What’s best for arthritis: elliptical or treadmill?

Dear Dr. Roach: If I have the beginnings of arthritis of the knee, is an elliptical machine better to use than a treadmill? — M.D.

Dear M.D.: If you had an inflammatory arthritis like rheumatoid arthritis, there are powerful medicines that can dramatically slow or stop progression of the disease. So I’m going to assume you have osteoarthritis, which is by far the most common arthritis of the knee.

No treatment is known to stop the progression of osteoarthritis. But exercise is one of the most effective treatments to reduce pain and especially to increase function. This is counterintuitive to many people — even many doctors are loath to prescribe exercise because for years osteoarthritis was considered a “wear and tear” injury of the joint. Research shows this not to be the case. Although joint injury can lead to development of osteoarthritis, regular exercise does not. Many studies have shown that a graded exercise program (starting slow and easy, and gradually building up) can lead to better function and endurance.

Unfortunately, many people with severe osteoarthritis have such pain that exercise seems impossible. People write to me that they just can’t do any exercise, and indeed, it can get to the point where any movement is so painful that joint replacement becomes the only viable option. But for people with early arthritis, like you, and even moderate arthritis, exercise is a powerful tool.

Elliptical machines put less impact pressure on the joint and will be better tolerated by people with more-advanced arthritis. Pools provide the most support for your joints. However, you can do whatever exercise feels best to you.