Dear Cindy:

What kind of exercise is best for an old woman with old knees? X-rays show bone to bone and it is painful to exercise. I need to because I am having difficulty getting up out of chairs, and standing for a long time makes my knees ache really bad. I know water exercise is good, but memberships are expensive and being on a fixed income makes that impossible. Can you recommend any other activity? -- Ginny

Dear Ginny: Your description of "bone to bone" is enough to make anyone cringe at the thought. I have little doubt that you are experiencing discomfort during movement from even simple tasks such as rising from a chair. Assuming you are equally affected in both knees, this would point toward a form of arthritis known as osteoarthritis or OA. If so, below are a few of the common symptoms of OA I'm sure you're familiar with:

Osteoarthritis affects joints after a break down in the cartilage, which is supposed to cushion or pad the joint. It becomes pitted and rough. Most commonly, the joints affected by OA are the fingers, hips, knees and spine. It targets women and, while it does not discriminate between "young knees and old knees," it is found more often in those over the age of 45. As the cartilage wears away, the bone continually forms new bone to try to repair itself, which distorts the intended shape of the bone and interferes with smooth movement in your knees.

Obesity is the strongest precursor for OA in the knee. The more weight the knee must bear the more everyday wear and tear it must undergo. It was once believed that those with arthritis should refrain from exercise. Yet, we now know that inactivity is far more detrimental and only worsens this condition. Moderate exercise keeps your cardiovascular system fit, encourages flexibility, helps maintain a healthy body weight, decreases pain and gives you a feeling of well being.

The key to exercising with OA is finding the right type and doing the right amount. Low impact activity at a moderate pace is the key. Movement performed after a thorough warm up followed by gentle range-of-motion stretches will keep the muscles and tendons that power the knee joint strong and flexible.

However, I do want to recommend water exercise swimming because it truly is the best choice for severe OA. The buoyancy of the water supports the body and reduces the stress to joints. Many local pools have water exercise and arthritis classes that may be within your budget. And keep in mind that YMCAs turn no one away for inability to pay and offer community assistance scholarships.

The Arthritis Foundation has designed a variety of exercise classes such as Tai Chi that are wonderful for people with arthritis. There are different levels of classes so that you can participate in one that meets your needs and doesn't exceed your abilities. Pilates and yoga are also good choices and can be found on videos, which would allow you do perform this type of movement in your home. In terms of equipment at home, resistance bands are particularly therapeutic and can help maintain joint stability and aid in stretching.

What you do now with regard to reasonable exercise will predict the way arthritis affects you in the future on a day to day basis. Light to moderate activity will go a long way toward living functionally and comfortably with OA.

Cindy Boggs, fitness presenter, author and Activate America director, has been an ACE-certified instructor/trainer since 1989. Send your questions about fitness, training or health to her at YMCA of Kanawha Valley, 100 YMCA Drive, Charleston, WV 25311, or e-mail cindys...@aol.com. Look for Cindy's award-winning fitness advice book, "CindySays . . . You Can Find Health in Your Hectic World," at www.cindysays.com, or contact the YMCA at 304-340-3527.