On a Tuesday morning, the waiting room of a busy rehab clinic on the edge of town is full of gray hair, creaking knees, and folded walking sticks. A smiling woman in a pool is on the TV in the corner, promising “gentle exercise for seniors.” A few patients nod as if they’ve already made up their minds: swimming is the answer. A man proudly looks through pictures of his Pilates reformer class, sure that he’s doing everything right.
Then the orthopedic doctor walks in and says something that makes everyone stop.
“Swimming and Pilates aren’t the answer to your joint problems,” she says softly. “For some of you, they’re part of the problem.”
The room gets very quiet.
Because the last thing they expect her to suggest is the real game-changer.
Why some doctors are telling older people not to swim or do Pilates
For years, doctors, magazines, and well-meaning grandchildren told older people with sore knees and hips to “go to the pool and try Pilates; it’s low impact.” It seemed safe. Clean. Graceful. You could almost wash away your pain in the bright lights of the public pool.
But a different story is happening in consulting rooms all over the country. Some seniors are limping in with more pain, even though they do laps or roll out their Pilates mat three times a week without fail. Their scans are true. The cartilage is thinner. Tendons are more angry. Muscles are still very weak.
Maria, 72, is a retired teacher who started swimming three mornings a week after her doctor told her that “water is gentle on the joints.” Every time she zipped up her floral swimsuit at 7 a.m., she felt good about herself. The lifeguards knew her by name.
Six months later, her knees still hurt on the stairs and her right shoulder hurt every time she reached the top shelf. Her orthopedic surgeon found that her shoulder tendons were inflamed from doing the front crawl too much and that her thighs were almost too weak to support her arthritic knees. “But I did exactly what they said,” she kept saying in disbelief.
A lot of people don’t hear the rest of the sentence: swimming and Pilates are not universal cures; they are *tools*. Water takes away stress, which is nice, but it also takes away the resistance that joints need to remodel and get stronger. With a trained eye, Pilates can be great for correcting posture, but in a crowded class with generic cues, many seniors end up straining areas that are already weak and leaving key stabilizing muscles undertrained.
The truth is that “low impact” doesn’t always mean “good for your joints” or “effective.” For some older bodies, it just means “not enough of the right stress and too much of the wrong movement.”
Doctors are quietly pushing for strength training, which is something that people don’t expect.
More geriatric specialists and sports doctors are pushing their older patients toward strength training with resistance, which they still think of as something bodybuilders do in sweaty gyms. Not crazy heavy deadlifts on the first day, but instead, targeted, progressive loading with bands, light weights, or even well-structured machines.
Imagine a 78-year-old woman holding a resistance band and slowly straightening her leg while a physical therapist counts, “Three… two… one…” Every time you do it, your bones, tendons, and cartilage get a clear message: you need to change. Most laps in warm water just don’t give that signal.
For a lot of older people, the first session feels like an insult. A chair. A light weight dumbbell. Ten times standing up and sitting down. That’s all? Some people roll their eyes. Some people laugh. Two weeks later, they see something strange. It seems easier to get out of the car. At home, the stairs are less of a hassle. That annoying pain in the knees at night gets a little better.
We’ve all been there: that moment when a small habit we almost ignored changes everything. An 80-year-old former swimmer told me, “Thirty years in the pool never did for my knees what three months with those silly red bands did.”
The mechanics are almost boring because they are so simple. Muscles work like shock absorbers. If they are thin and weak, the joints take the hit. Strength training makes muscle fibers thicker and tells bones to keep their density. Pressure and release help cartilage get better nutrition. Pilates and swimming can help, but if you don’t get enough progressive resistance, your body ages quickly.
Let’s be honest: no one does this every day. Consistency is better than perfection. A knee, hip, or spine can change more in two or three short, focused strength sessions each week than in endless low-resistance movement that never quite reaches the point of adaptation. **The unexpected prescription? On purpose, lift something, even if it’s just a little.
