How Does “Cardio” Fit with Osteoarthritis Joint Pain?

I’ve been asked this question, in one form or another, a lot.

“Is walking okay to do for my knee pain? I want to get the recommended minutes of activity and make sure I’m burning enough calories but I don’t understand if walking is okay to do.”

And you can swap “hip” or “foot” or “back” for knee.

It’s a good question. As you age, you need to keep moving – for your joints, your heart and lungs, your mind. That old adage “use it or lose it” is true . It’s just that you can lose it so slowly that you don’t notice it…until you do.

Usually, the driver of this need to walk (or some other “cardio” activity) is managing body weight or more precisely, body fat. Conventional Wisdom suggests that “cardio” is the best type of exercise to “burn” fat. It’s all about the calories which of course it’s not. It’s more complicated than just calories in and out. But that’s what you think and so when a joint pain shows up and suddenly the cardio activity causes symptoms, there’s a little bit of panic.

I’m going to gain weight if I can’t – fill in the blank.

Now, the battle is all in the mind. Do you keep walking even though it might cause pain or do you stop walking and potentially gain weight?

Well, you have to separate these issues first. Joint pain is one issue and weight gain is another. Usually they seem connected but often aren’t.

Let’s say your hip hurts after walking for 20 minutes and you usually walk an hour several days a week. If you believe that successful fat management is from sustained activity then you’ll probably feel a little stressed about the drop  in walking minutes per week.

The good news is that you can lose weight/fat with a lot less movement per session – say 5 minutes – and increase the number of sessions. If you were walking 180 minutes per week, just divide that up into 5 minute segments over the week. Let’s just make the math easy and use 200 minutes. That would be 40 sessions per week of five minutes or about 6 times a day you go for a 5 minute walk.

I know you’re probably grumbling about how I don’t know what I’m talking about. How could you possible lose weight moving for only 5 minutes per session?

It’s based on something called Non-Exercise Activity Thermogenesis or N.E.A.T.^[1]https://www.ahajournals.org/doi/full/10.1161/01.atv.0000205848.83210.73 Scientists discovered that people who move a lot per day but not enough to be classified as “exercise” have better control over their weight. In fact, there’s a tool just for this, something we often suggest for folks who have nagging knee pain – called a HOVR. You just swing your legs back and forth which when multiplied by several hours turns into a lot of movement and boosts your metabolism.

So back to the pain issue – see, if you disconnect the weight gain issue from the walking, you can now make different choices for your hip / joint pain.

Joints generally respond better when you respect their Load Tolerance. Load Tolerance is the amount of pain free force you can produce, absorb and/or sustain. In this example, we know that somewhere around 20 minutes pain shows up so your Load Tolerance is less than 20 minutes. You could test  yourself but there’s a good chance that 5 minutes would be okay.

When you ask your body to perform at or above its’ Load Tolerance, this is when symptoms usually show up.

Sometimes it’s not a big deal. Like when you perform a new exercise and your muscles are sore the next day or two. That’s an example of exceeding Load Tolerance, sustaining an injury (muscle soreness) and then a couple of days later, you’re okay. Recovered.

However, if the exercise load is high enough, you could have torn a muscle, in which case, you wouldn’t have recovered in a couple of days.

But with joints, when you exceed Load Tolerance of the joint, you’re apt to hurt for a longer time and have symptoms such as aching or swelling in addition to pain.

If you can move the joint at loads below the Load Tolerance and move it enough, the joint health starts to improve.

Synovial fluid gets thicker. Swelling subsides. Aching dies down. The muscles start working better.

You can still maintain your weight even though you have joint pain by using the N.E.A.T. principle and make your joints healthier too.

Thanks for reading.

If you like this article, why not share it with a friend? If you’re interested in coaching services, please contact my colleague Laurie Kertz Kelly for a free, 20-minute Strategy Session by, clicking here. To get my Secret Weapon to fight knee, hip & back pain and stiffness, subscribe for free today.

Doug Kelsey has been a physical therapist and human movement expert since 1981. He is formerly Associate Professor and Assistant Dean for Clinical Affairs at the University of Oklahoma Health Sciences Center and the author of several books. He has conducted over 250 educational seminars for therapists, trainers, physicians, and the public and has presented lectures at national and international scientific and professional conferences. His professional CV is here.