Exercise not the “silver bullet” for hip arthritis pain
Exercise can improve pain and function for those with hip osteoarthritis, but results may fall short of what patients would notice in daily life, a new Cochrane review finds.
Hip osteoarthritis is a condition affecting millions of people worldwide and a leading cause of chronic pain and disability. After diagnosis, many patients are recommended exercise as a first-line treatment for managing hip arthritis pain.
But a new Cochrane review by researchers at the University of Melbourne and the University of Sydney, shows that exercise only produces small improvements in pain and physical function and these improvements may not be large enough to make a meaningful difference to patients.
“There just isn’t a huge body of evidence out there,” said Dr 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.”
The review included 18 clinical trials involving 1,368 people with participants mostly women (63%) aged between 53 and 74 years. Exercise programmes varied widely, lasting between two and 52 weeks and covering a range of types including strengthening, aerobic, and mind-body approaches.
Quality of life, arguably the outcome patients care about most, showed little to no improvement with exercise regardless of the comparison used. 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 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.
"Exercise is recommended as a primary treatment for hip osteoarthritis, and this review doesn't overturn that," said Associate Professor 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."
More research and better-designed trials are needed to give patients and clinicians a clearer picture of what exercise can realistically achieve for patients with hip osteoarthritis.