Gout and Physical Exercise: Guidelines for Success

Gout is a painful inflammatory condition that is associated with overindulgence of foods like red meat, shellfish, and alcohol. In medieval times, gout was associated with nubility because of the cost of such a diet. This gave it the nickname “the disease of kings (1).”

Today, gout is an issue that affects many people in developed countries. Recent studies point to an increase in the incidence of gout worldwide (2).

In present times, the diet of kings is now readily available to most people in developed countries. In addition, modern conveniences have meant most humans are much less physically active.

Both of these factors contribute to the obesity epidemic which is associated with an increased incidence of gout. According to, there is a correlation between gout and issues such as heart disease, kidney disease, and atrial fibrillation (1).

Exercise is commonly recommended for gout (in addition to dietary modifications). However, knowing what gout is, when to exercise and what types of exercise to perform are important factors.

This article outlined what you need to know about gout, and offers guidelines for exercising with the condition.

Gout is a type of arthritis caused by excessive levels of uric acid in the body.

Uric acid is a normally occurring substance in the body that is excreted by the kidneys in urine. But if there is too much of it, uric acid crystals can collect in the joints, causing intense pain, redness, and swelling in the joints, tendons, and surrounding tissues (usually in the lower extremities) (2).

If untreated, gout can cause irreversible joint damage, chronic pain issues, as well as joint deformity. In addition, people are less inclined to move when in pain, and this leads to increased issues with lack of mobility, muscles weakness, and stiffness of the joints (2).

Gout is associated with obesity and weight gain, especially when levels of visceral fat are high (3). This risk increases with age. In addition, gout increases risk with eating purine-rich foods such as meat and seafood (4, 5).

Heavy alcohol intake, as well as consuming high levels of sugary drinks, increase the risk of a gout flare up (4).

Since gout is associated with obesity and weight gain, then weight loss is one good way to manage and control gout. Some methods are better than others, however. For instance, a keto diet is not recommended for those with gout, as ketosis can elevate uric acid levels in the body (4).

Recent research suggests physical activity of low to moderate intensity can have a positive effect on serum acid levels, whereas strenuous activity may exacerbate them (4). Therefore, moderate exercise and dietary modifications can help to manage uric acid levels and prevent flare ups from gout (6, 7).

Summary

Gout is a painful inflammatory issue caused by high levels of uric acid in the body. This excess acid forms crystals that are deposited in the joints, tendons, and surrounding tissues. It is associated with obesity and weight gain.

It’s best not to exercise during a gout attack, but rather in between flare ups. During a gout flare, you should rest, apply ice topically, and elevate the legs if the gout pain is in one of the joints in your lower body.

Typically during an acute episode of gout, the inflammatory process is at its worst. Increased movement at painful joints tends to exacerbate the inflammatory process. In addition, during a flare up, weight-bearing activities such as standing and walking can be painful.

Therefore, immediate treatment for gout flare ups requires managing the inflammation and lowering uric acid levels. Your doctor may prescribe anti-inflammatory medications (NSAID’s) and uric acid-reducing drugs such as Allopurinol to take after the gout attack has resolved (8).

Limiting strenuous exercise at the painful joints can be helpful in reducing inflammation. However, non weight-bearing, low-intensity exercise that doesn’t increase pain may be possible, and may help reduce inflammation (9).

In general, people with gout who maintain a regular routine of low- to moderate-intensity exercise have a better prognosis than those who are sedentary or those who exercise at high intensities (9). This is true before, during, and after a flare up.

Summary

Work with your doctor to manage a gout flare up, and listen to your body. During a gout attack, rest and do not exercise. In between gout flare ups, low to moderate intensity exercise may help reduce your inflammation levels.

Exercise has a protective effect when it comes to living with gout. Not only does it decrease uric acid levels in the blood, but some research has found that consistent exercise can extend lifespan by 4–6 years in people who have elevated uric acid levels (10).

Since weight gain and obesity increase uric acid levels, then reversing these issues will also decrease the risk of an acute gout flare up (4). What’s more, exercise has been shown to reduce inflammation (11).

