Exercise is widely prescribed for hip osteoarthritis, but a study suggests the relief it provides may be too small to notice in day-to-day life.
Exercise is one of the most common recommendations for hip osteoarthritis, but a major new evidence review suggests its average benefits may be smaller than many patients expect.
The Cochrane review found that exercise can reduce pain and improve physical function, although the changes were often below the level patients are likely to notice in everyday life. The researchers stress that this does not mean exercise should be abandoned, but it does raise questions about how its benefits are described and which programs work best for different people.
Why Exercise Is Still Recommended
Hip osteoarthritis develops as the joint gradually deteriorates, causing pain, stiffness, and difficulty with activities such as walking, climbing stairs, or getting out of a chair. Because there is no simple way to reverse the condition, treatment often focuses on controlling symptoms, preserving mobility, and delaying or avoiding joint replacement surgery.
Exercise is widely promoted as a first-line treatment because it is inexpensive, broadly accessible, and can strengthen the muscles that support the hip. It also provides cardiovascular, metabolic, and mental health benefits that extend well beyond the affected joint.
Researchers from the University of Sydney and the University of Melbourne reviewed 18 clinical trials involving 1,368 people with hip osteoarthritis. Participants were mostly women (63%) and ranged in age from 53 to 74 years, which means the results may not fully represent younger adults.
Small Gains in Pain and Mobility
The exercise programs varied substantially. Some lasted only two weeks, while others continued for as long as 52 weeks. They included strength training, aerobic exercise, and mind-body activities, making it difficult to determine whether any one approach was consistently more effective than the others.
Compared with usual care or no treatment, exercise reduced pain by an average of about 7 points on a 100-point scale. Experts generally estimate that an improvement of at least 12 points is needed before patients notice a meaningful difference in daily life.
Physical function followed a similar pattern, with small average gains that may not have translated into a noticeable improvement for many participants. However, the researchers cautioned that the thresholds used to define a meaningful change were developed largely from studies of knee osteoarthritis or mixed groups of arthritis patients. People with hip osteoarthritis may experience improvement differently.
Modest Results, Not a Rejection of Exercise
Exercise produced little or no measurable change in quality of life, regardless of which comparison group researchers used.
“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.”
The findings do not show that exercise is useless. Average results can also hide important differences between individuals. Some patients may experience substantial relief, while others may see little change, depending on factors such as disease severity, physical fitness, other health conditions, and the type and intensity of exercise.
Weak Evidence Clouds the True Impact
The review also found significant weaknesses in the available research. Many of the trials were small, and participants knew whether they had been assigned to exercise. Since pain and physical ability were usually self-reported, expectations may have influenced how people rated their improvement.
Blinding participants in exercise studies is difficult because people know whether they are working out. Even so, larger trials with better comparison groups, consistent exercise programs, and longer follow-up periods could provide a more reliable picture of the true effects.
The researchers say future studies should focus less on whether exercise works on average and more on identifying which exercises help particular groups of patients. That could allow clinicians to move away from a one-size-fits-all recommendation and toward more personalized treatment plans.
“There just isn’t a huge body of evidence out there,” said Belinda Lawford, co-lead author from the University of Melbourne. “For some people struggling with hip pain, exercise can really be their only hope, but I also don’t want to give patients false hope. It’s important future research is done with larger, better-quality trials, examining what types of exercise work specifically for different people.”
Reference: “Exercise for osteoarthritis of the hip” by Michelle Halla, Belinda J Lawforda, Rana S Hinman, Fiona Dobson, Libby Spiers, Alex Kimp, Helen P French, Stephan Reichenbach, Gabriela Hernandez-Molina and Kim L Bennell, 23 July 2026, Cochrane Database of Systematic Reviews.
DOI: 10.1002/14651858.CD007912.pub3
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