Patients › General-Health

Staying Active for Joint Health

PDF Evidence

Why physical activity protects joints and tendons, how exercise helps osteoarthritis and recovery, and how to stay active safely.

Updated Sep 202620 citations

Regular movement keeps joints, tendons and muscles healthy and aids recovery — motion is lotion. Kieran Hirpara 4.0

What it is

Staying active for joint health means moving your body regularly to keep your joints, muscles and general health working well. It covers everything from walking and swimming to structured exercise programmes. You do not need to be an athlete. Everyday movement counts.

This approach is used for people of all ages. Children and teenagers aged 6-17 who take part in moderate to vigorous activity gain a range of health benefits [1]. Older adults who keep moving also tend to have better overall health [2]. If you have joint pain or arthritis, your doctor may talk with you about staying active as part of your care, alongside any treatment they offer.

The idea is simple: joints and muscles respond to movement. Light activity, like gentle walking or moving around the house, makes up most of the energy people burn through daily movement, and it is an easy place to start [3]. Even small increases in activity can protect inactive adults against a range of long-term conditions [4]. Moving for about 30-40 minutes of moderate to vigorous activity a day can also offset some of the health risks linked to long periods of sitting [5].

There is little evidence that being active causes significant harm, and the benefits generally outweigh the risks [6]. Some programmes have helped people stick with it too. In one workplace programme, 85.6% of participants who started out inactive were meeting recommended activity levels at follow-up [7]. Maintenance programmes can also help you keep going and improve your physical function and quality of life [8].

If you are unsure where to begin, your doctor or a physiotherapist can help you find activities that suit your joints and your life.

Does it work?

The honest answer is that staying active helps with many things, but the evidence is not perfect everywhere. For your general health, large reviews have linked regular activity with a lower chance of developing dementia, including Alzheimer's disease and vascular dementia [1]. Exercise therapy has also been shown to reduce the risk of serious problems like hospitalisation and pneumonia [2]. For type 2 diabetes, there may be no minimum or maximum amount of activity needed to see a benefit [3].

For joints specifically, the picture is more mixed. In some knee conditions, exercise programmes that allow a bit of discomfort during the exercises worked slightly better in the short term than ones that kept you pain free [4]. For teenagers with kneecap pain, exercise helps some but not all, and sticking to the programme is a real challenge [5]. Those who managed their home exercises three times per week or more were four times more likely to have recovered after 12 months [5].

Some of the evidence is weaker than you might hope. Good randomised trials have not been able to prove that being active directly lowers your risk of dying, even though activity is linked with better health in many other ways [6]. For light activity like gentle walking and its effect on heart and metabolic health, the research base is still small and not fully consistent [7].

What does this mean for you? Moving more is linked with real benefits, and there is little sign of harm. But results vary from person to person, and the biggest challenge is often keeping it up rather than choosing the perfect programme. Your doctor or physiotherapist can help you find something you can stick with, because doing something regularly matters more than doing something intensively for a short burst.

What are the risks?

For most people, the main risk of staying active is doing a bit too much, too soon. Your joints and muscles may ache more than usual for a short time after you start or increase an activity. Some exercise programmes are designed to let you feel some discomfort during the exercises themselves, and trials found this gave a small but real short-term benefit over programmes that kept you pain free [1]. That is different from sharp pain or pain that keeps getting worse, which is a sign to ease off and check with your doctor or physiotherapist.

There is also a risk of injury if you push beyond what your body is ready for. The evidence on this is limited, but community football players themselves suggested that training programmes should include injury prevention work alongside fitness [2]. Coaches do not always deliver these programmes, which can lead to low compliance and limited success in preventing injuries [3]. If you are following a programme, doing it as prescribed matters.

The bigger risk for many people is the opposite one: doing nothing. Being inactive carries its own risks. Large studies have linked higher activity levels with lower rates of death from all causes and from cardiovascular disease [4]. Sitting for long periods each day is also linked with worse health outcomes, and about 30-40 minutes of moderate to vigorous activity a day can offset some of that risk [5].

One honest limitation: much of the evidence on activity and ageing comes from studies in relatively healthy community-dwelling older adults [6]. If you have other health conditions, the picture may be less clear. Your doctor can help you judge what is safe for your situation.

Is it right for you?

Staying active is an option worth considering for almost everyone, whatever your age or fitness level. The 2018 US physical activity guidelines recognise that any bouts of physical activity count for health [1], so you do not need to meet a strict target to start seeing benefits. If you have joint pain or arthritis, your doctor can help you judge what is safe for your situation.

Some people may find it harder to benefit. Much of the evidence on activity and ageing comes from studies in relatively healthy community-dwelling older adults [2], so if you have other health conditions, the picture may be less clear. Your doctor can help you weigh this up.

