Osteoarthritis is one of the most common joint conditions
By age 65, half of adults have radiographic evidence of OA. Most are still trainable. The job isn't to fix the OA — it's to keep the joint strong, the surrounding tissues healthy, and the client active despite the condition.
Exercise helps OA
Resistance training and aerobic exercise both reduce OA pain and improve function. The classic concern that "lifting wears out joints" doesn't hold up — joints stress-respond to loading by remodeling, just like bone.
What worsens OA:
- Sedentary lifestyle (muscle weakness around joint)
- Excessive body weight
- Repetitive high-impact loading at end ranges
- Progressive resistance training
- Low-impact cardio
- Maintaining or losing body weight
- Strong muscles around the joint
- Full ROM where tolerable
Programming for OA
General principles:- Find the pain-free or tolerable range
- Train within that range with progressive load
- Build the muscles supporting the joint
- Multi-joint movements that don't aggravate
- Avoid high-impact unless tolerated and beneficial
- Quad strength is protective
- Step-ups, split squats, leg press
- Cycling, swimming, elliptical for cardio
- Avoid deep squats if painful — partial ROM OK
- Hip flexor and glute strength
- Squats, hinges within tolerance
- Walking, swimming
- Avoid combined flexion + rotation if painful
- Scapular strength
- Pulling more than pressing initially
- Press in pain-free range
- Avoid behind-the-neck movements
Joint replacement clients
Pre-op (prehab): Strengthen the surrounding musculature before surgery. Better outcomes follow stronger pre-op clients. Post-op: Most clients have a 6-12 week post-op protocol with their surgeon and PT. After PT discharge: Begin gradual return to gym training with surgeon clearance. Total knee replacement:- No deep flexion limits typically, but check with surgeon
- Avoid high-impact (running, jumping) — recommendations vary
- Build quad and posterior chain strength
- Cycling and swimming are friends
- Most surgeons restrict deep flexion + adduction + internal rotation for 6-12 weeks (dislocation risk)
- After that, gradual return to most activities
- Walking, cycling, swimming for cardio
- Long rehab (3-6+ months)
- Limited overhead loading even after rehab
- Pulling generally tolerated better than pressing
Communication with the surgeon
For joint replacement clients, get specific restrictions from the surgeon:
- ROM limits
- Load limits
- Time post-op
- Impact restrictions
- Sports/activities to avoid permanently
Red flags
- New pain unrelated to training
- Sudden swelling
- Heat, redness around joint (possible infection)
- Loss of ROM
- Instability or "giving way"
TL;DR
OA clients benefit from progressive resistance training within pain-free ranges. Joint replacement clients need surgeon clearance, specific restrictions, and a graduated return. Build surrounding musculature. Avoid high-impact if it worsens pain. Communicate with the medical team for replacements.