Exercise may help hip arthritis, but the relief could be far less noticeable than patients hope, say experts, who found that exercise produces only small average improvements in hip osteoarthritis pain and physical function.
A major new Cochrane review concluded that while it might provide some relief for people with hip osteoarthritis, the improvements in pain and physical function may be too small for many patients to notice in everyday life.
The researchers cautioned that stronger evidence is still needed before firm conclusions can be drawn.
Modest benefits
Hip osteoarthritis affects millions of people worldwide and is a major cause of long-term pain and disability. Exercise is commonly recommended as one of the first treatments for reducing symptoms and maintaining mobility.
But although the researchers from the University of Sydney and University of Melbourne found that exercise leads to small average improvements in pain and physical function among people with hip osteoarthritis, those gains may not, however, be large enough to create a meaningful difference in patients’ daily lives, they said.
The review analysed 18 clinical trials involving 1 368 participants. Most were women (63%), and their ages ranged from 53 to 74, so the results may not apply as well to younger adults.
The exercise programmes also differed considerably across the studies. They lasted anywhere from two to 52 weeks and included strengthening exercises, aerobic activity, and mind-body approaches.
Relief may fall below noticeable levels
When exercise was compared with usual care or no treatment, it probably lowered pain by about seven points on a 100-point scale. Experts generally consider a reduction of at least 12 points necessary for patients to notice a meaningful improvement in daily life.
Physical function followed a similar pattern, with only modest average gains. The researchers noted that the thresholds used to define a meaningful improvement were developed mainly from studies involving knee osteoarthritis or mixed groups of osteoarthritis patients. As a result, they may not perfectly reflect the experience of people with hip osteoarthritis.
Exercise also appeared to produce little or no improvement in quality of life, regardless of which comparison group was 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.”
Still recommended
The findings do not suggest that exercise is ineffective or that it should no longer be recommended. Physical activity provides many health benefits beyond arthritis, costs relatively little, and is unlikely to cause harm.
Still, most of the studies included in the review were small and unblinded, which may have affected the results. Because participants knew whether they were exercising and reported their own pain and function, the benefits of exercise may have appeared larger than they actually were.
Better studies are needed
The authors say larger and more carefully designed trials are needed to show what exercise can realistically accomplish for people with hip osteoarthritis. Future research should also identify which types of exercise are most effective for particular patients.
“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.”
Study details:
Exercise for osteoarthritis of the hip
Michelle Hall, Belinda Lawford, Rana Hinman et al.
Published in Cochrane Database of Systematic Reviews on 23 July 2026
Abstract
Hip osteoarthritis is a major public health issue. International treatment guidelines recommend exercise to manage symptoms. This is an update of a review first published in 2009 and last updated in 2014.
Objectives
To determine the effects of land‐based exercise on pain, physical function, quality of life, participant‐reported treatment success, study withdrawals, and adverse events in people with hip osteoarthritis.
Search methods
We searched CENTRAL, MEDLINE, Embase, and two trial registries from February 2013 (search date for last update) to 5 February 2025. We also checked reference lists for additional studies.
Eligibility criteria
We included randomised controlled trials (RCTs) of adults with hip osteoarthritis. Eligible comparisons were as follows.
• Exercise versus attention control/placebo.
• Exercise versus no treatment/usual care/limited education.
• Exercise plus a co‐intervention (A) versus the co‐intervention (A) alone.
We excluded perioperative exercise programmes; interventions involving vibration therapy, gait aids, or retraining; and studies that added unequal co‐interventions in both groups or that compared only one form of exercise to another.
Outcomes
Our critical outcomes were pain, physical function, and quality of life. Our important outcomes were participant‐reported treatment success, study withdrawals, and adverse events.
Risk of bias
As this was a review update, we used the original Cochrane risk of bias tool (RoB 1).
Synthesis methods
We used standard methodological procedures expected by Cochrane. We synthesised results for each outcome using random‐effects meta‐analysis where appropriate. We used the GRADE approach to assess certainty of evidence.
Included studies
Eighteen studies (1368 participants) met our inclusion criteria. Two studies (123 participants) evaluated exercise versus attention control or placebo, 10 studies (494 participants) evaluated exercise versus no treatment/usual care/limited education, and seven studies (751 participants) evaluated exercise plus a co‐intervention (A) versus the co‐intervention (A) alone. One trial (210 participants) included two comparator categories. Most studies were small and unblinded.