Compared with other approaches, staying active is not a replacement for treatment but works alongside it. Exercise programmes that allow some discomfort during the exercises themselves have been shown to give a small but real short-term benefit over pain-free programmes for chronic musculoskeletal pain [3], so your doctor may discuss this with you.

This should be a shared decision with your doctor. They can help you find activities that suit your joints and your life, and refer to the risks section above to understand what to watch for.

The bottom line

Staying active is worth considering for almost everyone, and everyday movement counts as much as structured exercise. The realistic expectation is steady benefit from regular movement rather than a quick fix, and the hardest part is usually keeping it up rather than finding the perfect programme. The single most important caveat: if you have other health conditions, much of the evidence comes from studies in relatively healthy older adults [1], so check with your doctor or physiotherapist about what is safe for your joints and your situation before you start.

---

Reviewed by Kieran Hirpara · 13 June 2026.

Want the clinical detail? Read the clinician version.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

References

1. Physical activity and health in Chinese children and adolescents: expert consensus statement (2020). *British Journal of Sports Medicine*. 2020. 10.1136/bjsports-2020-102261
2. Taking up physical activity in later life and healthy ageing: the English longitudinal study of ageing. *British Journal of Sports Medicine*. 2013. 10.1136/bjsports-2013-092993
3. Unlocking the potential of light-intensity physical activity for public health: a call to action for research. *British Journal of Sports Medicine*. 2026. 10.1136/bjsports-2025-111179
4. Non-occupational physical activity and risk of cardiovascular disease, cancer and mortality outcomes: a dose–response meta-analysis of large prospective studies. *British Journal of Sports Medicine*. 2023. 10.1136/bjsports-2022-105669
5. Joint associations of accelerometer-measured physical activity and sedentary time with all-cause mortality: a harmonised meta-analysis in more than 44 000 middle-aged and older individuals. *British Journal of Sports Medicine*. 2020. 10.1136/bjsports-2020-103270
6. Strong, steady and straight: UK consensus statement on physical activity and exercise for osteoporosis. *British Journal of Sports Medicine*. 2022. 10.1136/bjsports-2021-104634
7. Bright spots, physical activity investments that work: Workplace Challenge. *British Journal of Sports Medicine*. 2017. 10.1136/bjsports-2017-097716
8. Effectiveness of maintenance interventions promoting physical activity following exercise therapy for chronic conditions: an umbrella review. *British Journal of Sports Medicine*. 2026. 10.1136/bjsports-2025-110444
9. Physical activity as a protective factor for dementia and Alzheimer’s disease: systematic review, meta-analysis and quality assessment of cohort and case–control studies. *British Journal of Sports Medicine*. 2022. 10.1136/bjsports-2021-104981
10. Infographic. Benefits and harms of exercise therapy in people with multimorbidity. *British Journal of Sports Medicine*. 2021. 10.1136/bjsports-2021-104367
11. Accelerometer-measured intensity-specific physical activity, genetic risk and incident type 2 diabetes: a prospective cohort study. *British Journal of Sports Medicine*. 2023. 10.1136/bjsports-2022-106653
12. Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis. *British Journal of Sports Medicine*. 2017. 10.1136/bjsports-2016-097383
13. 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 2: recommended physical interventions (exercise, taping, bracing, foot orthoses and combined interventions). *British Journal of Sports Medicine*. 2016. 10.1136/bjsports-2016-096268
14. Physical activity and longevity: how to move closer to causal inference. *British Journal of Sports Medicine*. 2018. 10.1136/bjsports-2017-098995
15. How does light-intensity physical activity associate with adult cardiometabolic health and mortality? Systematic review with meta-analysis of experimental and observational studies. *British Journal of Sports Medicine*. 2018. 10.1136/bjsports-2017-097563
16. What do community football players think about different exercise-training programmes? Implications for the delivery of lower limb injury prevention programmes. *British Journal of Sports Medicine*. 2013. 10.1136/bjsports-2013-092816
17. The reach and adoption of a coach-led exercise training programme in community football. *British Journal of Sports Medicine*. 2013. 10.1136/bjsports-2012-091797
18. Physical activity trajectories and accumulation over adulthood and their associations with all-cause and cause-specific mortality: a systematic review and meta-analysis. *British Journal of Sports Medicine*. 2025. 10.1136/bjsports-2024-109122
19. Copenhagen Consensus statement 2019: physical activity and ageing. *British Journal of Sports Medicine*. 2019. 10.1136/bjsports-2018-100451
20. Short and sporadic bouts in the 2018 US physical activity guidelines: is high-intensity incidental physical activity the new HIIT?. *British Journal of Sports Medicine*. 2019. 10.1136/bjsports-2018-100397

