Key messages
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In people with hip osteoarthritis (a condition where the cartilage cushioning the hip joint wears down, causing pain and stiffness), exercise compared with dummy treatment may have little to no effect on pain, but may improve joint function slightly. Compared with no treatment, usual care, or limited education, exercise probably leads to small improvements in pain and joint function, although these may not be noticeable in daily life. Adding exercise to another treatment probably has little to no effect on pain and joint function.
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We are unsure if exercise leads to more unwanted events than dummy treatment or no treatment/usual care in people with hip osteoarthritis. When added to another treatment, exercise probably reduces the risk of unwanted events slightly.
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We need more and better-designed studies that focus specifically on people with hip osteoarthritis to draw more solid conclusions about the effects of exercise.
What is hip osteoarthritis?
Hip osteoarthritis occurs when the cartilage cushioning the hip joint wears down. It is a common, long-lasting condition. People with hip osteoarthritis often experience joint pain and stiffness. They may have difficulty performing everyday activities such as climbing stairs and getting up from a chair.
How might exercise help?
Exercise aims to improve muscle strength, joint movement, and self-belief in the capacity to perform certain activities. These effects should reduce pain and disability, helping people to better manage their symptoms. Exercise programmes vary considerably, with a wide range of different exercise types, intensities, and delivery methods.
What did we want to find out?
We wanted to know whether exercise reduces pain and improves joint function and well-being for people with hip osteoarthritis. We also wanted to know if people in the studies who exercised were more likely to report treatment success and less likely to drop out of the study or have unwanted events.
What did we do?
We searched for studies that assessed the effects of exercise in adults with hip osteoarthritis. Exercise programmes had to be land-based, planned, structured, and repetitive. We compared and summarised the results of the studies and rated our confidence in the evidence, based on factors such as study methods and how consistent the results were across the studies.
What did we find?
We found 18 studies with 1368 adults. Participants were mostly women (63%) and aged between 53 years and 74 years. Studies took place in Australia, Canada, Denmark, Finland, Germany, Ireland, Italy, the Netherlands, New Zealand, Norway, Sweden, and the USA. Exercise programmes lasted between two and 52 weeks. Most studies measured results immediately after the exercise programme; some studies also reported longer-term results.
Exercise compared with dummy treatment (2 studies, 123 adults)
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Exercise may have little to no effect on pain.
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Exercise may improve joint function slightly. On a scale of 0 to 100, where a 13-point difference is a meaningful change, people who exercised scored 7.4 points better than those on dummy treatment.
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No studies reported well-being or treatment success.
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People who exercise may be no more likely to stop treatment.
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We are unsure if there are more unwanted events with exercise.
Exercise compared with no treatment, usual care, or limited education (10 studies, 494 adults)
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Exercise probably improves pain and joint function, but only slightly. On a scale of 0 to 100, people who exercised scored 7.2 points better for pain (where a 12-point difference is a meaningful change) and 8.8 points better for joint function (where a 13-point difference is a meaningful change), compared with people receiving no treatment, usual care, or education.
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Exercise probably has little to no effect on well-being.
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People who exercise may be no more likely to report treatment success or to stop treatment.
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We are unsure if there are more unwanted events with exercise.
Exercise plus another treatment compared with the other treatment alone (7 studies, 751 adults)
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Exercise probably has little to no effect on pain, joint function, well-being, or whether people stop treatment.
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Exercise may have little to no effect on whether people report treatment success.
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People who exercise probably have slightly fewer unwanted events.
What are the limitations of the evidence?
Because the studies included people with different levels of hip pain and disability, the results are likely to apply to most adults with hip osteoarthritis. However, there were very few younger adults in the studies, so the findings may not apply as well to younger people.
In most studies, people knew whether they were receiving exercise, and pain and physical function were self-reported. This may make exercise appear more effective than it really is.
We are moderately confident in some of the results and less confident in others. This is because many studies were small, and the results varied across the studies. Further research may change the results.
How up to date is this evidence?
This review updates our previous review published in 2014. The evidence is up to date to February 2025.
Read the full abstract
Current international treatment guidelines recommending therapeutic exercise for people with symptomatic hip osteoarthritis (OA) report are based on limited evidence.
Objectives
To determine the effects of land-based exercise on pain, physical function, quality of life, participant-reported treatment success, study withdrawals, and adverse events in people with hip osteoarthritis.
