Effect of Therapeutic Exercise for Hip Osteoarthritis Pain: Results of a Meta-Analysis

Arthritis Care Research News Alerts. 2008;59(9):1221-1228. 

Treatment strategies for osteoarthritis (OA) of the hip have traditionally involved pharmacologic pain relief, surgical intervention and other measures such as weight reduction, education and heat or cold therapy. While exercise is frequently incorporated in the treatment for hip OA, this recommendation is based on studies of knee OA because there is a lack of information regarding exercise for patients with hip OA. In fact, the American College of Rheumatology recommends consulting with a physical therapist for these patients, but no further specifics regarding exercise are provided. A new study examined the results of clinical trials on the effects of therapeutic exercise on hip OA and found that it is an effective treatment. The study was published in the September issue of Arthritis Care & Research (www.interscience.wiley.com/journal/arthritis).

Led by Gabriela Hernandez-Molina and David T. Felson of Boston University, researchers analyzed the results of nine studies of participants who had hip OA that compared exercise programs to treatments not including exercise and that lasted at least four weeks. The number of exercise sessions per week ranged from one to four and lasted from 30 to 60 minutes. The intensity of exercise was individually adjusted for each patient in the majority of the trials and took place on land and/or in water. Most trials involved exercising at a gym or pool under the supervision of a physical therapist, but in one trial patients exercised at home after initial instruction by a physical therapist and in another they exercised at home after watching a videotape of a trained demonstrator. All trials involved strengthening exercises and some combined them with aerobic exercise.

The results showed a significant positive effect of exercise over treatments not including exercise in terms of pain relief, even though there was a substantial difference among the trials. "Among the trials included in our meta-analysis, one common element was the performance of strengthening exercise and repeated in-person attempts to refine and individualize the program, suggesting that this type of exercise might be effective," the authors state. Furthermore, evidence from the trials suggests that exercise may be safe for those with OA.

Although the authors acknowledge that combining data from multiple small trials may not be equivalent to carrying out a trial where a large number of patients participate in supervised exercise, they note that their analysis provides insight into the effectiveness of exercise in treating hip OA. They conclude that "therapeutic exercise constitutes efficacious treatment for pain in patients with hip OA."

Item is available via Wiley InterScience at https://www.interscience.wiley.com/journal/arthritiscare.


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