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

• There is little evidence that physical activity is associated with significant harm [1].
• The benefits of physical activity, in general, outweigh the risks [1].
• Maintenance interventions may help people continue to be physically active [2].
• Maintenance interventions may improve physical function and health-related quality of life [2].
• The 2018 US physical activity guidelines recognised that any bouts of physical activity count for health [3].
• ISPAH's Eight Investments That Work for Physical Activity provides a summary of eight areas for action supported by scientific evidence [4].
• ISPAH's Eight Investments That Work for Physical Activity has worldwide applicability [4].
• In children and adolescents aged 6-17, participating in moderate to vigorous physical activities led to multiple positive health outcomes [5].
• The 2020 WHO guidelines on physical activity and sedentary behaviour update previous WHO recommendations released in 2010 [9].
• About 15 times more physical activity of at least moderate intensity is needed to achieve similar results regarding incident cardiovascular disease [17].
• RCTs have failed to provide conclusive evidence that physical activity causes a reduced risk of death [18].
• Changes to physical activity guidelines, such as removal of a 10-min bout criterion, pose challenges for physical activity surveillance [44].
• At follow-up, 65.0% of inactive participants were taking part in sport [46].
• At follow-up, 85.6% of inactive participants were meeting recommended MVPA guidelines [46].
• Most differences in functional outcomes from scapular exercise programs did not reach the minimum threshold to be considered clinically important [48].
• Individuals not achieving the WHO guideline for physical activity showed an elevated risk of cancer, even if they were abdominally lean [49].
• The hazard ratio for elevated cancer risk in individuals not achieving the WHO guideline for physical activity, even if abdominally lean, was 1.04 (95% CI 1.01 to 1.07) [49].

How It Works

• There is little evidence that physical activity is associated with significant harm, and the benefits generally outweigh the risks [1].
• Maintenance interventions may help people continue to be physically active and improve physical function and health-related quality of life [2].
• ISPAH's Eight Investments That Work for Physical Activity provides a summary of eight areas for action that are supported by scientific evidence and have worldwide applicability [4].
• Light-intensity physical activity accounts for the majority of physical activity energy expenditure (51–59%) [6].
• Sustained physical activity in older age is associated with improved overall health [7].
• Exercise interventions implemented at ≤12 weeks after total knee arthroplasty primarily improved functional performance [10].
• Exercise interventions lasting >12 weeks after total knee arthroplasty resulted in greater gains in muscle strength and joint flexibility [10].
• The proportion of participants meeting health-enhancing physical activity recommendations increased from 33.1% to 42.3% between baseline and first follow-up in the Allez Hop programme [12].
• The addition of wearable activity tracker use did not have any effect on perceived joint function or health-related quality of life in people with hip and knee osteoarthritis [14].
• Aquatic exercise appears to provide meaningful pain relief for musculoskeletal disorders, with benefits that may persist during follow-up [15].
• Moderate treadmill exercise following an initial period of short-term immobilization has a positive impact on tendon-bone interface healing after anterior cruciate ligament reconstruction in a murine model [19].
• Prolonged immobilization has a detrimental effect on physical recovery after anterior cruciate ligament reconstruction in a murine model [19].
• Small increases in non-occupational physical activity in inactive adults are associated with substantial protection against a range of chronic disease outcomes [20].
• The ProPASS consortium aims to produce evidence on the associations of physical activity, sitting, and sleep with long-term health outcomes and longevity [21].
• Consensus statements outline approaches that may identify determinants and modifiers of cardiorespiratory fitness exercise response [22].
• Not all daily metabolic equivalent task units (METs) are the same in their health benefits [23].
• Pain science education may act as a mechanism of action for exercise interventions for people with knee or hip osteoarthritis [25].
• Pain science education is less successful when delivered standalone for people with knee or hip osteoarthritis [25].
• Findings question whether total hip arthroplasty should be prioritized only for patients with severe hip osteoarthritis symptoms [26].
• Pain is modulated by many factors, and the relationship between pain and tissue becomes less predictable the longer pain persists [27].

