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A Balancing Act: Exercise, Inflammation and Metabolism

Getting the amount and type of exercise right is one of the most challenging aspects of treating arthrofibrosis. Exercise has positive effects on mood, sleep and feelings of empowerment, and is a cornerstone of healthy living programs. Yet it has long been known that aggressive exercise causes inflammation, cell and tissue damage and oxidative stress that can last from hours to days following an exercise bout in healthy people [1], and we don’t know what qualifies as “aggressive” in the context of active arthrofibrosis. Active arthrofibrosis is where inflammation and pain are present [2]. We do know that inflammation is the enemy of fibrotic joints, promoting more fibrosis and damage, and anecdotally there are many accounts of arthrofibrosis beginning, or re-starting, after overly aggressive physiotherapy [2] or even too much walking while on holiday.

Getting the amount and type of exercise right is one of the most challenging aspects of treating arthrofibrosis.

This might seem contradictory – while aggressive exercise is pro-inflammatory in the short term, mild to moderate exercise can reduce chronic low grade inflammation. Muscles are hungry for energy during exercise, and use up most of the glucose in the blood. This means there is less energy available in the blood for other high-energy processes including the activation of immune cells [3], production of inflammatory cytokines and cell proliferation (cancer and fibrosis). In addition, exercise stimulates senescent (aging) immune cells to be removed from the body, and these are replaced by healthy young cells that are better regulated [3]. Research indicates that long-term (more than 12-16 weeks) exercise training can lead to small reductions in systemic low-grade inflammation [4].

A Balancing Act: Exercise, Inflammation and Metabolism

So, how much is too much? Exercising the affected limb is probably best left until pain and inflammation have resolved, since important structures such as fat pads can become irreversibly damaged and fibrotic from the inflammatory stimulus of exercise. However, given the wide-ranging health benefits of exercise, moderate exercise of non-fibrotic parts of the body is likely to be beneficial.

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  1. Castell, L. M., Nieman, D. C., Bermon, S. & Peeling, P. Exercise-Induced Illness and Inflammation: Can Immunonutrition and Iron Help? Int J Sport Nutr Exerc Metab 29, 181-188, doi:10.1123/ijsnem.2018-0288 (2019).

  2. Usher, K. M. et al. Pathological mechanisms and therapeutic outlooks for arthrofibrosis. Bone Research 7, doi:10.1038/s41413-019-0047-x (2019).

  3. Padilha, C. S., Von Ah Morano, A. E., Kruger, K., Rosa-Neto, J. C. & Lira, F. S. The growing field of immunometabolism and exercise: Key findings in the last 5 years. J Cell Physiol 237, 4001-4020, doi:10.1002/jcp.30866 (2022).

  4. Hojman, P. Exercise protects from cancer through regulation of immune function and inflammation. Biochem Soc Trans 45, 905-911, doi:10.1042/BST20160466 (2017).

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