Exercise finds improvements in pain and function may fall short of what patients would notice in daily life, but more studies are needed to make firm conclusions, a new Cochrane review finds.

Hip osteoarthritis is a condition affecting millions of people worldwide and a leading cause of chronic pain and disability. Exercise is widely recommended as a first-line treatment for managing hip arthritis pain.

Led by researchers from University of Sydney and University of Melbourne, the findings show exercise produces small improvements in pain and physical function for people with hip osteoarthritis, but those improvements may not be large enough to make a meaningful difference to patients.

The review included 18 clinical trials involving 1,368 people. Participants were mostly women (63%) and were aged between 53 and 74 years, meaning findings may not apply to younger people. Exercise programmes in the included studies varied widely, lasting between two and 52 weeks and covering a range of types including strengthening, aerobic, and mind-body approaches.

Compared with no treatment or usual care, exercise probably reduces pain by around 7 points on a 100-point scale. However, experts generally consider an improvement of at least 12 points necessary for patients to notice a meaningful difference in daily life. Physical function showed a similar pattern. The authors note, however, that these thresholds were derived largely from knee and mixed osteoarthritis populations, and may not entirely reflect the hip osteoarthritis experience.

Quality of life, arguably the outcome patients care about most, showed little to no improvement with exercise regardless of the comparison 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."

Not a recommendation against exercise

The review stops short of saying exercise is ineffective or should be abandoned as a recommendation. Exercise carries broad health benefits beyond arthritis, is low-cost, and is unlikely to cause harm.

Most studies included in this review were small and unblinded, which may have influenced outcomes. Because pain and function were largely self-reported, and participants knew whether they were exercising, exercise may appear more effective than it truly is.

The authors call for larger, better-designed trials to give patients and clinicians a clearer picture of what exercise can realistically achieve for hip osteoarthritis specifically.

"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."

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