Exercise also decreases insulin resistance, which also increases the risk of a gout flare up. This in conjunction with a low-calorie eating plan have been shown to be the most effective non-drug related interventions to decrease gout symptoms (4).

The other area where exercise can be helpful for people who suffer from gout is in restoring strength and flexibility after an acute flare up.

Pain decreases your activity level, and when the body is not moving much, your joints can stiffen and become less flexible. A recent clinical review showed exercise modalities can be beneficial for restoring your ability after the immobility of a gout flare up (12).

Additionally, another study found that people with gout who exercised regularly were less likely to develop tophi, or the bulbous-looking joints that result from uric acid crystal buildup (13).

Summary

Exercise may have a protective effect for those living with gout. It can help reduce uric acid levels, reduce inflammation, maintain weight and mobility, improve insulin resistance, and even extend lifespan.

The main thing to remember about getting back into exercise after an acute gout flare up is to take your time resuming normal activities. If you were running before the flare up, you may want to start with low to mid intensity exercises such as walking or cycling.

It is a good idea to limit exercises that place a lot of impact on the joint such as skipping rope and plyometric jumps — especially immediately after the acute flare up.

It is better to avoid high intensity exercises as this can increase uric acid levels in the body that can cause another flare up of gout. High intensity exercise includes activities that put a person at 76–96% of their maximum heart rate, such as sprinting workouts, high intensity interval training (HIIT), and higher intensity cycling (2, 414).

Summary

After a flare up of gout, start at a lower intensity of exercise. Choose exercises that don’t place a lot of impact on the painful joint. Gradually increase intensity while avoiding high intensity exercise.

Exercises that work the body’s cardiovascular system are best for managing uric acid levels and help to manage body weight (4). Examples of these types of exercises include walking, cycling, and swimming.

In addition if someone has had multiple flare ups from gout, they may experience permanent arthritic changes in the joint. This can limit a joint’s range of motion.

Therefore, joints may benefit from lower impact exercises such as swimming and water aerobics that involve buoyancy to reduce stress on the joint.

In addition, general flexibility exercises can be helpful as well. Exercises such as yoga can be beneficial for maintaining mobility. In fact, one research study showed that yoga can help improve pain levels with gout (12).

Strength training has been shown to be helpful in managing other conditions such as osteoarthritis and rheumatoid arthritis, but little research has been done regarding strength training and gout (15).

Increasing, lower extremity strength often decreases in those managing gout. Therefore, strength training especially for the lower extremities can be helpful to add to your exercise plan (16).

Summary

Cardiovascular exercises are best for managing uric acid levels. But you may need to choose lower impact exercises such as water aerobics or swimming to manage joint pain. Flexibility exercises such as yoga can help restore motion. Maintaining strength, especially in the lower extremities, is also important.

  • Start slowly with an exercise program, but be consistent. The current exercise guidelines are to perform at least 150 minutes of moderate intensity exercise per week. This is a good place to start for maintaining weight and cardiovascular health (17).
  • Avoid high intensity exercise, especially during and immediately after a gout flare up. This can increase uric acid levels.
  • Remember to stay hydrated. Dehydration has been associated with increases in uric acid levels. This means drinking water and avoiding sugary drinks high in fructose, which is also linked to higher uric acid levels (418)
  • If you are having difficulty with controlling gout or issues with exercising, consult your physician for guidance. He may recommend physical therapy if needed.
  • When focusing on weight loss, it is best to use exercise in conjunction with diet to gradually lose weight. Abrupt weight loss can be associated with increased uric acid levels (4).

Summary

Start slowly with exercise but be consistent. Avoid high intensity exercise. Stay hydrated and lose weight gradually. Consult your physician if you’re having difficulty controlling gout.

Moderate intensity exercise is important for the management of gout. It can help to manage body weight and uric acid levels. It’s important to ease back into exercise after a flare up. Choose exercises that don’t increase pain but allow you to move your body.

It’s possible to improve your symptoms with gout, increase your lifespan, and decrease your risk of flare ups, all by exercising a little bit every day.

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