If you have osteoarthritis, there’s a good chance you’ve been told to “take it easy,” avoid certain activities, or rest when things flare up.
That advice feels reasonable. But for most people with OA, it’s the opposite of what the evidence recommends.
This post covers what the research says about movement and OA — including why fear of activity is so common, why it tends to make things worse, and what kinds of exercise actually help.
The Activity Gap in OA
Despite strong evidence that exercise is one of the most effective tools for managing OA, most people with the condition aren’t using it.
Research behind the EPIPHA-KNEE trial — led by Associate Professor Tasha Stanton at the University of South Australia — found that nine out of ten people with knee OA are inactive. The primary driver wasn’t physical inability. It was belief: specifically, the belief that physical activity is dangerous and will cause further joint damage.
That belief is understandable. It’s often reinforced by the language used around OA — “wear and tear,” “bone on bone,” “degenerative.” If your joint is described as broken down, movement feels like the last thing you should be doing.
But the evidence points in a different direction.
Fear of Movement Makes Symptoms Worse
Stanton’s research group has shown that people with knee OA who hold stronger fear-based beliefs about movement tend to be less active — and that inactivity is associated with worse outcomes over time, not better ones.
There’s also an interesting perceptual component to this. Stanton’s work on visuospatial perception found that people with painful knee OA tend to perceive their environment as more threatening than it actually is — hills appear steeper, distances appear greater. The higher the fear and pain, the stronger this effect. The body goes into a kind of protective mode that makes the world feel harder to navigate than it is.
That protective response makes sense from a survival standpoint. But when it leads to months or years of reduced activity, it contributes to muscle weakness, reduced joint support, and increased pain sensitivity — a cycle that’s hard to break without some intervention.
What the Evidence Supports
Multiple systematic reviews and guidelines consistently identify exercise as a core treatment for OA — not a bonus add-on, but a primary recommendation.
A 2024 systematic review and meta-analysis published in Cureus reviewed 12 studies involving nearly 5,000 participants and found that exercise interventions produced meaningful improvements in pain, physical function, and quality of life in people with knee and hip OA.
The OARSI clinical practice guidelines list exercise as a core recommendation for all people with OA, regardless of severity. They note that both land-based and aquatic exercise are appropriate options, and that the combination of exercise with education produces better results than either alone.
This matters: education about pain — what it means, why it varies, what drives it — combined with movement is more effective than movement on its own. Addressing the fear is part of the treatment.
What About Aquatic Exercise?
For people who find land-based exercise uncomfortable or difficult to start, water-based exercise is a well-supported alternative.
A Cochrane systematic review on aquatic exercise for knee and hip OA found moderate-quality evidence that it reduces pain and disability and improves quality of life in the short term compared to no exercise. A separate systematic review and meta-analysis found that pain was significantly reduced in people with hip and knee OA who participated in aquatic exercise programs.
The reason water exercise works well for OA comes down to buoyancy: water supports body weight, reducing the load on joints while still allowing you to build strength and maintain movement. It’s not a replacement for eventually returning to land-based activity, but it’s a useful and evidence-backed starting point.
In Kamloops, the Tournament Capital Centre has accessible pool facilities that several of our patients use as part of their regular routine. For people managing OA, this is a practical, local option worth considering.
What Type of Exercise Is Best?
The honest answer is: the kind you’ll do consistently.
That said, the evidence supports a few broad categories:
Aerobic exercise (walking, cycling, swimming) — supported for pain and function
Resistance or strength training — supported for building the muscle support around affected joints
Aquatic exercise — useful starting point, especially for higher pain or lower starting fitness
Tai Chi — emerging evidence for older adults with OA, particularly for balance and pain
The 2024 review noted that personalizing exercise based on individual characteristics — age, fitness level, comorbidities — is important for achieving sustained results. One approach doesn’t fit everyone.
How Massage Therapy Fits In
Hands-on care isn’t a substitute for exercise in OA. The evidence is clear on that. But it can play a useful supporting role.
For some people, muscle tension, guarding, or discomfort in surrounding tissue makes starting or maintaining activity harder. Massage therapy can be useful for addressing those barriers — working on the soft tissue that supports the joint, reducing the tension that limits movement, and helping people feel more ready to move.
At Well+Able, our RMTs work alongside your exercise routine, not instead of it. Sessions are assessment-led, and we talk about what you’re working toward — whether that’s walking the Rivers Trail, getting back into the pool, or just moving more comfortably through your day.
A Note on Starting Slowly
If you’ve been inactive for a while, starting exercise with OA can feel daunting. Pain during or after activity doesn’t automatically mean damage. Some discomfort during and after new activity is normal as the body adapts.
A general guide: if pain during activity is manageable and settles back to your usual level within a few hours, the activity level is likely appropriate. If pain is significantly elevated the next day, the volume or intensity may need to be adjusted.
This is worth discussing with whoever is supporting your care — your GP, a physiotherapist, or your RMT.
Related reading: What Is Osteoarthritis, Really? — How Massage Therapy Can Support You With OA