Synthesis of results
We converted all continuous effect estimates from standardised mean differences to mean differences (MDs) on a scale of 0 to 100. For pain and physical function, a negative MD indicates an improvement, while for quality of life, a positive MD indicates an improvement. Pain, physical function, quality of life, and participant‐reported treatment success were measured immediately after treatment, while study withdrawals and adverse events were recorded at the end of follow‐up.
Exercise versus attention control/placebo
Exercise, compared to attention control/placebo, may have little to no effect on pain (MD −6.31 points, 95% confidence interval (CI) −12.98 to 0.35; 2 studies, 123 participants; low certainty). Exercise may improve physical function slightly (MD −7.44 points, 95% CI −13.86 to −1.01; 2 studies, 123 participants; low certainty). No studies reported quality of life or participant‐reported treatment success. Exercise may have little to no effect on study withdrawals (relative risk (RR) 0.83, 95% CI 0.23 to 3.03; 1 study, 106 participants; low certainty). Exercise may increase the risk of adverse events, but the evidence is very uncertain (RR 8.00, 95% CI 1.13 to 56.79; 1 study, 18 participants; very low certainty).
Exercise versus no treatment/usual care/limited education
Exercise, compared to no treatment/usual care/limited education, probably reduces pain slightly (MD −7.19 points, 95% CI −10.70 to −3.68; 9 studies, 449 participants; moderate certainty) and probably improves physical function slightly (MD −8.79 points, 95% CI −12.00 to −5.41; 9 studies, 447 participants; moderate certainty); however, these improvements are unlikely to be clinically meaningful. Exercise probably has little to no effect on quality of life (MD 2.31 points, 95% CI −1.15 to 5.91; 6 studies, 279 participants; moderate certainty). Exercise may have little to no effect on participant‐reported treatment success (RR 1.57, 95% CI 0.62 to 3.99; 2 studies, 69 participants; low certainty) or study withdrawals (RR 1.51, 95% CI 0.80 to 2.86; 7 studies, 404 participants; low certainty). Exercise may have little to no effect on adverse events, but the evidence is very uncertain (RR 2.95, 95% CI 0.62 to 13.96; 6 studies, 257 participants; very low certainty).
Exercise plus a co‐intervention (A) versus the co‐intervention (A) alone
Exercise plus a co‐intervention (A), compared to the co‐intervention (A) alone, probably has little to no effect on pain (MD −3.86 points, 95% CI −8.07 to 0.35; 7 studies, 751 participants; moderate certainty), physical function (MD −2.37 points, 95% CI −6.59 to 1.86; 7 studies, 751 participants; moderate certainty), or quality of life (MD 3.60 points, 95% CI −1.30 to 8.36; 4 studies, 456 participants; moderate certainty). Exercise may have little to no effect on participant‐reported treatment success (RR 1.25, 95% CI 0.62 to 2.54; 2 studies, 399 participants; low certainty), and probably has little to no effect on study withdrawals (RR 0.85, 95% CI 0.55 to 1.32; 6 studies, 683 participants; moderate certainty). Exercise probably reduces the risk of adverse events slightly (RR 0.75, 95% CI 0.58 to 0.97; 6 studies, 731 participants; moderate certainty).
Authors’ conclusions
Compared with attention control or placebo, exercise may have little to no effect on pain and may improve physical function slightly. There was no evidence for quality of life or participant‐reported treatment success. Exercise may have little to no effect on withdrawals. Evidence regarding adverse events is very uncertain.
Compared with no treatment, usual care or limited education, exercise probably improves pain and physical function slightly, although these effects are unlikely to be clinically meaningful. Exercise probably has little to no effect on quality of life and may have little to no effect on participant‐reported treatment success or withdrawals. Evidence regarding adverse events is very uncertain.
Exercise plus a co‐intervention (A), compared to the co‐intervention (A) alone, probably has little to no effect on pain, physical function, quality of life, and study withdrawals, and may have little to no effect on participant‐reported treatment success. Exercise probably reduces the risk of adverse events slightly.
Cochrane Library – Exercise for osteoarthritis of the hip (Open access)
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