It's time to change how we think about exercise, researchers suggest

by University of South Carolina

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An abundance of clinical trials has shown that exercise reduces pain and facilitates everyday activities like climbing stairs for individuals with osteoarthritis. But researchers from the University of South Carolina, McMaster University and the University of Delaware believe it's time for a mindset shift. Instead of viewing exercise as a temporary treatment for the condition, clinicians and patients should view physical activity as a lifelong behavior.

"In traditional exercise interventions, including those prescribed in clinical trials, patients are given exercise as a treatment, where the frequency, intensity, time and type of each exercise are detailed, much like a medication dosage," says associate professor of exercise science Christine Pellegrini, the lead author of a multi-institution paper on the topic published in Osteoarthritis and Cartilage. "However, little attention is given to the fact that exercise is a behavior—an activity that adults need to intentionally choose to participate in regularly—and there are few resources provided to facilitate the integration of exercise into daily life beyond the treatment or intervention period."

A painful problem

Affecting 1 in 5 U.S. adults (more than 32 million Americans), osteoarthritis is the most common of more than 100 types of this progressive condition. Characterized by the erosion of cartilage that caps the bones between joints, osteoarthritis most often occurs in high-use areas of the body like the knees, hips, hands and spine.

The resulting discomfort is highly individualized, but research has shown that members of this population endure more pain, fatigue, disability and activity limitations than others in their age group. In a misguided attempt to alleviate these symptoms, patients tend to adopt increasingly sedentary lifestyles—leading to additional chronic conditions (one-third of them have five or more) like diabetes or hypertension, along with difficulty managing them.

Use it or lose it

Using exercise to treat osteoarthritis has become a common strategy in clinical practice, yet the positive impacts are often short-lived. One of the challenges in achieving long-term outcomes relates to how we view exercise. Defined as a structured, repetitive and planned activity aimed at improving physical fitness, exercise's benefits for pain reduction and daily functioning are largely overlooked—unless it is prescribed as part of a temporary treatment or intervention plan.

In addition, the expert and logistical supports (e.g., trained supervision, specialized equipment, clinical settings, insurance coverage for acute pain following initial diagnosis) often disappear after the treatment period ends. Together, these barriers inhibit sustained participation in exercise, leading to worsening symptoms, more sedentary behavior and exacerbated health problems.

From a temporary treatment to an embedded behavior

Some researchers are working to address the lack of access and prohibitive costs related to continued exercise for individuals with osteoarthritis. Pellegrini, for example, has led projects to assess the effectiveness of technology-based interventions to reduce sedentary behavior after a knee replacement and to encourage walking among individuals with arthritis. Innovative approaches such as these can help engage this population long term, but a broader change in perspective related to the role of exercise as a daily behavior must happen in parallel.

"Viewing exercise solely as a treatment rather than as a behavior limits its effectiveness," Pellegrini says. "We advocate for a shift in the approach to how exercise interventions are implemented in adults with osteoarthritis to facilitate long-term participation in exercise. As part of this shift, we must begin using behavioral theories to underpin new techniques that facilitate the long-term adoption of exercise."

Pellegrini and her colleagues at the USC Prevention Research Center are currently recruiting for the latest study. You can learn more about the Dream Study if you're interested in participating in a program that uses physical activity to benefit adults with arthritis.

More information

Christine A. Pellegrini et al, More than a prescription: The need for behavioral theory to guide exercise interventions for osteoarthritis—A narrative review, Osteoarthritis and Cartilage (2026). DOI: 10.1016/j.joca.2026.02.012

Key medical concepts

OsteoarthritisExercisePainSedentary Behavior

Clinical categories

Fitness & Physical activityOrthopedicsAllied healthCommon illnesses & Prevention Provided by University of South Carolina Who's behind this story?

Gaby Clark

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