I am 60 but retired early because of severe osteoarth­ritis in my knee and spine. The worse the pain has become, the less mobile I am and as a res­ult I am now very over­weight. I have been put on a strict diet but won­der if there are any exer­cises that would help?

Severe joint pain and weight gain work together in a debil­it­at­ing and depress­ing down­wards spiral. You need cour­age and determ­in­a­tion to break the cycle, but it is very import­ant to try, if you are going to main­tain your qual­ity of life and inde­pend­ence into your later years.

A strict and sens­ible diet is essen­tial, but so is a gradual increase in your daily levels of move­ment /​exer­cise. Do not expect instant res­ults – set your­self mod­er­ate monthly goals to achieve in both weight loss and move­ment gain. And be pre­pared for set­backs. It is com­mon for people with osteoarth­ritis to get increased pain when they start an exer­cise pro­gramme, and whenever the arth­ritis is par­tic­u­larly bad (in flare-​up) you should limit your exer­cise to stretch­ing and gentle loosening-​up work.

If you don’t already have it, the book­let “Exercise and Arthritis” by Arthritis Care is a really good prac­tical start­ing point. Alongside the exer­cises there, your next best buy is a water workout. Not aer­obics, but walk­ing in deep water. This will pro­tect your joints, have a sooth­ing effect and also give you a valu­able, cal­orie burn­ing total-​body fit­ness ses­sion.

These days many pools have “aqua belts”: bulky floats that wrap and belt up tightly around your body. Or you can buy one online. The belt keeps you upright in the water and will help sta­bil­ise your spine. You can then “walk” in the deep end (ie, 2m or more depth). If bend­ing your knee is pain­ful, try a “scis­sor” walk with straight legs and arms.

Start gently – per­haps just 10 minutes in the water, doing up to five widths in the deep end. It’s hard work. Stop when you get tired. Make a note of your times and num­ber of widths. Then aim to do at least that amount next time. Add a minute or an extra width each week as your stam­ina and fit­ness develop.

If the pool is not pos­sible, I sug­gest you try a “rebounder” at home. These small boun­cers (much less springy than a tram­po­line) are good for redu­cing impact on your vul­ner­able joints when you exer­cise. Try to buy one that comes with a sup­port frame, which you can use until you feel con­fid­ent and fit enough to do without. Use the rebounder to do steady “springy” walk­ing, not boun­cing or jump­ing.

If you are mobile enough to get to a gym, ask your GP to refer you to an “exer­cise refer­ral” scheme. This will give you a super­vised envir­on­ment with skilled instruct­ors who can draw up a per­son­al­ised gym pro­gramme to help speed your weight loss, build muscles to pro­tect your joints and reduce your pain.