Exercise is one of the main recommended treatments for knee and hip osteoarthritis, not something to avoid. Guidelines from NICE and the Osteoarthritis Research Society International list structured exercise (muscle strengthening and general aerobic fitness), education and, where relevant, weight management as core treatments. Expect some extra joint discomfort when you first start; regular, consistent exercise is expected to help the joint over the long term. Start light, choose low-impact options, progress slowly, and let your doctor or physiotherapist set the boundaries.
What the guidelines say
Two guidelines are worth knowing, because they say the same thing in different words.
The NICE osteoarthritis guideline (2022) says:
- The core treatments are therapeutic exercise and weight management (if appropriate), along with information and support.
- Offer all people with osteoarthritis therapeutic exercise tailored to their needs, for example local muscle strengthening and general aerobic fitness.
- Consider supervised exercise sessions.
- Advise people that joint pain may increase when they start exercising, and that regular, consistent exercise will benefit their joints long term even if it causes some discomfort at first.
- If medication is needed, use it alongside exercise and to support it, not instead of it.
The OARSI guidelines (2019) list arthritis education and structured land-based exercise programs, with or without dietary weight management, as core treatments for knee osteoarthritis, and education plus structured exercise for hip osteoarthritis.
Start with the right expectations
The NICE advice about early discomfort is important, because it’s the point where many men quit. A little more ache in the first weeks of a new program is expected and isn’t a sign of damage. What you’re looking for is the trend over weeks: easier stairs, less stiffness getting out of the car, longer walks.
Use a simple rule for each session: discomfort that stays mild and is back to your normal level by the next day is acceptable. Pain that’s clearly worse the next day, swelling after training, or a joint that feels unstable means reduce the load or change the exercise, and mention it to your physiotherapist.
What to do in the gym
Strength (two or three times a week)
Strengthening the muscles around the knee and hip is the centre of most programs.
| Muscle group | Arthritis-friendly options | Start with |
|---|---|---|
| Quadriceps | Box squat to a comfortable height, leg press with limited range, wall sit | 2 × 10–12, light |
| Glutes and hips | Glute bridge, hip thrust, side-lying or banded hip abduction, step-ups on a low step | 2 × 10–15 |
| Hamstrings | Romanian deadlift with dumbbells, hamstring curl machine | 2 × 10–12 |
| Calves | Calf raise holding a support | 2 × 12–15 |
| Upper body and core | Rows, presses, carries, side plank | As normal |
Progress by adding a set, a few reps, or a little depth before adding much weight. The knee-friendly leg workout uses this approach.
Aerobic fitness (most days)
| Usually well tolerated | Use with more care |
|---|---|
| Stationary or road cycling | Running on hard surfaces |
| Swimming and water walking | Jumping and plyometrics |
| Rowing (if the knee bend is comfortable) | Deep, fast stair climbing |
| Walking on flat ground, building distance gradually | Sports with sudden cutting and twisting |
Hip osteoarthritis: a few specifics
Hip pain has many possible causes, so get it diagnosed rather than assuming it’s arthritis. The NHS hip pain guidance suggests seeing a GP if hip pain stops you doing normal activities or affects your sleep, keeps coming back, hasn’t improved after two weeks of home care, or you have hip stiffness for more than 30 minutes after waking up.
In the gym, wide-stance and very deep squats and long lunges are often the first to complain. Box squats at a comfortable height, step-ups, bridges and cycling usually work well. Your physiotherapist can tell you which ranges to work in.
Weight and knee arthritis
Both guidelines include weight management for knee osteoarthritis when it’s relevant. For a man carrying extra weight around the middle, losing some of it reduces the load the knees take with every step, and the strength training above protects muscle while you do it. The guide to losing belly fat after 40 covers the eating side.
When to call your doctor
- A joint that becomes hot, red and swollen, especially with a fever.
- A joint that locks, gives way or suddenly becomes much more painful.
- Pain at night that stops you sleeping and is getting worse.
- Stiffness or swelling in several joints at once, which needs a doctor’s assessment.
If you’ve been told you’re heading for a joint replacement, ask your surgeon or physiotherapist about exercise before surgery; many programs encourage it.
The bottom line
With knee or hip arthritis, exercise is part of the treatment. Strengthen the muscles around the joint, keep your aerobic fitness with low-impact options, expect some early discomfort, and progress slowly with your physiotherapist’s guidance. No program can reverse arthritis, but staying strong and active is what the guidelines recommend to manage it. If you’d like a coach to build and progress a program around your joints, alongside your doctor and physiotherapist, weekly 1:1 coaching starts from $99 a week.
Questions people also ask
Is exercise good for knee arthritis?
Yes. Major guidelines, including NICE and the Osteoarthritis Research Society International, list structured exercise as a core treatment for knee osteoarthritis, together with education and, where appropriate, weight management.
Will lifting weights make my arthritis worse?
Guidelines recommend local muscle strengthening for osteoarthritis. Joint pain may increase at first when you start, but regular, consistent exercise is expected to benefit the joint long term. Start light, progress slowly and let your symptoms guide the load.
Should I stop running if I have knee arthritis?
Not necessarily, but many people with painful knee or hip osteoarthritis do better with cycling, swimming, rowing or walking. Discuss running with your doctor or physiotherapist, who can advise based on your symptoms and imaging.
Does losing weight help knee arthritis?
For people with knee osteoarthritis who carry extra weight, guidelines include weight management alongside exercise as a core treatment. Less body weight means less load on the knee with every step.