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Staying Active for Joint Health

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

Overview

Exercise interventions following joint arthroplasty yield distinct benefits based on duration and timing. Interventions implemented within 12 weeks post-total knee arthroplasty primarily improve functional performance [1]. Extending these interventions beyond 12 weeks results in greater gains in muscle strength and joint flexibility [1]. For patients with knee osteoarthritis, aerobic exercise elicits improvements in cardiopulmonary fitness [3].

In the context of osteoarthritis management, exercise may improve pain and function with low to moderate certainty, though it remains uncertain whether these differences are clinically important [5]. Self-monitoring physical activity using wearable activity trackers does not affect perceived joint function or health-related quality of life in people with hip and knee osteoarthritis [7]. Regarding total hip arthroplasty, outcomes should not be prioritized only for patients with severe hip osteoarthritis symptoms, although this requires confirmation in a trial [2].

For upper extremity disorders, scapular exercise programs for hand, wrist, or elbow disorders show most differences in functional outcomes that did not reach the minimum threshold to be considered clinically important [8]. Proximal interphalangeal joint orthosis and therapeutic exercise demonstrate feasibility and short-term clinical improvement for trigger finger, but cannot establish superiority over other conservative treatments due to the absence of a control group [9]. In wrist osteoarthritis, few participants in either group required surgery at 24 months in a randomized controlled trial of neuromuscular exercise therapy, indicating that exercise programs may contribute to symptom management over time [10].

How It Works

Post-Arthroplasty Rehabilitation: Exercise interventions implemented ≤12 weeks after total knee arthroplasty primarily improve functional performance [1]. Interventions lasting >12 weeks result in greater gains in muscle strength and joint flexibility [1].

Osteoarthritis Management: Exercise may improve pain and function in knee osteoarthritis with low to moderate certainty [5]. It is uncertain whether these improvements are clinically important [5]. Aerobic exercise elicits improvements in cardiopulmonary fitness for people with knee osteoarthritis [3]. The addition of whole-body vibration to exercise therapy led to greater improvements in several outcomes for end-stage knee osteoarthritis, suggesting it may be a valuable adjunct to optimize the benefits of exercise therapy [12]. Pain science education may act as a mechanism of action for exercise interventions in people with knee or hip osteoarthritis [14]. Pain science education is less successful when delivered standalone compared to when it is part of an exercise intervention [14].

Adjunctive Technologies and Devices: 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 [7]. Proximal interphalangeal joint orthosis and therapeutic exercise demonstrate feasibility and short-term clinical improvement for trigger finger management [9].

Upper Extremity and Hand Disorders: Most differences in functional outcomes from scapular exercise programs for hand, wrist, or elbow disorders did not reach the minimum threshold to be considered clinically important [8]. Few participants in either group required surgery at 24 months in a trial of neuromuscular exercise therapy for wrist osteoarthritis, indicating that exercise programs may contribute to symptom management over time [10].

Biomechanical Healing Mechanisms: Prolonged immobilization has a detrimental effect on physical recovery in the context of tendon-bone interface healing after anterior cruciate ligament reconstruction in a murine model [13]. 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 [13].

What the Evidence Shows

Post-Arthroplasty Rehabilitation: Exercise interventions implemented ≤12 weeks after total knee arthroplasty primarily improve functional performance [1]. Interventions lasting >12 weeks result in greater gains in muscle strength and joint flexibility [1]. For anterior cruciate ligament reconstruction, an individually tailored, supervised prehabilitation program resulted in superior improvements in perceived knee function compared to a self-administered program [16].

Osteoarthritis Management: Aerobic exercise elicits improvements in cardiopulmonary fitness for people with knee osteoarthritis [3]. Moderate-certainty evidence indicates Pilates and Tai Chi may be the most effective mind–body exercises for improving pain and physical function in knee osteoarthritis, while Tai Chi may be the best for improving quality of life [21]. Both combined mode kinetic chain exercises with core strengthening and combined kinetic chain exercise only reduced pain, improved knee flexion and extension, and improved overall quality of life in patients with knee osteoarthritis [17]. Exercise may improve pain and function in knee osteoarthritis with low to moderate certainty, but it is uncertain whether these differences are clinically important [5]. The addition of whole-body vibration to exercise therapy led to greater improvements in several outcomes for end-stage knee osteoarthritis, suggesting it may be a valuable adjunct to optimize the benefits of exercise therapy [12].

