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Joint pain, arthritis, menopause and exercise



Joint pain, arthritis, and exercise

Today we are exploring a topic that comes up time and time again, particularly in midlife. That is joint pain.


Joints can feel stiff. They may ache. Sometimes they feel unreliable.


And what often follows is a shift in behaviour. Movement starts to feel like something to be cautious about. Or even something to avoid.



But what we know from the science, and from practice, is that avoiding movement can actually make things worse over time.


  • So today, we are going to take a step-by-step look at:

    • what joint pain actually is

    • how it relates to arthritis and arthralgia

    • why menopause plays such a key role

    • and most importantly, how we can support the body through movement and lifestyle


What is Arthritis?

Arthritis is a general term used to describe a group of conditions that affect the joints.


A joint is where two bones meet. Its role is to allow movement while providing stability. In arthritis, the structures within the joint become affected, leading to symptoms that may include:

  • pain

  • stiffness

  • reduced range of movement

  • and sometimes swelling or inflammation


Arthritis is not a single condition. There are over 100 different types. However, the two most common and relevant are osteoarthritis and rheumatoid arthritis.


Osteoarthritis is the most common form of arthritis.


It is associated with changes in the joint over time. These include:

  • thinning of cartilage

  • changes in the underlying bone

  • reduced joint space


It is often linked with:

  • ageing

  • previous injury

  • repeated loading

  • reduced muscle support


Typical symptoms:

  • stiffness after rest

  • discomfort with movement

  • reduced ease in daily tasks


Common areas affected include the knees, hips and hands.


These conditions often involve:

  • pain

  • stiffness

  • reduced movement

  • and sometimes inflammation


But not all arthritis is the same.


Two types are particularly important to understand.


First, osteoarthritis.


Osteoarthritis develops gradually. It is often linked with long-term joint loading and changes in the tissues.


Cartilage starts to become thinner and the joint may become less smooth in how it moves.


You might notice:

  • stiffness after sitting

  • discomfort with repeated movement

  • or a sense that the joint is not quite as fluid as it used to be


A common example is the knee - and you may notice little things like going up or down stairs may feel more demanding. Or pain in the knee after a long car journey. Or a dull ache or sharp pain on moving.


Another common area is the hands - women in particular may notice changes in their finger joints during around 50 onwards when we have gone through menopause - fingers might look slightly enlarged or our grip strength may feel reduced. (this becomes relevant when introducing resistance training. Particularly when holding weights).



Rheumatoid arthritis is different. It is an autoimmune condition.


The immune system becomes overactive and starts to target the lining of the joints.


This creates:

  • swelling

  • warmth

  • pain that is often symmetrical


For example, both wrists or both hands may be affected at the same time.

There may also be fatigue and periods of flare and recovery.


So, it is important to recognise:

  • osteoarthritis is more mechanical and structural

  • rheumatoid arthritis is driven by the immune system



Now, let’s introduce another term. Arthralgia. Arthralgia simply means joint pain. It is not a diagnosis. It does not tell us the cause. It just describes the experience of pain in a joint.

This is really important. Because not all joint pain is arthritis. And not all muscle pain is related to joints.


For example:

  • aching joints during a stressful week

  • discomfort after poor sleep

  • generalised soreness during hormonal change


All of these can be described as arthralgia. This is where menopause becomes highly relevant.


Key Distinction

  • Osteoarthritis → primarily structural and related to joint loading over time

  • Rheumatoid arthritis → immune-driven and inflammatory

 

Menopause and Joint Pain

Magliano (2010) explored whether joint pain during menopause is a distinct clinical issue or part of broader musculoskeletal ageing.


Key points:

  • Joint pain (arthralgia) is commonly reported during the menopausal transition.

  • There is a clear association between declining oestrogen levels and increased reports of joint discomfort and stiffness.

  • Symptoms often affect the hands, knees, hips, and spine.


