The Persistent Myth: With chronic pain, one should rest to avoid “worsening” the condition. The data tells a different story. Targeted movement acts like an individually dosed analgesic – without side effects, with additional benefits for energy, sleep, and mood. Particularly noteworthy: In osteoarthritis, a U-shaped relationship emerged between the dosage of movement and pain – too little yields little, while too much can dissipate; the optimum was around 620 MET-minutes per week, which corresponds to approximately 120 minutes of moderate water aerobics ^[1].

Chronic pain is more than just a signal from joints or muscles. It arises from a hypersensitive “pain matrix” in the nervous system, fueled by inflammation, stress, and fear of movement. Movement therapies address these levels simultaneously: they improve pain modulationthe ability of the nervous system to dampen pain signals, lower systemic stress responses, and reduce muscular protective tension. Aerobic activities promote blood circulation and release endogenous endorphins. Strength training stabilizes joints, relieves passively overused structures, and improves proprioceptionthe perception of joint position and movement. Yoga integrates breathing and posture, which lowers the HPA-axis toneactivity level of the hypothalamic-pituitary-adrenal axis and stimulates the vagus nerve – both have pain-relieving effects. Water aerobics takes advantage of buoyancy, reduces joint load, and enables less painful movement execution. The insight: For high performers, the smart dosage is crucial – a precise training stimulus triggers adaptation, not exhaustion.

Moderate endurance training measurably reduces pain in fibromyalgia and improves daily function – especially when starting with low intensity and increasing gradually over 6–12 weeks ^[2]. In knee or hip osteoarthritis, movement – regardless of the exact method – significantly reduces pain; aerobic sessions, yoga, as well as strength and flexibility training rank among the likely most effective options ^[1]. Strength training, even in brief, structured forms, diminishes osteoarthritis pain, improves function, and can reduce stiffness or significantly increase muscle strength depending on the intensity – both relieve joints in daily life ^[3]. For fibromyalgia, targeted muscle training is shown to be safe, enhances strength, and reduces pain when starting with low weights ^[4]. Water-based programs reduce osteoarthritis pain more effectively than land training and improve quality of life as well as joint function – with buoyancy being a therapeutic ace ^[5].

A recent meta-analysis on fibromyalgia consolidates the evidence: 17 randomized studies demonstrate that aerobic movement – ranging from walking to swimming – significantly reduces pain. The dosage following the FITT-VP principle with a gentle start and progressive increase over weeks is crucial to ensure adherence and effect ^[2]. For knee and hip osteoarthritis, a large network and dose-response analysis from 92 RCTs shows that various forms of movement are similarly effective, with a probabilistic ranking favoring aerobics, a combination of strength and flexibility, as well as yoga. Particularly relevant in practice: the U-shaped dose-response with an optimal range around 620 MET-minutes per week and a minimum threshold of 180 MET-minutes for clinically detectable effects ^[1]. Additionally, an intervention study demonstrates that 12 sessions of strength training within four weeks improve pain and function in knee osteoarthritis; low weights reduced stiffness, while high weights increased strength – both clinically valuable, depending on the target profile ^[3]. For individuals with fibromyalgia, a systematic overview confirms that carefully structured progressive muscle training is safe and reduces pain – an important signal against fear of movement ^[4].

- Start with moderate endurance training: 2–3 sessions per week of 25–40 minutes, brisk walking, cycling, or swimming. Begin low, increasing intensity and duration over 6–12 weeks. Target area: at least 100 minutes/week, aiming long-term for around 620 MET-min/week ^{[2] [1]}.
- Integrate yoga 2–3 times/week: 20–45 minutes of gentle flows plus breathing exercises (e.g., prolonged exhalation). Focus on stress reduction and vagus activation for pain relief ^[6].
- Perform strength training twice a week: full body with light weights or bodyweight. For osteoarthritis: either lower weights to reduce stiffness or higher weights for strength gain – both reduce pain, depending on tolerability ^{[3] [4]}.
- Utilize water aerobics 1–2 times/week: joint-friendly intervals in the pool (e.g., 10×2 minutes moderate, 1 minute easy). Particularly useful for osteoarthritis; it can be superior to land training in terms of pain ^[5].
- Plan the week: combine endurance (short daily segments), yoga on recovery days, and strength on separate days. Maintain a “breakable” intensity where you can speak – a sign of good dosage control ^{[2] [1]}.

The evidence is strengthening: correctly dosed exercise is an effective, low-side-effect pain therapy with a performance bonus. Future studies will provide more precise dose recipes based on profiles (e.g., biomarkers of stress reactivity, muscle status) and test personalized mixed protocols of aerobics, strength, and yoga in digital programs. Particularly exciting: adaptive algorithms that adjust the U-shaped dose-response in real-time based on pain and recovery data ^[1].