Quick answer: During a flare-up you usually do not need to stop moving. Cut back to gentle range-of-motion exercises and short walks, and rest the most inflamed joint. Keep pain at a level you find acceptable that settles within 24 hours. Restart your usual exercise gradually once the flare eases, and get help if a joint is hot, red and very swollen.
When your arthritis flares, it is natural to want to stop moving and wait for it to pass. Rest does have a place, especially for a hot, swollen joint. But stopping completely for days or weeks can leave you stiffer, weaker and more tired, which makes the next flare harder to deal with. The aim during a flare is not to keep up your usual routine; it is to keep gently moving in a way that does not make things worse. This guide explains how to judge what is right on the day, gives you a short flare-day routine, and shows how to build back up once the flare settles.
Is it a flare, or normal exercise soreness?
It helps to know the difference, because they need different responses.
| Normal soreness after exercise | Arthritis flare | |
|---|---|---|
| When it starts | Usually within a day of new or harder exercise | Can happen any time, sometimes with no clear trigger |
| What it feels like | Muscle aching or mild joint ache | Increased joint pain, stiffness, warmth or swelling |
| How long it lasts | Usually eases within 24 to 48 hours | Can last days or weeks |
| Other symptoms | Usually none | With inflammatory arthritis, often fatigue, longer morning stiffness, and feeling generally unwell |
| What to do | Keep going, perhaps slightly lighter next time | Scale back to gentle movement, use your flare plan, and get advice if needed |
Osteoarthritis flares versus inflammatory arthritis flares
Osteoarthritis (OA) flares are often linked to doing more than usual, such as a long walk, gardening or decorating, though sometimes there is no obvious cause. The joint may ache more, feel stiff and sometimes swell a little. These flares usually settle within days to a few weeks. Gentle movement is generally helpful and NICE guideline NG226 recommends exercise as a core treatment for OA; during a flare you simply reduce the amount and intensity.
Inflammatory arthritis flares, such as in rheumatoid arthritis, psoriatic arthritis or axial spondyloarthritis, are caused by increased inflammation. Joints may be hot, swollen and very painful, often with fatigue and long morning stiffness. Resting the most inflamed joints is sensible, but gentle range-of-motion movements help prevent stiffness. Contact your rheumatology team or advice line if a flare is severe or not settling, as your treatment may need reviewing.
Gout flares are different again: the joint is usually extremely painful, and rest, raising the joint and treatment are needed. Wait until the attack has settled before exercising that joint, but you can usually move other parts of your body gently.
The traffic-light approach
| Level | How you feel | What to do |
|---|---|---|
| Green | Normal or mild extra ache, joints not hot or very swollen | Carry on with your usual exercise, perhaps a little lighter |
| Amber | More pain and stiffness than usual, mild swelling, more tired | Halve the amount and intensity; swap to gentle range-of-motion, short walks, cycling or pool exercise |
| Red | Joint hot, red, very swollen or very painful; feeling unwell | Rest the affected joint; gentle movement of other joints only; follow your flare plan and get advice |
Many physiotherapists use a simple pain guide: pain during exercise that stays at a level you find acceptable (often around 4 out of 10 or lower) and settles back to your usual level within 24 hours is generally fine. If pain is higher, or you are worse the next morning, cut back further.
What helps during a flare
- Gentle range-of-motion exercises. Moving each joint slowly through a comfortable range a few times a day helps reduce stiffness.
- Short, frequent bouts of movement. Five minutes several times a day is often better than one long session.
- Low-impact activity. Short walks on the flat, a stationary bike at low resistance, or gentle movement in a warm pool.
- Isometric (static) exercises. Tightening muscles without moving the joint, such as pressing the back of your knee into the bed, helps maintain strength with very little joint movement.
- Breathing and relaxation. Slow breathing and gentle stretching can ease muscle tension and help you cope with pain.
- Heat or cold. Warmth before moving can ease stiffness; a cold pack wrapped in a towel can help a hot, swollen joint. Limit to about 15 to 20 minutes and check your skin.
What to avoid during a flare
- High-impact exercise such as running or jumping.
- Heavy strength training on the flaring joint.
- Forcing stretches into pain or pushing through sharp pain.
- Long sessions to "make up" for missed exercise.