Proposed mechanisms:

  • Reduced oestrogen may influence cartilage health and joint lubrication.

  • Changes in collagen and connective tissue may affect joint stability.

  • Low-grade inflammation may contribute to symptom development.


Clinical considerations:

  • Menopausal arthralgia is recognised, but it can overlap with conditions such as osteoarthritis.

  • Diagnosis should consider other causes of joint pain rather than attributing symptoms solely to menopause.

  • Hormone replacement therapy (HRT) may improve symptoms in some women, although responses vary.


Conclusion:Menopausal joint pain is a genuine and commonly reported phenomenon, likely influenced by hormonal changes. However, it should be assessed within a broader clinical context to ensure appropriate management.

Joint and muscle pain are very commonly reported during menopause. Research by Fiona E Watt and Cheng-Bin Lu and colleagues shows a clear increase in musculoskeletal symptoms during this stage.


So, what is happening?


One of the key factors is oestrogen.


Oestrogen plays several roles in the body:

  • it helps regulate inflammation

  • it supports connective tissue

  • it influences how we perceive pain


As oestrogen levels decline:

  • inflammation may increase

  • tissues may become less resilient

  • the nervous system may become more sensitive


So, the same movement may feel different, and this helps to explain why our:

  • joints may feel stiffer

  • aches may appear without clear injury

  • and recovery may feel slower


There is also evidence that osteoarthritis becomes more prevalent around this time. Particularly in the hands - but this is not a reason to avoid loading the joints, but how to be thoughtful in how we introduce it.


The Cycle of Pain and Inactivity

Now let’s talk about behaviour - because this is where things often start to shift.

When joints feel sore or unreliable, it is completely understandable to reduce movement.


You may think:“I will rest it.”“I do not want to make it worse.”


That is a very natural response.


But over time, this can create a cycle.


Less movement leads to:

  • increased stiffness

  • reduced muscle strength

  • lower joint support


And then everyday tasks begin to feel harder.


This might be:

  • getting up from a chair

  • carrying shopping

  • walking for longer periods


So, confidence reduces, and the cycle continues. Pain leads to less movement. Less movement leads to more discomfort. Breaking this cycle is key - and movement is part of that solution.


Exercise and Arthralgia

Peeler and Ripat (2018) examined whether reducing joint load during exercise could improve outcomes for individuals with knee osteoarthritis.


The study used a 12-week walking programme supported by lower body positive pressure (LBPP). This equipment reduces body weight through air pressure, allowing walking with less joint stress.


Key findings:

  • Joint pain was reduced.

  • Physical function improved.

  • Participants reported better ability to complete daily activities that they previously found difficult.

  • Quality of life increased over the intervention period.


Interpretation:Lower-load exercise enables movement without aggravating symptoms. This supports adherence, which is central to long-term improvement. It also allows individuals who may struggle with full weight-bearing exercise to begin rehabilitation safely.


Clinical relevance:

  • Exercise remains a first-line treatment for knee osteoarthritis.

  • Load management is a key variable in programme design.

  • Gradual progression from reduced-load to full weight-bearing activity may improve outcomes.


Conclusion:Well-structured, low-load exercise can reduce pain and restore function in knee osteoarthritis. The ability to move with less discomfort appears to be a critical step in improving daily living and overall quality of life.


Peeler et al. (2015) investigated whether body weight–supported exercise could improve outcomes in people with knee osteoarthritis. Participants completed a programme of reduced-load physical activity, typically using support systems that decrease the amount of body weight passing through the knee joint during movement.


Key findings:

  • Joint pain was reduced.

  • Physical function improved.

  • Strength of the thigh muscles (particularly the quadriceps) increased.


Interpretation:Reducing load on the joint allows individuals to exercise with less discomfort. This supports better movement quality and enables meaningful strength gains without exacerbating symptoms.


Clinical relevance:

  • Quadriceps strength is closely linked to knee joint stability and function.

  • Lower-load environments can help individuals who are unable to tolerate full weight-bearing exercise.

