up from the floor, and reducing fall risk.
Importantly, exercise doesn’t have to start at a high level to be effective. With the right guidance, many people with arthritis or persistent pain can work toward higher-level strength training safely and effectively, improving not just how they feel, but how they function day to day. The key message is that avoiding movement entirely is rarely the answer.
If you’re dealing with arthritis or ongoing pain and aren’t sure where to start, this is exactly where professional guidance can make a difference. An exercise physiologist can help you understand your pain, identify what’s appropriate for your current level, and build a structured plan that progresses safely over time. The sooner you start building capacity, the sooner you can start regaining confidence in your movement. Don’t wait for pain to disappear before taking action!
