Is exercise an effective therapy for hip osteoarthritis?

Key messages

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.
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.
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)

Exercise may have little to no effect on pain.
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.
No studies reported well-being or treatment success.
People who exercise may be no more likely to stop treatment.
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)

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.
Exercise probably has little to no effect on well-being.
People who exercise may be no more likely to report treatment success or to stop treatment.
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)

Exercise probably has little to no effect on pain, joint function, well-being, or whether people stop treatment.
Exercise may have little to no effect on whether people report treatment success.
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.