- Complete bed rest for long periods, unless your doctor has advised it.
A 10-minute flare-day routine
Do this once or twice a day, sitting or lying down if needed. Move slowly, breathe normally and stay within a comfortable range. Skip any move that hurts the flaring joint.
- Breathing, 1 minute. Breathe in slowly through your nose, and out slowly through your mouth.
- Neck turns, 5 each side. Turn your head slowly to look over each shoulder.
- Shoulder rolls, 10. Roll your shoulders up, back and down.
- Elbow bends, 10. With arms by your side, bend and straighten your elbows.
- Wrist circles and finger stretches, 5 each. Make gentle circles, then open and close your hands slowly.
- Seated marching, 1 minute. Lift your knees alternately in a comfortable range.
- Knee straightening, 5 each leg. Sitting, slowly straighten one knee, hold for 3 seconds, lower.
- Thigh squeezes, 10 each leg. Sitting or lying with your leg straight, tighten the thigh muscle to press the back of your knee down, hold 5 seconds.
- Ankle pumps and circles, 10 each. Point and flex your feet, then circle them.
- Buttock squeezes, 10. Squeeze your buttocks together, hold 5 seconds, relax.
For more gentle moves for better days, see our daily mobility routine. If standing is difficult, the moves in our chair exercise guide can be done from a seat.
Adapting by joint
| Flaring joint | Gentle options | Ease off |
|---|---|---|
| Knee | Thigh squeezes, heel slides, seated knee straightening, pool walking | Stairs, squats, long walks, kneeling |
| Hip | Buttock squeezes, gentle hip rolls lying on your back, short flat walks | Long walks, low chairs, crossing legs |
| Hand and wrist | Gentle finger and wrist movements in warm water | Strong gripping, putty and grip-strength work, heavy carrying |
| Shoulder | Pendulum swings, gentle supported arm lifts | Overhead reaching, resistance band work, lifting |
| Back | Knee rocking lying on your back, short walks, pelvic tilts | Prolonged sitting, heavy lifting, bending and twisting |
| Foot and ankle | Ankle pumps and circles while seated, toe movements | Long periods on your feet, walking on uneven ground |
Pacing and planning
Pacing means spreading activity through the day and alternating activity with rest, rather than doing a lot on a good day and paying for it later. During a flare:
- Break tasks into smaller chunks with rests between.
- Set a timer to remind you to change position every 30 to 45 minutes.
- Prioritise what really needs doing and postpone the rest.
- Get a good night's sleep where possible; fatigue tends to make pain feel worse.
It is worth writing a flare plan when you are well, so you know what to do when a flare starts. Our flare action plan includes space for your exercise steps, medicines and contact numbers, and our guide to managing flare-ups at home covers pain relief and self-care.
Restarting your usual exercise after a flare
Once the flare starts to settle, build up step by step. Going straight back to your full routine is a common reason for another flare.
| Stage | When | What to do |
|---|---|---|
| 1 | Flare settling, still sore | Flare-day routine plus short walks; about a third to a half of your usual amount |
| 2 | Pain and swelling much better | Add your usual strength exercises with fewer sets or lighter weight; walks a little longer |
| 3 | Close to your normal | Return to about three-quarters of your usual routine |
| 4 | Back to normal for a week | Your full routine, then resume gradual progression |
Spend at least a few days at each stage, and move on only if your joints feel no worse the next day. If a longer flare has left you weaker, our guide to rebuilding after a flare has more detail.
An example flare week
This shows how one person with knee osteoarthritis might adjust a normal week of walking and strength exercise during a moderate flare. It is an illustration, not a prescription.
| Day | Usual plan | During the flare |
|---|---|---|
| 1 | 30-minute walk | Flare-day routine twice; two 5-minute walks around the house or garden |
| 2 | Strength session | Thigh squeezes and seated knee straightening only; flare-day routine |
| 3 | 30-minute walk | Flare-day routine; two 10-minute flat walks if comfortable |
| 4 | Rest or swim | Gentle pool walking for 15 minutes, or rest |
| 5 | Strength session | Half the usual sets with no added weight |
| 6 | Long walk | 15-minute flat walk |
| 7 | Rest | Rest and gentle mobility |
Medicines and exercise during a flare
Pain relief can make gentle movement easier. Some people find it helps to time exercise for when their pain relief is working best. Follow the dose instructions and check with a pharmacist or GP if you are unsure which pain relief is suitable for you; NICE advises that topical anti-inflammatory gels are considered first for knee osteoarthritis. If you have inflammatory arthritis, keep taking your disease-modifying or biologic medicine unless your team tells you otherwise, and tell them about frequent flares. Steroid injections or other treatment changes are decisions for your clinical team. Never increase painkillers just so you can push through high-intensity exercise during a flare.
