A review of the literature has shown strength training, stretching, and flexibility exercises are of significant benefit to people with mild-to-moderate hip osteoarthritis. The expert group that performed the review also came to a consensus in recommending 2 to 3 months of physician-supervised use of these approaches, particularly strength training, for people between the ages of 55 and 70 years with hip osteoarthritis.
Lucie Brosseau, PhD, Professor and University Research Chair on Evidence-Based Practice in Rehabilitation, School of Rehabilitation Sciences, University of Ottawa, Ontario, Canada, led the effort. She and the other members of the Ottawa Panel performed a systematic literature search that yielded full-text articles on 4 randomized controlled trials (RCTs) of moderate to high quality as rated by the Panel using the Physiotherapy Evidence Database (PEDro) scale.
One RCT was a 3-month comparison of supervised group strength training, functional, and flexibility exercises along with patient education versus education only. The patients performed 26 different supervised exercises twice a week and had unsupervised access to a gym the rest of the time. At the end of 12 weeks, there was significant improvement in physical function. Based on this study, the members of the Ottawa Panel subsequently came to a consensus, via an online Delphi survey, to strongly recommend 12 weeks of supervised therapeutic exercises plus a patient-education program.
The second RCT compared supervised group, low-load, non–weight-bearing strength training and flexibility exercises to no exercise. The patients received 6 to 8 supervised 30-minute training sessions over the 8-week duration of the study. They were also instructed in a home-based exercise program and were encouraged to do aerobic exercises such as walking and swimming. At 24 weeks’ follow-up, the study yielded improvement in physical function, reduction in pain during activities, and increase in range of motion. Therefore, the Ottawa Panel strongly recommended this approach.
The third RCT investigated the effects of supervised group strength training and stretching exercises under general practitioner care versus general practitioner care alone. The program involved once-weekly 45-minute strengthening and stretching exercise classes for 12 weeks. The participants in the active group experienced significant reduction in pain and increase in physical function compared with controls at 24 weeks of follow-up. The Ottawa Panel also strongly recommended this approach.
The remaining RCT compared supervised group strength training combined with unsupervised home exercises focused on the legs versus general practitioner care alone. The 1-hour classes, which primarily focused on equipment-based strength-training exercises, such as the leg press and pull-down, were held every week for 8 weeks. The investigators reported a decrease in both pain and self-reported disability at 20 weeks’ follow-up. The Ottawa Panel, therefore, strongly recommended this program.
“All of these programs are proven effective. The ones that are supervised are available through a physiotherapist, and the ones that are unsupervised are available through the Arthritis Society of Canada’s website,” said Dr Brosseau, who noted that the website showing the choices of unsupervised exercises is arthritis.ca/peoplegettingagrip. “Also patient preference is important. The patient can choose amongst the various effective exercises with the guidance of the physiotherapist to decide which ones best suit her or him.”
Brosseau L, Wells GA, Pugh AG, et al. Ottawa Panel evidence-based clinical practice guidelines for therapeutic exercise in the management of hip osteoarthritis Clin Rehabil. 2015 Sep 23. Epub ahead of print.