Upper Extremity and Hand Disorders: Most differences in functional outcomes for patients with hand, wrist, or elbow disorders following a scapular exercise program did not reach the minimum threshold to be considered clinically important [8]. Proximal interphalangeal joint orthosis and therapeutic exercise demonstrate feasibility and short-term clinical improvement in trigger finger management, but cannot establish superiority over other conservative treatments due to the absence of a control group [9]. Few participants in either group required surgery at 24 months in a randomized controlled trial of neuromuscular exercise therapy for wrist osteoarthritis, indicating that exercise programs may contribute to symptom management over time [10]. Mobile game-based home exercise programs may be considered a potentially effective option for thumb rehabilitation, with significantly higher adherence to home exercises observed compared to standard home exercise programs [19].

Tendon and Soft Tissue Recovery: Progressive tendon-loading eccentric exercise therapy in athletes with patellar tendinopathy resulted in statistically significant decreases in center of pressure velocity and increases in Y-Balance Test reach distances compared to baseline [18]. 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 in a murine model of anterior cruciate ligament reconstruction [13].

Adjuncts and Precautions: 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 [7]. Ankle pump exercises significantly reduce the incidence of deep vein thrombosis and increase venous haemodynamic parameters—specifically maximum venous outflow and maximum venous capacity—in patients undergoing lower limb orthopaedic surgery [20].

Surgical Prioritization: Findings from propensity-matched data question whether total hip arthroplasty should be prioritized only for patients with severe hip osteoarthritis symptoms, though confirmation in a trial is required [2].

Practical Considerations

Timing and Duration of Exercise: Exercise interventions implemented ≤12 weeks after total knee arthroplasty primarily improve functional performance [1]. Interventions lasting >12 weeks result in greater gains in muscle strength and joint flexibility [1].

Joint-Specific Evidence: * Knee Osteoarthritis: Aerobic exercise elicits improvements in cardiopulmonary fitness [3]. Exercise may improve pain and function with low to moderate certainty, but it is uncertain whether these differences are clinically important [5]. The addition of whole-body vibration to exercise therapy led to greater improvements in several outcomes for end-stage knee osteoarthritis, suggesting it may be a valuable adjunct to optimize the benefits of exercise therapy [12]. * Hip Osteoarthritis: Total hip arthroplasty should not necessarily be prioritized only for patients with severe hip osteoarthritis symptoms, although this requires confirmation in a trial [2]. Self-monitoring physical activity with wearable activity trackers does not have any effect on perceived joint function or health-related quality of life in people with hip and knee osteoarthritis [7]. * Hand, Wrist, and Elbow: Most differences in functional outcomes from scapular exercise programs for hand, wrist, or elbow disorders did not reach the minimum threshold to be considered clinically important [8]. Few participants in either group required surgery at 24 months in a trial of neuromuscular exercise therapy for wrist osteoarthritis, indicating that exercise programs may contribute to symptom management over time [10]. Proximal interphalangeal joint orthosis and therapeutic exercise demonstrate feasibility and short-term clinical improvement for trigger finger, but cannot establish superiority over other conservative treatments due to the absence of a control group [9].

Post-Arthroplasty Care: Heterogeneity in functional recovery among joint arthroplasty patients underscores the importance of a personalised, data-driven approach to post-operative care to optimise long-term outcomes [15].