What the Evidence Shows

• There is little evidence that physical activity is associated with significant harm, and the benefits, in general, outweigh the risks [1].
• There is moderate certainty evidence that fall prevention exercise programmes are likely to be cost-effective [11].
• Much of the evidence regarding physical activity and ageing is based on longitudinal associations from observational and randomised controlled intervention studies, as well as quantitative and qualitative social studies in relatively healthy community-dwelling older adults [13].
• Participants in the NMC programme found it to be less physically challenging but more enjoyable and potentially of more benefit compared with control players [16].
• About 15 times more physical activity of at least moderate intensity is needed to achieve similar results regarding the joint associations of device-measured physical activity and abdominal obesity with incident cardiovascular disease [17].
• Randomised controlled trials have failed to provide conclusive evidence that physical activity causes a reduced risk of death [18].
• Exercise may improve pain and function in knee osteoarthritis with low to moderate certainty, but it is uncertain whether differences are clinically important [29].
• Protocols using painful exercises offer a small but significant benefit over pain-free exercises in the short term, with moderate quality of evidence [30].
• A school-based intervention resulted in a significant group-by-time interaction for mean minutes of moderate-to-vigorous physical activity per day in favour of the intervention group (adjusted difference between groups at follow-up=3.85 min, 95% CI (0.79 to 6.91), p≤0.01) [31].
• The school-based intervention included significantly more vigorous physical activity (2.45 min, p≤0.01), equating to 27 min more moderate-to-vigorous physical activity per week [31].
• There was no significant effect of an augmented exercise referral scheme using web-based behavioural support on weekly moderate-to-vigorous physical activity at 12 months between the groups recorded in ≥10 min bouts (mean difference 11.8 min of MVPA, 95% CI: −2.1 to 26.0; p=0.10) [33].
• There was no significant effect of an augmented exercise referral scheme using web-based behavioural support on weekly moderate-to-vigorous physical activity at 12 months between the groups without bouts (mean difference 13.7 min of MVPA, 95% CI: −26.8 to 54.2; p=0.51) [33].
• Findings from a prospective case series on proximal interphalangeal joint orthosis and therapeutic exercise for trigger finger demonstrate feasibility and short-term clinical improvement but cannot establish superiority over other conservative treatments due to the absence of a control group [34].
• Results from a formal 2-year cluster randomised-controlled trial confirmed the Youth-Physical Activity Towards Health programme was effective in improving youth fundamental movement skills proficiency [35].
• Brief interventions promoting physical activity in primary care and the community are likely to be inexpensive compared with usual care [37].
• A coaching intervention to enhance physical activity and prevent falls in community-dwelling people aged 60+ years improved daily steps, moderate-to-vigorous physical activity, hours per week of walking, overall well-being, quality of life and disability [38].
• Treatment groups in the WALK 2.0 trial differed significantly in trajectories of minutes/day of physical activity (p=0.0198), through a greater change at 3 months for Web 2.0 than Web 1.0 (7.3 min/day, 95% CI 2.4 to 12.3) [39].
• Compared with obesity-low physical activity, there was no survival benefit of being normal weight if physical activity levels were low [40].
• Exercise therapy is effective for some adolescents with patellofemoral pain but not all, and adherence to exercises is a challenge [41].
• Adolescents doing home exercises three times per week or more are four times more likely to be recovered after 12 months [41].
• Physical activity interventions that combine self-monitoring with other components provide an additional modest yet sustained increase in step count compared with self-monitoring alone [42].
• The PERSiST guidance attempts to address the problem of poor reporting of medical and healthcare systematic reviews in the sports and exercise medicine, musculoskeletal rehabilitation, and sports science fields [43].
• Approximately 65 min per day of walking was linked to a more favourable cardiometabolic profile [45].
• Approximately 5 min of stair climbing was linked to a more favourable cardiometabolic profile [45].
• The adverse effects of sitting became pronounced above 12 hours per day [45].
• Researchers need to prevent the '24-hour Babel' by coming to agreement about how to collectively define physical activity, sedentary behaviour and sleep through an inclusive and systematic consensus process [47].
• Exercise therapy improved health-related quality of life (SMD 0.37) in people with multimorbidity [50].
• Exercise therapy improved objectively measured physical function (SMD 0.33) in people with multimorbidity [50].
• Exercise therapy reduced depression (SMD −0.80) in people with multimorbidity [50].
• Exercise therapy reduced anxiety symptoms (SMD −0.49) in people with multimorbidity [50].

Practical Considerations

• Light-intensity physical activity is an accessible public health target and a potentially valuable complement to existing physical activity guidelines [6].
• The proportion of participants meeting the health-enhancing physical activity (HEPA) recommendations increased from 33.1% to 42.3% between baseline and first follow-up in the Allez Hop programme [12].
• Compared with control players, those who participated in the NMC programme found it to be less physically challenging but more enjoyable and potentially of more benefit [16].
• Policymakers should introduce physical activity promotion into the Quality and Outcomes Framework (QOF) as an individual indicator at a cost of approximately £1 million [24].
• Brief advice is a cost-effective way to improve physical activity among adults, provided short-term mental health gains are considered [32].

