Motion as Medicine: Rethinking Exercise When Your Joints Hurt

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Living with a chronic condition often means living in two realities at once. There’s the version of yourself from before the diagnosis — the person who didn’t have to think about inflammation, morning stiffness or flare-ups — and then there’s the version of yourself navigating them now.

For many people newly diagnosed with rheumatoid arthritis (RA), that gap between “who I was” and “who I am now” can feel disorienting. And when you’re in pain, it’s natural for the first question to be: Why me?

In my recent conversation with Saloni Mitchell, M.D., a rheumatologist at Mount Sinai West/Morningside, she shared that this early phase is often the most challenging part of a patient’s journey. The first few weeks after diagnosis tend to be the steepest hill, both emotionally and physically, because you’re still grieving the previous version of your body while trying to understand the new one.

But Mitchell also emphasized something important: With the right plan, the right people and the right mindset, improvement is closer than you think.

And that’s where movement comes in.

Moving From “Why Me?” to “What Can I Do Next?”

People dealing with RA are managing not only symptoms but also identity shifts, expectations and the unknown. Before we talk about exercise, we need to talk about mindset. When working through the “why me” moment, start here: Acknowledge it.

A “why me” reaction is human and part of the grieving process. But it can’t be the place you stay. At some point, the loop needs to close so you can make space for the next question: What can I do next?

That shift gives you clarity on the person you are now, the person who lives with RA instead of the person who didn’t. And when you see yourself as this new version, your options change, along with your standards. You’re not less capable, you’re differently capable.

RA forces a new level of honesty about your health, habits and support system. And with that honesty comes a new opportunity to take ownership.

Why Movement Matters When Your Body Says Stop

One of the most counterintuitive things Mitchell shared is that the less you move, the more your joints hurt.

Inactivity worsens stiffness and amplifies pain signals. Our instinct during a flare-up is often to shut down and rest. But in RA, rest alone can create more discomfort in the long run. Movement, especially low-impact movement, helps the following:

• Reduce inflammation
• Maintain flexibility
• Improve circulation
• Support long-term joint function
• Build confidence in your body’s capabilities

It's important to understand the nuance: Not all movement is right for every person. Your current fitness level, history, pain threshold and environment all matter.

Before you choose a movement routine, start with being honest about where you are today. If you’ve been sedentary for years, find one accessible, reliable form of movement that your body can succeed with. If you’re already active, your goal might be adapting what you love.

Your “Break-Glass-in-Case-of-Flare-Up” Plan

One of the most practical things you can do is build a shortlist of low-impact options you can rely on when your mind is in a “why me” state. When you’re frustrated or in pain, you won’t choose the activity that requires extra mental effort. You need an automatic choice with a proven history of working for you.

Here are a few modalities that tend to help people with RA:

• Swimming: buoyancy reduces joint load while promoting full-body movement
• Cycling: smooth, circular motion builds strength without pounding the joints
• Walking: accessible, low-impact and easy to scale
• Yoga or tai chi: blends mobility, breathwork and gentle strengthening
• Light resistance or physical therapy movements: guided stability work promotes long-term joint health

Experiment on the days you feel good. Discover what your body gravitates toward. That “go-to” movement becomes your safety net when flare-ups hit.

Why Your Support System Matters More Than Ever

One theme that keeps showing up across health conditions, especially in RA, is the role of social support.

Surrounding yourself with people who understand the condition, or who approach it with optimism and resilience, makes a tangible difference. The mindset of your environment becomes the mindset you adopt.

You can find groups online that spiral into negativity. But you can also find communities (and individual role models, think Brielle from Episode 1) who approach chronic conditions as something to work with, not something to surrender to.

Those are the people who help you stay grounded, encouraged and proactive.

Mitchell also emphasized the value of building a care team early, such as a rheumatologist and physical or occupational therapist, in addition to your primary care physician. You are your best health advocate, so ask questions, communicate your needs, and stay informed along the way.

Seeing Your Health as an Arc, Not a Moment

One of the hardest truths about RA is that it’s lifelong. You will have great days and you will have flare-ups. You’ll have moments where you regain footing and moments where you lose it again.

Accompanying this long arc is purpose. RA can be a forced constraint, causing someone to prioritize their health in a way they never would have otherwise. It could be the reason you started seeing a primary care doctor consistently, or adopting an exercise routine.

RA might shift your relationship with time, because when you don’t know whether tomorrow will be a flare day, you stop postponing the things that make you feel good. If you wake up feeling strong, you move. You go for the walk, the swim, the bike ride, not because you should, but because you can. That appreciation for the present moment becomes one of the unexpected gifts of the diagnosis.

Your Contingency Model for “What Can I Do Next?”

When you’re faced with a setback, here’s the framework I come back to:

1. Recognize the “why me” moment.
   Don’t fight it. Name it. Then close the loop.
2. Identify the new you.
   Your goals, expectations and options have changed — not disappeared.
3. Build your movement baseline.
   Choose one low-impact option that supports your body on both good days and bad days.
4. Move even when you don’t want to.
   Gentle, consistent motion is medicine.
5. Lean on your people.
   Seek out communities that reinforce resilience instead of resignation.
6. Zoom out.
   Remember: RA management is a long arc.

This is how you take ownership. This is how you shift from blame to abundance. And this is how you turn movement into purpose.