  • This approach may improve adherence by making exercise more achievable and less painful.


Conclusion: Body weight–supported exercise provides a practical and effective method for reducing pain while improving strength and function in knee osteoarthritis. It offers a useful starting point for progression towards more demanding, weight-bearing activity.

 

Lange, Vanwanseele and Fiatarone Singh (2008) conducted a systematic review to evaluate the effectiveness of strength training for knee osteoarthritis.


Key findings:

  • Strength training consistently reduced knee pain.

  • Improvements were seen in physical function and mobility.

  • Increases in muscle strength, particularly the quadriceps, were strongly linked to better outcomes.


Mechanisms:

  • Stronger muscles improve joint stability and reduce mechanical stress on the knee.

  • Enhanced neuromuscular control supports more efficient movement patterns.

  • Strength gains may also contribute to reduced pain perception.


Programme considerations:

  • Both high- and low-intensity strength training can be effective.

  • Programmes should be progressive and tailored to the individual.

  • Supervision improves technique, safety, and outcomes.


Clinical relevance:

  • Strength training is a core component of osteoarthritis management.

  • It is suitable across a range of abilities when appropriately adapted.

  • Consistency and progression are key to maintaining benefits.


Conclusion:There is strong evidence that strength training is a safe and effective intervention for reducing pain and improving function in knee osteoarthritis. It should be considered a central element of long-term management.


Baker et al. (2001) investigated whether a home-based progressive strength training programme could improve outcomes in older adults with knee osteoarthritis.


Study design:

  • Randomised controlled trial.

  • Participants completed a structured strength programme at home, with gradual progression in load.


Key findings:

  • Significant reductions in knee pain.

  • Improvements in physical function and mobility.

  • Increases in muscle strength, particularly in the lower limbs.


Interpretation:Strength gains achieved at home can translate into meaningful reductions in pain and improved daily function. The progressive nature of the programme was central to these outcomes.


Clinical relevance:

  • Effective exercise does not require a clinical or gym setting.

  • Well-designed home programmes can support accessibility and long-term adherence.

  • Progressive overload remains a key principle, even at lower starting intensities.


Conclusion:Home-based strength training is a practical and effective intervention for managing knee osteoarthritis. It supports pain reduction, improved function, and increased independence, making it a valuable option for long-term self-management.


Golightly et al. (2021) explored whether high-intensity interval training (HIIT) is a safe and effective option for individuals with knee osteoarthritis.


Study design:

  • Pilot study assessing feasibility, safety, and preliminary outcomes.

  • Participants completed structured HIIT sessions, typically involving short bursts of higher intensity exercise with recovery periods.


Key findings:

  • HIIT was feasible and well tolerated by participants.

  • No significant adverse effects were reported.

  • Improvements were observed in pain, physical function, and fitness.


Interpretation:Higher intensity exercise may be appropriate for some individuals with knee osteoarthritis when carefully prescribed. It challenges the assumption that only low-intensity exercise is suitable for this group.


Clinical relevance:

  • Exercise intensity can be progressed beyond traditional low-load approaches where appropriate.

  • Individualisation is essential, based on symptoms, fitness level, and confidence.

  • Supervision and gradual progression support safety and adherence.


Conclusion:HIIT shows potential as an effective and safe training option for knee osteoarthritis. While larger studies are needed, it provides an additional tool within a graded and personalised exercise approach.


Mazloum et al. (2018) compared the effects of Pilates-based exercise with conventional therapeutic exercise in individuals with knee osteoarthritis.


Study design:

  • Participants were assigned to either a Pilates programme or a traditional exercise group.

  • Outcomes focused on pain and physical function.


Key findings:

  • Both groups showed significant reductions in pain.

  • Both groups improved physical function.

  • The Pilates group demonstrated greater improvements in some functional measures.


Interpretation:While conventional exercise remains effective, Pilates may offer additional benefits through its focus on movement control, alignment, and muscle activation.


