Best Exercise for Hip Osteoarthritis
The best exercise approach for hip osteoarthritis is progressive resistance strengthening of the hip girdle muscles (particularly gluteus medius) combined with low-impact aerobic activity and range of motion exercises, performed at least 2 days per week at moderate to vigorous intensity (60-80% of one repetition maximum) for 8-12 repetitions. 1, 2
Core Strengthening Program
Target the gluteus medius as the primary muscle group through progressive resistance exercises, as this is specifically emphasized by both the American College of Rheumatology and European League Against Rheumatism 1, 2. The strengthening program should include:
- Gluteal strengthening exercises such as gluteal squeezes held for 6-7 seconds, repeated 5-7 times, performed 3-5 times daily 2
- Quadriceps exercises including quad sets and short-arc quad sets in lying or sitting positions 2
- Both isometric (sustained) and dynamic strengthening exercises for comprehensive muscle development 1, 2
- Progressive intensity starting at manageable levels and gradually increasing over several months 1, 2
The most recent high-quality trial (2025) showed that resistance exercise alone produces substantial improvements in hip pain (mean reduction of 2.2 points on a 0-10 scale) and function (mean improvement of 8.9 points on WOMAC), with no additional benefit from adding aerobic activity 3. However, guidelines still recommend combining both modalities for comprehensive management 1.
Aerobic Activity Component
Perform 30-60 minutes of moderate-intensity aerobic exercise daily using low-impact activities 1. The best options include:
- Aquatic exercise - particularly beneficial as buoyancy reduces joint loading by approximately 50-90% while providing resistance for strengthening 1, 2
- Stationary cycling - minimal impact with controlled resistance 1, 2
- Walking - accessible and effective when performed on appropriate surfaces 1, 2
- Tai Chi - combines aerobic activity with balance and flexibility training 2
Target moderate intensity at approximately 70% of maximal heart rate for 45 minutes per day, 3 days per week 2.
Range of Motion Exercises
Daily stretching and range of motion exercises are critical and should be performed as an adjunct to strengthening and aerobic components 2. These exercises maintain hip mobility and prevent contractures that can worsen functional limitations 2.
Implementation Strategy
Begin with 12 or more supervised sessions with a physical therapist to ensure proper form and technique, as this produces significantly better outcomes than fewer sessions (effect size 0.46 vs 0.28 for pain improvement) 1, 4. After the supervised period, transition to home exercises using a "small amounts often" approach rather than prolonged single sessions 2.
Link exercises to daily activities (before morning shower, before meals, or before bed) to establish habitual patterns and improve long-term adherence 2.
Critical Caveats
Never delay exercise initiation due to pain presence - clinical trials demonstrate that patients with OA pain and functional limitations can still achieve improvements with exercise 2. The 2025 PHOENIX trial showed both exercise groups experienced related adverse events (24 in the combined group, 31 in resistance-only group), but none were serious 3.
Resistance exercise alone may be sufficient - the most recent 2025 randomized trial found no additional benefit from adding moderate-intensity aerobic activity to resistance exercise for hip pain or function 3. This suggests that if time or adherence is limited, prioritize resistance training over aerobic activity.
Adjunctive Strategies
If BMI >25, implement weight loss strategies as a 5% reduction in body weight produces clinical improvements, with greater benefits at 10-20% weight loss 1. Weight management should include increased physical activity, structured meal planning, and regular self-monitoring 2.
Use appropriate footwear with shock-absorbing properties to minimize joint stress during all activities 1, 2. Consider a walking cane on the contralateral side to reduce hip joint loading by up to 40% 2.
Never hold your breath during exercises as this increases intra-abdominal pressure and cardiovascular stress 2.