Working with your physiotherapist or rheumatology team
If flares keep interrupting your exercise, ask your physiotherapist to help you write a flare plan with specific exercises for your joints and clear rules for when to scale back and when to build up. If you have inflammatory arthritis, your rheumatology nurse or advice line can help you judge whether a flare needs a review of your treatment. Bring your flare diary to appointments; it helps them see patterns.
Reducing the chance of the next flare
- Build up exercise gradually; avoid sudden big increases in activity.
- Keep moving regularly, even on good days, rather than doing a lot at once.
- Take medicines as prescribed and do not stop disease-modifying treatment without speaking to your team.
- Keep a simple diary of flares, activity, sleep and stress to spot patterns.
- Look after your general health, including sleep, weight and stress.
When to get medical help
- Call 999 if you have chest pain, severe breathlessness or signs of a stroke.
- Call NHS 111 or go to A&E if a single joint suddenly becomes hot, red, swollen and very painful, especially with a high temperature or feeling unwell; this can be a sign of a joint infection. This is particularly important if you take medicines that affect your immune system.
- Contact your rheumatology advice line or GP if a flare of inflammatory arthritis is severe, lasts more than a few days without improving, or flares are becoming more frequent.
- See your GP or a physiotherapist if an OA flare does not start to settle within 2 to 3 weeks, if you cannot put weight on a joint, or if a joint locks or gives way.
Should I exercise during an arthritis flare?
Usually yes, but less. Rest the most inflamed joint and keep the rest of your body gently moving with range-of-motion exercises, short walks or pool movement. Stop or cut back if pain increases significantly or does not settle within 24 hours.
Can exercise cause a flare-up?
A sudden increase in activity can trigger a flare in some people, particularly with osteoarthritis. Building up gradually and pacing activity reduce this risk. Regular, moderate exercise is generally helpful for arthritis in the long term.
Is it OK to exercise with a swollen joint?
Gentle, pain-free movement of a mildly swollen joint is usually fine. If a joint is hot, red and very swollen, rest it and get advice, as this needs checking, especially if you feel unwell or have a high temperature.
How long should I rest during a flare?
Rest the most painful joint for short periods, but avoid long periods of complete rest. Keep up gentle movement every day if you can, and gradually return to your usual exercise as the flare settles.
Is walking good during a flare-up?
Short, gentle walks on flat ground are often helpful during a mild flare. Make them shorter than usual, use a walking aid if needed, and avoid hills and long distances until the flare settles.
Is swimming good during a flare-up?
Gentle movement in a warm pool can be comfortable during a flare because the water supports your weight. Keep sessions short and avoid strokes that strain painful joints.
How do I know if I have done too much?
If your pain is much worse during exercise, does not settle within 24 hours, or your joint is more swollen the next day, you have probably done too much. Reduce the amount next time rather than stopping completely.
Sources and further reading
- NICE NG226: Osteoarthritis in over 16s
- NICE NG100: Rheumatoid arthritis in adults
- NHS: Rheumatoid arthritis – treatment
- NHS: Osteoarthritis – living with
- Versus Arthritis / Arthritis UK: Exercising with arthritis
- NRAS: Exercise and rheumatoid arthritis
Educational information for people in the United Kingdom — not a diagnosis or personal medical advice. Charity no. 1218461. Pending clinical review. Everyone's situation is different, so always follow the advice of your own GP, pharmacist or rheumatology team. If you feel very unwell, call 999 or go to A&E. For urgent advice, contact NHS 111.
Continue with related help
- Managing flare-ups at home — self-care plan
- Flare action plan — printable plan
- Rebuilding after a flare — deconditioning
- Daily mobility routine — gentle moves
- Exercise hub — exercises by joint