Guidelines recommend that postmenopausal women with hormone-receptor positive breast cancer receive an aromatase inhibitor (AI) as part of their breast cancer treatment. However, side effects often result in poor AI adherence, with up to 50% of patients not taking AIs as prescribed, and discontinuation rates of 20% within the first year of use. Both non-adherence and early discontinuation of AIs have been shown to be independent predictors of mortality. Arthralgia, defined as pain or stiffness in the joints, is the most common reason for poor AI adherence and drug discontinuation, and is reported in up to 50% of breast cancer patients within six months of initiating AI therapy. There are few data regarding effective treatment of AI-induced arthralgias. Exercise may improve AI-induced arthralgias as it has been shown to be beneficial for osteoarthritis. Exercise may also have beneficial effects on disease-free survival and quality of life, which is also adversely affected by AI therapy. We conducted, in 121 breast cancer survivors taking AIs and reporting arthralgias, a yearlong randomized trial of exercise vs. usual care on arthralgia severity, entitled the Hormones and Physical Exercise (HOPE) Study. Results from the HOPE Study and other exercise and arthralgia studies will be discussed, as well as future research and clinical and community-based exercise opportunities in the management of arthralgia.