COMMENTARY

Is Exercise Beneficial for Hip Osteoarthritis Pain?

Kevin Deane, MD

Disclosures

March 18, 2009

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

Hernandez-Molina G, Reichenbach S, Zhang B, Lavalley M, Felson DT
Arthritis Rheum. 2008;59:1221-1228

Study Summary

Hip osteoarthritis (OA) is a major cause of morbidity in older populations. Exercise therapy may offer benefit,[1] but most of the exercise recommendations for hip OA are derived from studies in knee OA.[2] The purpose of this meta-analysis was to determine the benefits of hip-specific exercise therapy.

The authors identified 8 randomized controlled trials that were relatively similar, consisting of an exercise intervention with some aspect of muscle strengthening that was at least initially guided by a trained specialist. Specific exercise interventions were somewhat different across studies and may have included warm-ups, balance activities, use of fitness equipment, cardiovascular exercise, Tai Chi, aquatic exercises, and flexibility training; typically these were administered 2-3 times weekly for 6-12 weeks.

Outcomes for each of the studies included in this meta-analysis were patient-reported pain levels assessed by various scales. Overall, these 8 studies demonstrated that exercise therapy for hip OA offered a mild-to-moderate improvement in pain.

Viewpoint

The authors of this meta-analysis concluded that exercise therapy with strength training is efficacious for the treatment of OA. This finding may encourage healthcare providers to prescribe exercise therapy more often for patients with hip OA, especially given the growing aging population with perhaps less access to other treatments for hip OA (such as surgical replacement) due to costs.

The benefit of exercise therapy as reported in this meta-analysis was modest at best, and there are still questions that need to be answered, including:

  1. which individuals with hip OA may benefit most;

  2. which specific exercise therapies are most beneficial;

  3. how does exercise therapy compare with pharmacologic, injection, and surgical interventions (both in terms of benefit and cost);

  4. is there a functional and quality of life improvement; and

  5. does exercise therapy alter the progression of disease?

Until these questions are answered, exercise therapy (with strength training) administered by a trained specialist may be a viable option for treating hip OA.

Abstract

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