Key Evidence

• [L5] There is little evidence that physical activity is associated with significant harm, and the benefits, in general, outweigh the risks. [1] (10.1136/bjsports-2021-104634)
• [L1] Maintenance interventions may help people continue to be physically active and improve physical function and health-related quality of life. [2] (10.1136/bjsports-2025-110444)
• [L5] The 2018 US PA guidelines opened new horizons for PA and exercise medicine practice by recognising that any bouts of PA count for health. [3] (10.1136/bjsports-2018-100397)
• [Paper] ISPAH's Eight Investments That Work for Physical Activity provides a summary of eight areas for action that are supported by scientific evidence and have worldwide applicability. [4] (10.1136/bjsports-2020-103635)
• [Paper] The panel agreed on 10 major themes with strong scientific evidence that, in children and adolescents aged 6-17, participating in moderate to vigorous physical activities led to multiple positive health outcomes. [5] (10.1136/bjsports-2020-102261)
• [L5] LPA is an accessible public health target and a potentially valuable complement to existing PA guidelines, as it accounts for the majority of PA energy expenditure (51–59%). [6] (10.1136/bjsports-2025-111179)
• [L3] Sustained physical activity in older age is associated with improved overall health. [7] (10.1136/bjsports-2013-092993)
• [Paper] These 2020 WHO guidelines update previous WHO recommendations released in 2010. [9] (10.1136/bjsports-2020-102955)
• [L1] The interventions implemented at ≤12 weeks primarily improved the functional performance, whereas those lasting >12 weeks resulted in greater gains in the muscle strength and joint flexibility. [10] (10.1186/s13018-025-06430-7)
• [L1] There is moderate certainty evidence that fall prevention exercise programmes are likely to be cost-effective. [11] (10.1136/bjsports-2022-105747)
• [L4] The proportion of participants meeting the health-enhancing physical activity (HEPA) recommendations increased from 33.1% to 42.3% between baseline and first follow-up. [12] (10.1136/bjsm.2009.070201)
• [Paper] Much of the evidence presented in the statements is based on longitudinal associations from observational and randomised controlled intervention studies, as well as quantitative and qualitative social studies in relatively healthy community-dwelling older adults. [13] (10.1136/bjsports-2018-100451)
• [L1] The addition of WAT-use did not have any effect on perceived joint function or HRQoL. [14] (10.1186/s12891-024-08238-8)
• [L1] AQE appears to provide meaningful pain relief for musculoskeletal disorders, with benefits that may persist during follow-up. [15] (10.1186/s12891-026-09953-0)
• [L1] Compared with control players, those who participated in the NMC programme found it to be less physically challenging but more enjoyable and potentially of more benefit. [16] (10.1136/bjsports-2013-092816)
• [L3] About 15 times more physical activity of at least moderate intensity is needed to achieve similar results. [17] (10.1136/bjsports-2023-107252)
• [L5] RCTs have failed to provide conclusive evidence that physical activity causes a reduced risk of death. [18] (10.1136/bjsports-2017-098995)
• [L5] Moderate treadmill exercise following an initial period of short-term immobilization has a positive impact on tendon-bone interface healing, whereas prolonged immobilization has a detrimental effect on physical recovery. [19] (10.1177/2325967125s00320)
• [L1] Inverse non-linear dose–response associations suggest substantial protection against a range of chronic disease outcomes from small increases in non-occupational physical activity in inactive adults. [20] (10.1136/bjsports-2022-105669)
• [L5] The ProPASS consortium aims to bring together existing and future observational studies of thigh-worn accelerometry to produce evidence on the associations of physical activity, sitting, and sleep with long-term health outcomes and longevity. [21] (10.1136/bjsports-2019-100786)
• [Paper] The consensus statement outlines approaches that may identify determinants and modifiers of CRF exercise response and recommends future research to better understand exercise response variability. [22] (10.1136/bjsports-2018-100328)
• [L5] Acknowledging the possibility that not all daily METs are the same in our scientific inquiry is an important step towards realising the full potential of bodily movement for promoting health. [23] (10.1136/bjsports-2017-098693)
• [L5] The authors propose that policymakers should introduce physical activity promotion into the Quality and Outcomes Framework (QOF) as an individual indicator at a cost of approximately £1 million. [24] (10.1136/bjsm.2010.073726)
• [L1] PSE may act as a mechanism of action for exercise interventions, and is less successful delivered standalone. [25] (10.1186/s12891-025-09313-4)
• [L3] These findings question whether THA should be prioritized only for those patients who have severe hip OA symptoms, but require confirmation in a trial. [26] (10.1016/j.arth.2025.04.032)
