Exercise eases hip OA pain, but perhaps not noticeably

Clinical takeaway: Exercise remains first-line for hip osteoarthritis, but counseling can be candid that average gains in pain and function are modest and quality of life may not improve.

Exercise appears at the top of every major guideline for hip osteoarthritis, and clinicians prescribe it with confidence. But a recent review of 18 randomized trials suggests that recommendation should come with a caveat. The average patient probably gets a real but small benefit in pain and function, and the improvement may often be too small to register in daily life.

Hip osteoarthritis ranks among the most common reasons US adults live with chronic joint pain, with incidence peaking in the early 60s. Exercise is the standard initial advice. The updated review examined what that recommendation actually accomplishes for patients.

Compared with no treatment, usual care, or minimal education, exercise probably reduced pain by about 7 points on a 100-point scale, and improved physical function by about 9 points, both with moderate certainty. Experts generally consider roughly 12 points the minimum patients notice in daily life. Quality of life, arguably the outcome patients care most about, showed little to no improvement.

The comparator mattered. When exercise was added to another treatment and measured against that treatment alone, it added little to nothing for pain, function, or quality of life, though it slightly reduced adverse events.

The review pooled 1,368 participants, mostly women aged 53 to 74, across trials that were generally small and unblinded, with self-reported outcomes. Programs ranged from 2 to 52 weeks and spanned strengthening, aerobic, and mind-body approaches, with no evidence that any type outperformed the others.

"Exercise is recommended as a primary treatment for hip osteoarthritis, and this review doesn't overturn that," said Michelle Hall, co-lead author from the University of Sydney. "But it does suggest we should be honest with patients that the average benefit may be modest, and that we need better-designed trials to understand who benefits most and from which type of exercise."

Source: Hall M, et al (2026 Jul 22) Cochrane Database Syst Rev. Exercise for osteoarthritis of the hip