Key Evidence

  • [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. (10.1186/s13018-025-06430-7)
  • [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. (10.1016/j.arth.2025.04.032)
  • [L1] These results support the hypothesis that aerobic exercise can elicit improvements in cardiopulmonary fitness for people with knee OA. (10.1186/s12891-025-08746-1)
  • [L1] Exercise may improve pain and function with low to moderate certainty, but it is uncertain whether differences are clinically important. (10.1097/corr.0000000000003476)
  • [L1] The addition of WAT-use did not have any effect on perceived joint function or HRQoL. (10.1186/s12891-024-08238-8)
  • [L1] However, most of these differences did not reach the minimum threshold to be considered clinically important. (10.1016/j.jht.2024.07.006)
  • [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. (10.1016/j.jhsg.2026.101038)
  • [L1] Nevertheless, few participants in either group required surgery at 24 months, indicating that both exercise programs may contribute to symptom management over time. (10.1186/s12891-025-09463-5)
  • [L3] The addition of WBV to exercise therapy led to greater improvements in several outcomes, suggesting that WBV may be a valuable adjunct to optimize the benefits of exercise therapy. (10.1186/s42836-025-00301-6)
  • [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. (10.1177/2325967125s00320)
  • [L1] PSE may act as a mechanism of action for exercise interventions, and is less successful delivered standalone. (10.1186/s12891-025-09313-4)
  • [L3] The findings highlight heterogeneity in functional recovery and underscore the importance of a personalised, data-driven approach to post-operative care to optimise long-term outcomes. (10.1186/s42836-025-00339-6)
  • [L1] An individually tailored, supervised prehabilitation program resulted in superior improvements in perceived knee function compared to a self-administered program. (10.1177/2325967126s00041)
  • [L2] The study concluded that both the experimental group receiving core strengthening exercises with combined mode kinetic chain exercises and the control group receiving combined kinetic chain exercise only reduced pain, improved knee flexion and extension, and improved the overall quality of life of patients with knee Osteoarthritis. (10.1186/s12891-026-09531-4)
  • [L2] The intervention group showed statistically significant decreases in center of pressure velocity and increases in Y-Balance Test reach distances compared to baseline. (10.1016/j.jisako.2026.101105)
  • [L2] Mobile game-based home exercise programs may be considered a potentially effective option in thumb rehabilitation and, at the very least, not inferior to standard home exercise programs, with significantly higher adherence to home exercises observed in the mobile game group. (10.1177/17589983251387079)
  • [L1] This meta-analysis provides Level I evidence that ankle pump exercises significantly reduce the incidence of deep vein thrombosis (DVT) and increase venous haemodynamic parameters—specifically maximum venous outflow (MVO) and maximum venous capacity (MVC)—in patients undergoing lower limb orthopaedic surgery. (10.1186/s13018-025-06236-7)
  • [L1] There is moderate-certainty evidence that Pilates and Tai Chi may be the most effective mind–body exercises for improving pain and physical function in knee osteoarthritis, while Tai Chi may be the best for improving quality of life. (10.1186/s13018-025-05682-7)

References

[1] 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

[2] 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

[3] Effect of aerobic exercise on cardiopulmonary fitness among people with knee osteoarthritis: a systematic review and meta-analysis. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08746-1

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

[7] 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

[8] 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

[9] 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

[10] Long-term effects of neuromuscular exercise therapy and the need for surgical conversion in wrist osteoarthritis: 24-month results from a randomized controlled trial. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-09463-5

[12] Improving pain, function and quality of life in end-stage knee osteoarthritis: a patient-preference cohort study on whole-body vibration and exercise as bridging therapies for total knee replacement. Arthroplasty. 2025. DOI: 10.1186/s42836-025-00301-6

[13] 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

[14] 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

[15] Unsupervised machine learning models reveal two distinct post-operative physical activity profiles among joint arthroplasty patients: a United Kingdom biobank cohort study. Arthroplasty. 2025. DOI: 10.1186/s42836-025-00339-6

[16] Effectiveness of Exercise Prehabilitation Before Anterior Cruciate Ligament Reconstruction on Functional Outcomes – A Single-Blinded Randomized Controlled Trial: Prevention, Prehab and Rehab. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/2325967126s00041

[17] Combined mode-kinetic chain exercise with and without core stability exercises on patients with knee osteoarthritis. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09531-4

[18] Progressive tendon-loading eccentric exercise therapy in athletes with patellar tendinopathy improves postural control, quadriceps strength, and pain: A randomized clinical trial. Journal of ISAKOS. 2026. DOI: 10.1016/j.jisako.2026.101105

[19] Effects of home exercise-based mobile games on thumb rehabilitation outcomes. Hand Therapy. 2025. DOI: 10.1177/17589983251387079

[20] Effect of postoperative ankle pump exercises on the prevention of deep vein thrombosis and venous hemodynamics following lower limb orthopedic surgery: a meta-analysis of randomized controlled trials. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06236-7

[21] Comparative efficacy of mind–body exercise for pain, function, quality of life in knee osteoarthritis: a systematic review and network meta-analysis. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-05682-7

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