Clinical relevance:

  • Multiple exercise approaches can be effective for managing knee osteoarthritis.

  • Pilates provides a structured method for improving strength, flexibility, and neuromuscular control.

  • It may be particularly useful for individuals who benefit from guided, low-impact movement.


Conclusion: Both traditional exercise and Pilates reduce pain and improve function in knee osteoarthritis. Pilates may offer added value for functional movement and control, making it a useful option within a varied exercise programme.


What the evidence shows

Across the papers you provided, several consistent themes emerge:


1. Strength training is fundamental

  • Strong evidence supports resistance training for reducing pain and improving function.

  • Quadriceps strength is particularly important for knee joint stability.

  • Both home-based and supervised programmes are effective when progressive.


2. Aerobic exercise improves pain and function

  • Walking programmes, including reduced-load approaches, improve daily function and quality of life.

  • Cardiovascular exercise supports overall health and symptom management.


3. Load management is key

  • Reduced-load exercise (e.g. supported walking) helps individuals who cannot tolerate full weight-bearing.

  • This improves adherence and allows early engagement in movement.


4. Movement quality and control matter

  • Approaches such as Pilates improve function through better alignment and neuromuscular control.

  • This may enhance how forces are distributed across the joint.


5. Intensity can be progressed

  • Higher intensity training (e.g. HIIT) can be safe and effective for some individuals.

  • This depends on appropriate selection, progression, and tolerance.


Best practical approach

The strongest evidence supports a blended model:

  • Strength training → core component

  • Aerobic exercise → supports function and general health

  • Mobility and control work → improves movement efficiency

  • Progressive loading → adapted to symptoms and capacity


Key principle

The most effective programme is:

  • Individualised 

  • Progressive 

  • Consistent over time 


Adherence is more important than the specific type of exercise.

Conclusion

Rather than one superior method, osteoarthritis management is best supported by a well-structured, progressive exercise programme combining strength, aerobic, and movement control training. This approach provides the most reliable improvements in pain, function, and quality of life.

 

There is consistent evidence that moderate levels of exercise can improve arthralgia.

Movement helps the body in several ways:


  • it improves joint lubrication

  • it maintains range of motion

  • it strengthens the muscles around the joint


This improves joint stability.


But the approach matters.


It needs to be gradual.


If someone has been inactive, or is experiencing pain, we do not jump straight into high loads.


We start where they are.

That might mean:

  • smaller ranges of movement

  • lower resistance

  • slower tempo



Consistency is more important than intensity.

And it is helpful to reframe discomfort - and some level of discomfort does not always mean damage, and it could be increased sensitivity. With appropriate loading, that sensitivity can reduce over time.


Lifestyle, Inflammation and Recovery

Now, let’s widen the lens slightly - as joint health is not only about movement, because lifestyle plays a role as well.


Research by Agnieszka Skoczek-Rubińska and colleagues shows that diet can influence levels of inflammation in postmenopausal women.


Higher inflammatory diets are associated with higher levels of inflammatory markers.

This can influence:

  • pain perception

  • recovery

  • and overall joint comfort


Supportive strategies include:

  • eating more whole foods

  • including healthy fats such as omega 3

  • ensuring adequate protein

  • reducing highly processed foods


Alongside this:

  • good sleep supports tissue repair

  • stress management supports hormonal balance


These factors work together and help to create the environment in which the body responds to movement.


So, let’s bring this together.

Joint pain during menopause is common - but it is not something we simply have to accept as it is influenced by multiple factors:

  • hormonal change

  • inflammation

  • strength and conditioning

  • and behaviour


And importantly, it is modifiable.


With the right approach, joints can feel stronger and more capable.