How to go from “gentle exercise” to strength training that protects your joints
A pencil and five minutes of quiet time are the first things you need, not a membership card. Write down the three things you do every day that hurt the most: getting up from the couch, climbing a curb, lifting a shopping bag, or turning in bed. Then, for each one, do a strength move that looks like it. The classic squat to a chair is now sit-to-stand. Climbing a step becomes step-ups on a low platform. When you lift a bag, it turns into a light deadlift with a kettlebell or even a grocery bag full of books.
This way of starting keeps things painfully real. You’re not training “muscles.” You’re getting ready for your next set of stairs, your next vacation, and your next afternoon with the grandkids.
The second key is to keep a steady pace. Many older people start going to the gym like it’s a New Year’s resolution, but then they disappear for three months when their back hurts. That up-and-down pattern is what really scares joints and tendons. It’s best to start with very small amounts: one set of 8 to 10 slow repetitions for each key move, with as much rest as you need.
Stubborn pride and silent pain are the two mistakes I hear about the most. “I didn’t want to use the light weights because they looked stupid.” “I didn’t tell the trainer that my shoulder was already hurting.” This is when it matters more than any fancy brochure to have an open and honest conversation with a physiotherapist, sports doctor, or experienced trainer who knows how to work with older bodies.
A sports doctor I talked to in Lyon said it this way:
“Swimming and Pilates are like dessert for a lot of old people.” Strength training is what their joints really need right now.
To make things easy, he gives every patient with joint pain the same basic list:
- Twice a week: strength training for the lower body (squats to a chair, step-ups, leg presses, and banded leg extensions).
- Twice a week: work on your upper body strength with rows, a light chest press, and gentle overhead work if your shoulders can handle it.
- 5 to 10 minutes of balance work every day, like standing on one leg next to a wall or walking down a hallway with someone else.
- As a “bonus,” you can swim or do Pilates, but they shouldn’t be the main part of your plan.
That’s the quiet revolution: putting resistance at the top of the hierarchy and having the “gentle” stuff support it instead of taking its place.
Changing how you think about what it means to “be kind” to your joints
It’s strange how we talk to older people about moving around. We tell them to be careful, gentle, and soft, as if their bodies were made of glass. We also hope they will continue to live on their own, carrying groceries, traveling, and bending down to tie their shoes in airport lines. The two messages don’t agree with each other. Joints that never have to deal with problems slowly forget how to deal with real life.
The doctors who are being criticized for “discouraging” swimming and Pilates aren’t trying to stop people from having fun at the pool or close down reformer studios. They’re asking a more specific question: is your favorite activity really helping you get stronger, or is it just making you feel like you’re doing something?
The truth may be uncomfortable for some older adults. That doesn’t mean you have to stop going to Pilates class or doing water aerobics with friends. It means planning strength training sessions with the same level of importance as a doctor’s appointment and letting everything else revolve around them. A 20-minute band workout in the living room can protect your knees more than a thousand fancy roll-ups done without thinking.
The surprising twist is that those “fun” activities become more free once the joints feel safer and stronger. These are the real numbers that matter: walking on vacation, dancing at weddings, and carrying a grandchild for a few more minutes.
Some people will feel defensive right now. Others were happy to finally learn why all those pool sessions didn’t help their pain. It’s easy to see why both reactions are valid. The next step is less about feeling bad and more about being curious: What would happen if you treated resistance as medicine and swimming or Pilates as a supplement for the next three months?
Your future self might quietly thank you for getting out of a chair without holding on to the armrests.
| Key point | Detail | Value for the reader |
|---|---|---|
| Swimming and Pilates have limits | They soothe joints and improve mobility but often lack enough resistance to rebuild strength | Helps explain why pain persists despite being “active” |
| Strength training protects joints | Targeted resistance builds muscle, supports cartilage and reduces daily pain triggers | Shows a clear path to walking, climbing stairs and living more freely |
| Small, consistent steps work | 2–3 short weekly sessions with simple moves already change outcomes | Makes change feel realistic, even with pain, fatigue or limited time |
