what exercise protocols are recommended for dogs with osteoarthritis to preserve function without worsening disease?

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Controlled, low-impact exercise is the recommended foundation for preserving function in dogs with osteoarthritis, with the specific modalities including controlled walking, isometric and balance exercises, range-of-motion and muscle-strengthening exercises, swimming, and underwater treadmill work.1 Daily walking is directly associated with a decrease in the severity of lameness in dogs with hip dysplasia, making it a supported first-line exercise intervention.2 Controlled exercise activates endogenous analgesic neuromodulatory systems including opioid, nitric oxide, serotonin, catecholamine, and endocannabinoid pathways, and improves cartilage structure and function, muscle and fascial mobility, and bone integrity.1 Inactivity worsens pain from soft tissue sources, making exercise restriction counterproductive in the absence of acute flare.1 Rehabilitation therapy should be incorporated as part of a comprehensive management plan and encompasses manual techniques (joint mobilization, passive range of motion, stretching, massage, myofascial release), treatment modalities (photobiomodulation/laser therapy, extracorporeal shock wave therapy, neuromuscular electrical stimulation, therapeutic ultrasound, thermal tissue modification), and therapeutic exercise including hydrotherapy.2 "Therapeutic exercise" specifically targets defined goals — restoring range of motion in arthritic joints, rebuilding muscle after surgery or prolonged immobility, or retraining proprioception after neurological injury.2 Collaboration between the owner and a trained rehabilitation specialist can produce effective at-home exercise alternatives without specialized equipment.2 Exercise is not contraindicated in the presence of joint pain — the key qualifier is that exercise must be controlled rather than unrestricted.1 The full multimodal osteoarthritis protocol also includes weight management, nutritional support, systemic analgesia (NSAIDs, COX-inhibiting and non-COX-inhibiting options, anti-N