Exercise as Medicine During the Course of Hip Osteoarthritis

Inger Mechlenburg; Lisa Cecilie Urup Reimer; Troels Kjeldsen; Thomas Frydendal; Ulrik Dalgas


Exerc Sport Sci Rev. 2021;49(2):77-87. 

In This Article

Abstract and Introduction


Exercise is now considered medicine in numerous chronic conditions and is essentially without side effects. We hypothesize that exercise is primary, secondary, and tertiary prevention at different stages of hip osteoarthritis (preclinical, mild-moderate, and severe hip osteoarthritis) and after total hip arthroplasty.


Osteoarthritis (OA) is the most frequent joint diseases in men and women characterized by slow progressive degeneration as affected people age.[1] Along with knee and hand OA, the hip joint is most frequently affected by OA.[2,3] A systematic review performed by Pereira et al.[4] found that the prevalence of hip OA varied from 1% to 45% depending on the definition and the country of origin, with an overall prevalence of 11%. In addition, the burden of the disease is expected to rise further due to increased longevity and obesity in many populations.[5]

Hip OA typically manifest by pain and physical disability, often causing a lower daily physical activity (PA) level.[6] As a result, hip OA may lead to substantial functional limitations for the individual while at the same time also increasing the risk of developing various comorbidities.[7] Besides, hip OA has substantial economic consequences at the societal level.[8]

Currently, there is no cure for hip OA, and the management, therefore, largely relies on symptomatic treatment. Moreover, management of risks and predisposing factors are vital in postponing disease progression while waiting for effective disease-modifying treatments.[5] However, total hip arthroplasty (THA) may be necessary in patients who progressively develop severe hip pain that does not respond to pharmacological or nonsurgical treatments and that substantially affects quality of life (QoL).[9,10]

Given the few pharmacological treatment options in hip OA, identification of nonpharmacological interventions that are efficient as either preventive treatment (preventing the development of hip OA or stopping individuals from becoming at high risk, i.e., primary prevention[11]), or disease-modifying treatment (decreasing the severity of hip OA or halting progression of the disease by affecting the underlying pathology/pathophysiology, i.e., secondary prevention[11]), or alleviating treatment (attenuating symptoms of hip OA, i.e., tertiary prevention[11]), is, therefore, highly warranted.

Interestingly, exercise has attracted increased attention over the last decade in hip OA[12] and may pose the potential to offer primary, secondary, and tertiary prevention in hip OA and play a key role in the recovery after THA. This paradigm is in line with the current international focus, in which exercise prescription is now considered "medicine" in 26 chronic conditions, including metabolic, cardiovascular, pulmonary, and musculoskeletal diseases, essentially without side effects.[13] Nevertheless, no previous reviews have summarized whether exercise is a preventive, alleviating, or disease-modifying treatment in people with hip OA. We hypothesize that exercise is primary, secondary, and tertiary prevention at different stages of hip OA (preclinical, mild-moderate, and severe hip OA) and after THA.