Exercise as Medicine During the Course of Hip Osteoarthritis

Inger Mechlenburg; Lisa Cecilie Urup Reimer; Troels Kjeldsen; Thomas Frydendal; Ulrik Dalgas

Disclosures

Exerc Sport Sci Rev. 2021;49(2):77-87. 

In This Article

Definitions and Framework

As depicted in Table 1, this narrative review focuses on the impact of exercise or PA at four different stages of the typical hip OA disease course. First, we summarize evidence investigating PA or exercise (or proxies such as muscle strength and occupation) as risk factors in the development of hip OA during the preclinical stage of hip OA (primary prevention). Second, we summarize secondary and tertiary preventive effects of exercise in patients having mild to moderate hip OA. This is often how the disease manifests during the early disease stages where patients are classified as having clinically hip OA (Table 2). Third, we evaluate secondary and tertiary preventive effects of exercise in patients with severe hip OA. These patients often have "end-stage" hip OA, meaning that THA is considered or planned. In addition to clinical hip OA, these patients most often also have confirmed radiographic hip OA (Table 2). Finally, we evaluate the effects of exercise in the early postoperative recovery phase after exercise interventions initiated within one year of THA and in the later recovery phase after exercise interventions initiated later than one year after THA (tertiary prevention).

Daily PA can be categorized into occupational, sports, conditioning, household, or other activities. Accordingly, PA is defined as "any bodily movement produced by skeletal muscles that result in energy expenditure".[71] As a consequence, exercise is defined as "a subset of PA that is planned, structured and repetitive and has as a final or an intermediate objective — the improvement or maintenance of physical fitness".[71] We present a conceptual illustration (Figure 1) of the potential effects of "optimal" exercise (i.e., a regular individually tailored exercise program including efficient modalities and a sufficient volume and intensity) during different disease stages of hip OA. As illustrated, optimal exercise effects are likely seen if undertaken both before and after THA, although more studies investigating this are still required.

Figure 1.

Conceptual illustration of the potential effects of optimal exercise (i.e., a regular individually tailored exercise program including efficient modalities and a sufficient volume and intensity) during different disease stages of hip osteoarthritis (OA). The potential effects of exercise before or after total hip arthroplasty (THA) on 1) patient-reported hip function, 2) patient-reported hip pain, 3) muscle strength and performance-based function, and 4) hip cartilage thickness and quality are depicted as the trajectories for nonexercising patients with hip OA as well as healthy people without hip OA, who are not undergoing THA. As illustrated, optimal exercise effects are likely seen if undertaken both before and after THA, although long-term studies investigating this are still warranted. In the studies performed after THA, the typical comparisons are patients receiving standard postoperative rehabilitation versus a more intensive rehabilitation intervention. It can also be seen that exercise holds the potential to beneficially impact several key symptoms (tertiary prevention) while potentially also being able to modify the disease course of hip OA (i.e., protect against cartilage degradation offering secondary prevention), although supporting data are from experimental studies in knee OA. In addition, exercise may hold the potential to postpone or even obviate THA, but this is not illustrated in the figure as no published studies have evaluated this. aBased on experimental studies from knee OA.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....