• [L5] Instead, pain is modulated by many factors, and the relationship between pain and tissue becomes less predictable the longer pain persists. [27] (10.1136/bjsports-2017-098983)
• [L1] Exercise may improve pain and function with low to moderate certainty, but it is uncertain whether differences are clinically important. [29] (10.1097/corr.0000000000003476)
• [L1] Protocols using painful exercises offer a small but significant benefit over pain-free exercises in the short term, with moderate quality of evidence. [30] (10.1136/bjsports-2016-097383)
• [L1] There was a significant group-by-time interaction for mean minutes of MVPA per day in favour of the intervention group (adjusted difference between groups at follow-up=3.85 min, 95% CI (0.79 to 6.91), p≤0.01), including significantly more vigorous physical activity (2.45 min, p≤0.01), equating to 27 min more MVPA per week. [31] (10.1136/bjsports-2014-094523)
• [Paper] BA is a cost-effective way to improve PA among adults, provided short-term mental health gains are considered. [32] (10.1136/bjsports-2013-092897)
• [L1] There was no significant effect of the intervention on weekly MVPA at 12 months between the groups recorded in ≥10 min bouts (mean difference 11.8 min of MVPA, 95% CI: −2.1 to 26.0; p=0.10) or without bouts (mean difference 13.7 min of MVPA, 95% CI: −26.8 to 54.2; p=0.51). [33] (10.1136/bjsports-2020-103121)
• [L4] Because of the absence of a control group, these findings demonstrate feasibility and short-term clinical improvement but cannot establish superiority over other conservative treatments. [34] (10.1016/j.jhsg.2026.101038)
• [Paper] Results from a formal 2-year cluster randomised-controlled trial confirmed the programme was effective in improving youth FMS proficiency. [35] (10.1136/bjsports-2018-099745)
• [L1] Brief interventions promoting physical activity in primary care and the community are likely to be inexpensive compared with usual care. [37] (10.1136/bjsports-2015-094655)
• [L1] However, this programme improved other physical activity measures (ie, daily steps, MVPA, hours per week of walking), overall well-being, quality of life and disability. [38] (10.1136/bjsports-2023-107027)
• [L1] Treatment groups differed significantly in trajectories of minutes/day of physical activity (p=0.0198), through a greater change at 3 months for Web 2.0 than Web 1.0 (7.3 min/day, 95% CI 2.4 to 12.3). [39] (10.1136/bjsports-2016-096890)
• [L2] Compared with obesity-low physical activity, there was no survival benefit of being normal weight if physical activity levels were low. [40] (10.1136/bjsports-2021-104827)
• [Paper] Exercise therapy is effective for some adolescents but not all, and adherence to exercises is a challenge, with those doing home exercises three times per week or more being four times more likely to be recovered after 12 months. [41] (10.1136/bjsports-2016-096268)
• [L1] Physical activity interventions that combine self-monitoring with other components provide an additional modest yet sustained increase in step count compared with self-monitoring alone. [42] (10.1136/bjsports-2021-105198)
• [Paper] The Prisma in Exercise, Rehabilitation, Sport medicine and SporTs science (PERSiST) guidance attempts to address the problem of poor reporting of medical and healthcare systematic reviews in the sports and exercise medicine, musculoskeletal rehabilitation, and sports science fields. [43] (10.1136/bjsports-2021-103987)
• [Paper] Changes to the PA guidelines, such as removal of a 10-min bout criterion, pose challenges for PA surveillance. [44] (10.1136/bjsports-2020-102621)
• [L5] The resource also delivered the first pooled analysis exploring physical activity type in relation to cardiometabolic health, showing that approximately 65 min per day of walking and 5 min of stair climbing were each linked to a more favourable cardiometabolic profile, while the adverse effects of sitting became pronounced above 12 hours per day. [45] (10.1136/bjsports-2025-111283)
• [Paper] At follow-up, 65.0% of inactive participants were taking part in sport and 85.6% were meeting recommended MVPA guidelines. [46] (10.1136/bjsports-2017-097716)
• [L5] Researchers need to prevent this looming ‘24-hour Babel’ by coming to agreement about how to collectively define PA, SB and sleep through an inclusive and systematic consensus process. [47] (10.1136/bjsports-2021-104487)
• [L1] However, most of these differences did not reach the minimum threshold to be considered clinically important. [48] (10.1016/j.jht.2024.07.006)
• [L2] Similarly, individuals not achieving the WHO guideline for physical activity showed an elevated risk, even if they were abdominally lean (HR 1.04, 95% CI 1.01 to 1.07). [49] (10.1136/bjsports-2024-108708)
• [L1] Exercise therapy improved health-related quality of life (SMD 0.37) and objectively measured physical function (SMD 0.33) and reduced depression (SMD −0.80) and anxiety symptoms (SMD −0.49). [50] (10.1136/bjsports-2021-104367)

