Osteoarthritis: How Might Exercise Protect Aging

How could exercise support aging cartilage?

The study, published September 29, found that aerobic exercise in older adults increased microRNA-29 in circulating extracellular vesicles. These small packages carry biological material between cells; microRNAs help regulate gene activity. The finding connects physical activity with a potential communication pathway affecting cartilage.

In laboratory experiments, exercise-associated vesicles improved cartilage cell characteristics through changes involving KL, the gene encoding the protein α-Klotho. Injecting these vesicles into aged mouse joints also improved cartilage health. [Nature Aging study](https://www.nature.com/articles/s43587-026-01225-9).

Does this mean exercise can reverse osteoarthritis?

The clinical question remains whether targeting this pathway produces lasting improvements that patients can feel. Future treatment trials would need to measure pain, walking ability, daily function and adverse effects, alongside joint structure. A change in a molecular marker alone cannot establish that a treatment improves someone's life.

Osteoarthritis also involves more than cartilage: the surrounding tissues and the rest of the joint contribute to symptoms and disability. WHO estimates that approximately 528 million people had osteoarthritis in 2019, including around 365 million with knee involvement. These historical estimates show the scale of the problem, while WHO emphasizes that osteoarthritis is not an inevitable consequence of aging. [WHO osteoarthritis fact sheet](https://www.who.int/news-room/fact-sheets/detail/osteoarthritis).

What exercise is recommended for people with osteoarthritis?

NICE recommends therapeutic exercise for everyone with osteoarthritis, adapted to their needs. This can include strengthening muscles around affected joints and improving aerobic fitness. The practical starting point is a manageable plan that accounts for symptoms, mobility and other health conditions. Supervised sessions can help people learn suitable movements and build confidence. [NICE exercise recommendations](https://www.nice.org.uk/guidance/NG226/chapter/recommendations).

Some discomfort can occur when exercise begins. NICE advises that regular participation can improve pain, function and quality of life over time. Persistent difficulty following a program is a reason to seek adjustments and support. For people living with overweight or obesity, weight management is another recommended component of care. The useful clinical message is to make exercise sustainable through individualized advice and follow-up. [NICE osteoarthritis management guidance](https://www.nice.org.uk/guidance/NG226/chapter/recommendations).