10 Point Summary

  1. Arthritis is a general term for conditions affecting the joints

  2. Osteoarthritis involves gradual structural changes in the joint

  3. Rheumatoid arthritis is an autoimmune condition involving inflammation

  4. Arthralgia simply means joint pain and is not a diagnosis

  5. Joint pain is common during menopause

  6. Declining oestrogen affects inflammation, tissue health, and pain sensitivity

  7. Reduced movement can worsen stiffness and weakness

  8. This creates a cycle of pain and inactivity

  9. Moderate, progressive exercise can improve joint function and reduce symptoms

  10. Lifestyle factors, including diet, sleep, and stress, influence inflammation and recovery


If you are interested in finding out more, this blog is taken from a talk that I do in the online Cafe Rachel series and forms part of the ongoing work I do to help people understand the benefit of exercise in helping us manage changes as we get older. Click here to find out more about the Cafe and if you think that this might work for you too.

References:

  • Baker, K.R., Nelson, M.E., Felson, D.T., Layne, J.E., Sarno, R. and Roubenoff, R. (2001) The efficacy of home based progressive strength training in older adults with knee osteoarthritis: a randomized controlled trial. The Journal of Rheumatology, 28(7), pp.1655–1665.

  • Davis, A.M., Davis, K.D., Skou, S.T. et al. (2020) Why is exercise effective in reducing pain in people with osteoarthritis? Current Treatment Options in Rheumatology, 6, pp.146–159.

  • Golightly, Y.M., Smith-Ryan, A.E., Blue, M.N., Alvarez, C., Allen, K.D. and Nelson, A.E. (2021) High-intensity interval training for knee osteoarthritis: a pilot study. ACR Open Rheumatology, 3(10), pp.723–732.

  • Lange, A.K., Vanwanseele, B. and Fiatarone Singh, M.A. (2008) Strength training for treatment of osteoarthritis of the knee: a systematic review. Arthritis Care & Research, 59(10), pp.1488–1494.

  • Lu, C.B., Liu, P.F., Zhou, Y.S., Meng, F.C., Qiao, T.Y., Yang, X.J., Li, X.Y., Xue, Q., Xu, H., Liu, Y. and Han, Y. (2020) Musculoskeletal pain during the menopausal transition: a systematic review and meta-analysis. Neural Plasticity, 2020. Available at: https://doi.org/10.1155/2020/8703902 

  • Magliano, M. (2010) Menopausal arthralgia: fact or fiction. Maturitas, 67(1), pp.29–33.

  • Mazloum, V., Rabiei, P., Rahnama, N. and Sabzehparvar, E. (2018) The comparison of the effectiveness of conventional therapeutic exercises and Pilates on pain and function in patients with knee osteoarthritis. Complementary Therapies in Clinical Practice, 31, pp.343–348.

  • Peeler, J. and Ripat, J. (2018) The effect of low-load exercise on joint pain, function, and activities of daily living in patients with knee osteoarthritis. The Knee, 25(1), pp.135–145.

  • Peeler, J., Christian, M., Cooper, J., Leiter, J. and MacDonald, P. (2015) Managing knee osteoarthritis: the effects of body weight supported physical activity on joint pain, function, and thigh muscle strength. Clinical Journal of Sport Medicine, 25(6), pp.518–523.

  • Skoczek-Rubińska, A., Muzsik-Kazimierska, A., Chmurzynska, A., Jamka, M., Walkowiak, J. and Bajerska, J. (2021) Inflammatory potential of diet is associated with biomarkers levels of inflammation and cognitive function among postmenopausal women. Nutrients, 13(7), p.2323. Available at: https://doi.org/10.3390/nu13072323 

  • Watt, F.E. (2018) Musculoskeletal pain and menopause. Post Reproductive Health, 24(1), pp.34–43. Available at: https://doi.org/10.1177/2053369118757537 

  • Wluka, A.E., Cicuttini, F.M. and Spector, T.D. (2000) Menopause, oestrogens and arthritis. Maturitas, 35(3), pp.183–199. Available at: https://doi.org/10.1016/S0378-5122(00)00118-3

 
 
 

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