context: Although arthritis treatment usually includes medication, a tailored arthritis exercise program can help relieve pain and fatigue and preserve joint structure and function. The stiffness, pain, and swelling associated with arthritis can severely reduce the range of motion of joints (the distance joints can move in certain directions). Avoiding physical activity because of pain or discomfort also can lead to significant muscle loss and excessive weight gain. Exercise, as part of a comprehensive arthritis treatment plan, can improve joint mobility, muscle strength, and overall physical conditioning, and help you maintain a healthy weight. Once you know what type of arthritis you have and understand your symptoms, you and your doctor or physical therapist can develop a balanced program of physical activity to reduce the damaging effects of arthritis and promote optimal health. A tailored program that includes a balance of three types of exercises -- range-of-motion, strengthening, and endurance -- can relieve the symptoms of arthritis and protect joints from further damage. Exercise also may: Help maintain normal joint movement Increase muscle flexibility and strength Help maintain weight to reduce pressure on joints Help keep bone and cartilage tissue strong and healthy Improve endurance and cardiovascular fitness To help relieve pain, people with arthritis often keep their affected joints bent -- especially those in the knees, hands, and fingers -- because it's more comfortable in that position. Although this may temporarily relieve discomfort, holding a joint in the same position for too long can cause permanent loss of mobility and further hinder the ability to perform daily activities. Range-of-motion exercises (also called stretching or flexibility exercises) help maintain normal joint function by increasing and preserving joint mobility and flexibility. In this group of exercises, gently straightening and bending the joints in a controlled manner as far as they comfortably will go can help condition the affected joints. During the course of a range-of-motion exercise program, the joints are stretched progressively farther until normal or near-normal range is achieved and maintained. This helps to maintain comfort while function is preserved. In addition to preserving joint function, range-of-motion exercises are an important form of warm-up and stretching, and should be done prior to performing strengthening or endurance exercises, or engaging in any other physical activity. A doctor or physical therapist can provide you with instructions on how to perform range-of-motion exercises. Strong muscles help keep weak joints stable and comfortable and protect them against further damage. A program of strengthening exercises that targets specific muscle groups can be helpful as part of your arthritis treatment. There are several types of strengthening exercises that, when performed properly, can maintain or increase muscle tissue to support your muscles without aggravating your joints. Some people with arthritis avoid exercise because of joint pain. However, a group of exercises called "isometrics" will help strengthen muscles without bending painful joints. Isometrics involve no joint movement but rather strengthen muscle groups by using an alternating series of isolated muscle flexes and periods of relaxation. Isotonics is another group of exercises that involve joint mobility. However, this group of exercises is more intensive, achieving strength development through increased repetitions or by introducing increasing weight resistance such as with with small dumbbells or stretch bands. A physical therapist or fitness instructor (preferably one who has experience working with people with arthritis) can tell you how to safely and effectively perform isometric and isotonic exercises. Hydrotherapy, also called "aqua therapy" (water therapy), is a program of exercises performed in a large pool. Aqua therapy may be easier on joints because the buoyancy of water takes some of the weight off the painful joints while providing resistance training. The foundation of endurance training is aerobic exercise, which includes any activity that increases the heart rate for a prolonged period of time. Aerobic activity conditions the heart and lungs to: Use oxygen to more efficiently supply the entire body with larger amounts of oxygen-rich blood Build stronger muscles for endurance activity When paired with a healthy diet, aerobic activity also is fundamental for controlling weight (which is important for people with arthritis since it reduces excess pressure on affected joints) and for improving overall general health. At first, people with arthritis should perform about 15 to 20 minutes of aerobic activity at least three times a week, and then gradually build up to 30 minutes daily. The activity also should include at least five to 10 minutes of warm-up plus five to 10 minutes of cool-down. Although peak benefits are achieved when an aerobic activity is performed continuously for at least 30 minutes, aerobic exercise can be spread out in smaller segments of time throughout the day to suit your comfort level, without overexerting yourself. Aerobic exercise should be performed at a comfortable, steady pace that allows you to talk normally and easily during the activity. Ask your therapist what intensity of exercise is appropriate for your fitness level. During exercise, your heart's "training range," or target heart rate, should be closely monitored. To improve your body's aerobic condition, you should calculate your maximum heart rate -- 220 minus your age -- and exercise at a level of intensity between 60% and 80% of your maximum heart rate. Examples of aerobic activities include walking, swimming, low-impact aerobic dance, skiing, and biking, and may even include such daily activities as mowing the lawn, raking leaves, or playing golf. Walking is one of the easiest aerobic exercises to begin because it requires no special skills or equipment other than a good pair of supportive walking shoes, and it's less stressful on joints than running or jogging. Biking is another good choice for people with arthritis, because it places less stress on knee, foot, and ankle joints. Swimming is also often recommended because there is minimal pressure on joints while in water. Appropriate recreational exercise, including sports, can be helpful to most people with arthritis. These activities are best preceded by a program of range-of-motion and strength exercises to reduce the chance of injury. Regardless of your condition, discuss exercise options with a doctor before beginning any new exercise program. People with arthritis who are beginning a new exercise program should spend some time conditioning with a program that consists of only range-of-motion and strengthening exercises, depending on their physical condition and level of fitness. Endurance exercises should be added gradually, and only after you feel comfortable with your current fitness level. As with any change in lifestyle, your body will need time to adapt to your new program. During the first few weeks, you may notice changes in the way your muscles feel, your sleep patterns, or energy levels. These changes are to be expected with increased activity. However, improper exercise levels or programs may be harmful, making symptoms of arthritis worse. Check with your doctor and adjust your program if you experience any of the following: Unusual or persistent fatigue Sharp or increased pain Increased weakness Decreased range of motion Increased joint swelling Continuing pain Regardless of the exercise program you select, it's important to begin slowly and choose a program you enjoy so that you maintain it. Make exercise part of your daily routine so that it becomes a lifetime habit.