Search strategy
We searched CENTRAL, MEDLINE, Embase, and two trial registries from February 2013 (search date for last update) to 5 February 2025. We also checked reference lists for additional studies.
Selection criteria
All randomised controlled trials (RCTs) recruiting people with hip OA and comparing some form of land-based therapeutic exercise (as opposed to exercises conducted in water) with a non-exercise group.
Data collection and analysis
Four review authors independently selected studies for inclusion. We resolved disagreements through consensus. Two review authors independently extracted data, assessed risk of bias and the quality of the body of evidence for each outcome using the GRADE approach. We conducted analyses on continuous outcomes (pain, physical function and quality of life) and dichotomous outcomes (proportion of study withdrawals).
Main results
We considered that seven of the 10 included RCTs had a low risk of bias. However, the results may be vulnerable to performance and detection bias as none of the RCTs were able to blind participants to treatment allocation and, while most RCTs reported blinded outcome assessment, pain, physical function and quality of life were participant self reported. One of the 10 RCTs was only reported as a conference abstract and did not provide sufficient data for the evaluation of bias risk.
High-quality evidence from nine trials (549 participants) indicated that exercise reduced pain (standardised mean difference (SMD) -0.38, 95% confidence interval (CI) -0.55 to -0.20) and improved physical function (SMD -0.38, 95% CI -0.54 to -0.05) immediately after treatment. Pain and physical function were estimated to be 29 points on a 0- to 100-point scale (0 was no pain or loss of physical function) in the control group; exercise reduced pain by an equivalent of 8 points (95% CI 4 to 11 points; number needed to treat for an additional beneficial outcome (NNTB) 6) and improved physical function by an equivalent of 7 points (95% CI 1 to 12 points; NNTB 6). Only three small studies (183 participants) evaluated quality of life, with overall low quality evidence, with no benefit of exercise demonstrated (SMD -0.07, 95% CI -0.23 to 0.36). Quality of life was estimated to be 50 points on a norm-based mean (standard deviation (SD)) score of 50 (10) in the general population in the control group; exercise improved quality of life by 0 points. Moderate-quality evidence from seven trials (715 participants) indicated an increased likelihood of withdrawal from the exercise allocation (event rate 6%) compared with the control group (event rate 3%), but this difference was not significant (risk difference 1%; 95% CI -1% to 4%). Of the five studies reporting adverse events, each study reported only one or two events and all were related to increased pain attributed to the exercise programme.
The reduction in pain was sustained at least three to six months after ceasing monitored treatment (five RCTs, 391 participants): pain (SMD -0.38, 95% CI -0.58 to -0.18). Pain was estimated to be 29 points on a 0- to 100-point scale (0 was no pain) in the control group, the improvement in pain translated to a sustained reduction in pain intensity of 8 points (95% CI 4 to 12 points) compared with the control group (0 to 100 scale). The improvement in physical function was also sustained (five RCTs, 367 participants): physical function (SMD -0.37, 95% CI -0.57 to -0.16). Physical function was estimated to be 24 points on a 0- to 100-point scale (0 was no loss of physical function) in the control group, the improvement translated to a mean of 7 points (95% CI 4 to 13) compared with the control group.
Only five of the 10 RCTs exclusively recruited people with symptomatic hip OA (419 participants). There was no significant difference in pain or physical function outcomes compared with five studies recruiting participants with hip or knee OA (130 participants).
Authors' conclusions
Compared with attention control or placebo, exercise may have little to no effect on pain and may improve physical function slightly. There was no evidence for quality of life or participant-reported treatment success. Exercise may have little to no effect on withdrawals. Evidence regarding adverse events is very uncertain.
Compared with no treatment, usual care or limited education, exercise probably improves pain and physical function slightly, although these effects are unlikely to be clinically meaningful. Exercise probably has little to no effect on quality of life and may have little to no effect on participant-reported treatment success or withdrawals. Evidence regarding adverse events is very uncertain.
Exercise plus a co-intervention (A), compared to the co-intervention (A) alone, probably has little to no effect on pain, physical function, quality of life, and study withdrawals, and may have little to no effect on participant-reported treatment success. Exercise probably reduces the risk of adverse events slightly.
Funding
No funding.
Registration
The original protocol was for a review on exercise for osteoarthritis of the hip or knee (https://doi.org/10.1002/14651858.CD004376). The review on hip osteoarthritis alone was first published in 2009 (https://doi.org/10.1002/14651858.CD007912), and last updated in 2014 (https://doi.org/10.1002/14651858.CD007912.pub2).