References

[1] Strong, steady and straight: UK consensus statement on physical activity and exercise for osteoporosis. British Journal of Sports Medicine. 2022. DOI: 10.1136/bjsports-2021-104634

[2] Effectiveness of maintenance interventions promoting physical activity following exercise therapy for chronic conditions: an umbrella review. British Journal of Sports Medicine. 2026. DOI: 10.1136/bjsports-2025-110444

[3] Short and sporadic bouts in the 2018 US physical activity guidelines: is high-intensity incidental physical activity the new HIIT?. British Journal of Sports Medicine. 2019. DOI: 10.1136/bjsports-2018-100397

[4] Infographic. ISPAH’s Eight Investments That Work for Physical Activity: infographic, animation and call to action. British Journal of Sports Medicine. 2021. DOI: 10.1136/bjsports-2020-103635

[5] Physical activity and health in Chinese children and adolescents: expert consensus statement (2020). British Journal of Sports Medicine. 2020. DOI: 10.1136/bjsports-2020-102261

[6] Unlocking the potential of light-intensity physical activity for public health: a call to action for research. British Journal of Sports Medicine. 2026. DOI: 10.1136/bjsports-2025-111179

[7] Taking up physical activity in later life and healthy ageing: the English longitudinal study of ageing. British Journal of Sports Medicine. 2013. DOI: 10.1136/bjsports-2013-092993

[9] World Health Organization 2020 guidelines on physical activity and sedentary behaviour. British Journal of Sports Medicine. 2020. DOI: 10.1136/bjsports-2020-102955

[10] Changes in knee outcome measures following later-stage exercise interventions implemented ≤ 12 weeks vs. > 12 weeks after total knee arthroplasty: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06430-7

[11] Economic evaluations of fall prevention exercise programs: a systematic review. British Journal of Sports Medicine. 2022. DOI: 10.1136/bjsports-2022-105747

[12] Allez Hop, a nationwide programme for the promotion of physical activity in Switzerland: what is the evidence for a population impact after one decade of implementation?. British Journal of Sports Medicine. 2010. DOI: 10.1136/bjsm.2009.070201

[13] Copenhagen Consensus statement 2019: physical activity and ageing. British Journal of Sports Medicine. 2019. DOI: 10.1136/bjsports-2018-100451

[14] Effects of self-monitoring physical activity with wearable activity trackers on perceived joint function and health-related quality of life in people with hip and knee osteoarthritis: a secondary analysis of a cluster-randomised clinical trial. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-024-08238-8

[15] The dose-response relationship of aquatic exercise for musculoskeletal pain relief: a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09953-0

[16] What do community football players think about different exercise-training programmes? Implications for the delivery of lower limb injury prevention programmes. British Journal of Sports Medicine. 2013. DOI: 10.1136/bjsports-2013-092816

[17] Joint associations of device-measured physical activity and abdominal obesity with incident cardiovascular disease: a prospective cohort study. British Journal of Sports Medicine. 2023. DOI: 10.1136/bjsports-2023-107252

[18] Physical activity and longevity: how to move closer to causal inference. British Journal of Sports Medicine. 2018. DOI: 10.1136/bjsports-2017-098995

[19] Poster 234: Improvement of Tendon-Bone Interface Healing by Moderate Treadmill Exercise Combined with Knee Brace Immobilization Following an Anterior Cruciate Ligament Reconstruction in a Murine Model. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/2325967125s00320

[20] Non-occupational physical activity and risk of cardiovascular disease, cancer and mortality outcomes: a dose–response meta-analysis of large prospective studies. British Journal of Sports Medicine. 2023. DOI: 10.1136/bjsports-2022-105669

[21] Emerging collaborative research platforms for the next generation of physical activity, sleep and exercise medicine guidelines: the Prospective Physical Activity, Sitting, and Sleep consortium (ProPASS). British Journal of Sports Medicine. 2019. DOI: 10.1136/bjsports-2019-100786

[22] Precision exercise medicine: understanding exercise response variability. British Journal of Sports Medicine. 2019. DOI: 10.1136/bjsports-2018-100328

[23] Do all daily metabolic equivalent task units (METs) bring the same health benefits?. British Journal of Sports Medicine. 2018. DOI: 10.1136/bjsports-2017-098693

[24] Physical activity in the UK: a unique crossroad?. British Journal of Sports Medicine. 2010. DOI: 10.1136/bjsm.2010.073726

[25] Pain science education and exercise interventions for people with knee or hip osteoarthritis: a systematic review, content and meta-analysis. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-09313-4

[26] Total Hip Arthroplasty versus Education and Exercise: A Secondary Analysis of Propensity Matched Data Comparing Outcomes Across Hip Osteoarthritis Symptom Severity. The Journal of Arthroplasty. 2025. DOI: 10.1016/j.arth.2025.04.032

