Exercise can be a double-edged sword if you’re an active older adult. You know that it can help manage or prevent musculo­skeletal disorders like osteoarthritis and osteoporosis, but you wonder sometimes whether the aches and pains you sometimes feel when exercising—as well as a risk of sustaining an injury or exacerbating your condition—are worth the effort.

A study in 2017 in Arthritis Care & Research, which included 350 people with knee osteoarthritis, revealed that nearly 80 percent of the participants feared movement and physical activity. Most were afraid of worsening joint pain or an injury. Yet exercise is so good for you that its ben­efits almost always outweigh its risks. Studies repeatedly show that exercise helps adults maintain physical function and mobility well into their golden years.

Strength-training and weight-bearing activities are particularly beneficial for people who have conditions such as arthri­tis or low bone density because they can improve muscle strength and flexibility, minimize bone loss, improve balance, and reduce fall risk. Aerobic exercise improves heart health and mood and helps keep off excess weight, which can put enormous pressure on joints like the knees and hips.

Osteoarthritis. Try not to let fatigue and joint and muscle pain discourage you from working out. Inactivity can worsen joint pain and decrease function. The dis­comfort or pain you feel during activity won’t damage your joints (unless the pain is sudden and sharp—then stop your activ­ity immediately), although some people with significant osteoarthritis may have too much pain to exercise the affected joint. Exercise keeps joints healthy by increasing the flow of nutrient-rich blood to them. If you stick with regular activity, you should find that it can help relieve joint pain and stiffness, build stronger muscles that reduce joint stress, improve flexibility, and decrease disease activity.

Low-impact strengthening exercises, such as those that use your body weight, light dumbbells, or resistance bands, help stabilize joints by strengthening surround­ing muscles, which helps reduce injury risk. If you have lower-extremity arthritis, try strength training that targets the thigh muscles (quadriceps and hamstrings).

Range-of-motion exercises, such as stretching, yoga, or tai chi, relieve stiffness and restore flexibility. Aerobic or endur­ance exercise, such as walking, cycling (at low pedal resistance), and water exercise, helps with joint movement.

Fibromyalgia. Characterized by ten­der points around the back, hips, knees, and shoulders, fibromyalgia is best man­aged with exercise that involves endur­ance and gentle stretching. Resistance training with proper supervision has been shown to help relieve some tenderness.

Lupus. Symptoms of this autoim­mune disorder include joint discomfort and inflammation, fatigue, shortness of breath, and pain, which make it difficult to exercise. But if you persist with a rou­tine, you may find that regular workouts reduce fatigue. Stretching at bedtime may help lessen joint stiffness in the morning.

Low bone density. If you have osteo­porosis or osteopenia (a potential precursor to osteoporosis), you might worry that activity will increase your fracture risk, which can be true if you participate in high-impact activities, have advanced bone loss, or have a history of fractures. Other­wise, with your doctor’s approval, focus on resistance and balance training, especially exercises that target the back and help cor­rect posture, and weight-bearing activity like walking or low-impact aerobics. Such activities appear to slow bone loss, improve muscle strength, and lower the risk of falls.

Most clinical guidelines call for moder­ate-intensity, low-impact training to man­age osteoporosis. However, an Australian study in the Journal of Bone and Mineral Research in October 2017 found that intensify­ing resistance training and adding higher-impact moves appeared to measurably improve strength and increase bone mass and height without causing fractures in postmenopausal women with low to very low bone density. The women’s twice-weekly high-intensity training program consisted of weighted resistance training and a high-impact exercise. Notably, the participants were closely supervised as they performed the exercises; such a program should never be undertaken without the assistance of a physical therapist or an ath­letic trainer.

Low back pain. Short-term (acute or subacute) low back pain can become chronic if you fear that movement will cause or increase your pain. You’re more likely to avoid activities and be more sed­entary, which only makes things worse by weakening muscles. And if you suffer from chronic nonspecific low back pain, your doctor may suggest core stability exercises to strengthen the muscles that support your spine. You may also need stretching exercises to improve your hip flexibility, which will help decrease the demands on your back. A 2017 Cochrane review found that yoga resulted in small to moderate improvements in back-related function and pain after three to six months compared with no exercise.

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