[27] Musculoskeletal pain and exercise—challenging existing paradigms and introducing new. British Journal of Sports Medicine. 2018. DOI: 10.1136/bjsports-2017-098983

[29] Cochrane in CORR®: Exercise for Osteoarthritis of the Knee. Clinical Orthopaedics & Related Research. 2025. DOI: 10.1097/corr.0000000000003476

[30] Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis. British Journal of Sports Medicine. 2017. DOI: 10.1136/bjsports-2016-097383

[31] ‘Physical Activity 4 Everyone’ school-based intervention to prevent decline in adolescent physical activity levels: 12 month (mid-intervention) report on a cluster randomised trial. British Journal of Sports Medicine. 2015. DOI: 10.1136/bjsports-2014-094523

[32] Is brief advice in primary care a cost-effective way to promote physical activity?. British Journal of Sports Medicine. 2013. DOI: 10.1136/bjsports-2013-092897

[33] Randomised controlled trial of an augmented exercise referral scheme using web-based behavioural support for inactive adults with chronic health conditions: the e-coachER trial. British Journal of Sports Medicine. 2020. DOI: 10.1136/bjsports-2020-103121

[34] Effectiveness of Proximal Interphalangeal Joint Orthosis and Therapeutic Exercise in the Management of Trigger Finger: A Prospective Case Series. Journal of Hand Surgery Global Online. 2026. DOI: 10.1016/j.jhsg.2026.101038

[35] Bright spots physical activity investments that work: Youth-Physical Activity Towards Health (Y-PATH). British Journal of Sports Medicine. 2018. DOI: 10.1136/bjsports-2018-099745

[37] Are brief interventions to increase physical activity cost-effective? A systematic review. British Journal of Sports Medicine. 2015. DOI: 10.1136/bjsports-2015-094655

[38] Effect of a coaching intervention to enhance physical activity and prevent falls in community-dwelling people aged 60+ years: a cluster randomised controlled trial. British Journal of Sports Medicine. 2024. DOI: 10.1136/bjsports-2023-107027

[39] Using Web 2.0 applications to promote health-related physical activity: findings from the WALK 2.0 randomised controlled trial. British Journal of Sports Medicine. 2017. DOI: 10.1136/bjsports-2016-096890

[40] Device-measured physical activity, adiposity and mortality: a harmonised meta-analysis of eight prospective cohort studies. British Journal of Sports Medicine. 2021. DOI: 10.1136/bjsports-2021-104827

[41] 2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 2: recommended physical interventions (exercise, taping, bracing, foot orthoses and combined interventions). British Journal of Sports Medicine. 2016. DOI: 10.1136/bjsports-2016-096268

[42] Do physical activity interventions combining self-monitoring with other components provide an additional benefit compared with self-monitoring alone? A systematic review and meta-analysis. British Journal of Sports Medicine. 2022. DOI: 10.1136/bjsports-2021-105198

[43] Implementing the 27 PRISMA 2020 Statement items for systematic reviews in the sport and exercise medicine, musculoskeletal rehabilitation and sports science fields: the PERSiST (implementing Prisma in Exercise, Rehabilitation, Sport medicine and SporTs science) guidance. British Journal of Sports Medicine. 2021. DOI: 10.1136/bjsports-2021-103987

[44] How can global physical activity surveillance adapt to evolving physical activity guidelines? Needs, challenges and future directions. British Journal of Sports Medicine. 2020. DOI: 10.1136/bjsports-2020-102621

[45] Prospective Physical Activity, Sitting and Sleep consortium (ProPASS): addressing methodological and geographical barriers to inform global public health guidelines, interventions and precision medicine. British Journal of Sports Medicine. 2026. DOI: 10.1136/bjsports-2025-111283

[46] Bright spots, physical activity investments that work: Workplace Challenge. British Journal of Sports Medicine. 2017. DOI: 10.1136/bjsports-2017-097716

[47] Preventing the ‘24-hour Babel’: the need for a consensus on a consistent terminology scheme for physical activity, sedentary behaviour and sleep. British Journal of Sports Medicine. 2021. DOI: 10.1136/bjsports-2021-104487

[48] Effectiveness of a scapular exercise program on functional outcomes in patients with hand, wrist or elbow disorders: A comprehensive systematic review with meta-analysis. Journal of Hand Therapy. 2025. DOI: 10.1016/j.jht.2024.07.006

[49] WHO guidelines on waist circumference and physical activity and their joint association with cancer risk. British Journal of Sports Medicine. 2025. DOI: 10.1136/bjsports-2024-108708

[50] Infographic. Benefits and harms of exercise therapy in people with multimorbidity. British Journal of Sports Medicine. 2021. DOI: 10.1136/bjsports-2021-104367