What exercises are recommended for older adults with hip osteoarthritis and potential comorbid conditions?

Exercise Recommendations for Hip Osteoarthritis

Older adults with hip osteoarthritis should engage in a comprehensive exercise program consisting of strengthening exercises (particularly for hip and thigh muscles), low-impact aerobic activities, and daily flexibility exercises, with initial professional instruction followed by long-term self-management. 1, 2

Core Exercise Components

Strengthening Exercises

Hip and proximal muscle strengthening forms the foundation of treatment, targeting both the affected and unaffected sides. 2

• Perform isometric exercises for quadriceps and hip girdle muscles bilaterally, holding contractions for 6-7 seconds, repeated 5-7 times, performed 3-5 times daily 1, 2
• Include gluteal strengthening exercises (gluteal squeezes) with the same duration and frequency 1, 2
• Start at 30% of maximal voluntary contraction intensity for isometric exercises, progressing to 75% as tolerated 1
• For dynamic strengthening, perform 2-4 sets of 8-12 repetitions at 60-80% of one-repetition maximum, at least 2 days per week 1
• Avoid exercising muscles to fatigue and use submaximal resistance 1

Critical principle: For acutely inflamed or unstable joints, use only isometric strengthening with minimal repetitions and no resistance. 1

Aerobic Exercise

Choose low-impact activities that minimize joint loading while providing cardiovascular benefits. 1, 2

• Recommended activities include: swimming, cycling, walking, aquatic exercise, Tai Chi, dance, treadmill, or rowing machines 1, 2
• Aquatic exercise in warm water (86°F) is particularly beneficial, as buoyancy reduces joint loading while providing resistance 1, 2
• Target moderate-intensity training (70% of maximal heart rate) for 30-60 minutes per day, at least 3 days per week 1, 2
• Utilitarian activities count: walking the dog, mowing the lawn, raking leaves, or playing golf 1

Flexibility and Range of Motion

Daily stretching is essential for maintaining hip mobility and should precede strengthening activities. 1, 2

• Perform static stretches daily when pain and stiffness are minimal (e.g., before bedtime) 1
• Hold each stretch for 30-60 seconds in older adults, repeating 2-4 times per muscle group 1
• Stretch to the point of slight discomfort or tightness, not pain 1
• Precede stretching with warm shower or moist heat application 1
• Breathe during each stretch and move slowly 1

Exercise Session Structure

Every exercise session must include three phases to maximize benefit and minimize injury risk. 1

1. Warm-up (5-10 minutes): Low-intensity range-of-motion exercises 1
2. Training period: Strengthening, aerobic, or flexibility exercises providing the overload stimulus 1
3. Cool-down (5 minutes): Static stretching of worked muscles 1

Supervision and Progression

Initial professional instruction is critical, but long-term success requires integration into daily life. 1

• Twelve or more directly supervised sessions are significantly more effective than fewer sessions for both pain (effect size 0.46 vs 0.28) and function (effect size 0.45 vs 0.23) 1
• After initial instruction, patients should self-manage exercises integrated into daily routines 1, 2
• Link exercises to daily activities (before morning shower, before meals, before bed) to establish habits 2
• Follow a "small amounts often" approach rather than prolonged single sessions 2

Safety Monitoring and Red Flags

Joint pain lasting more than 1 hour after exercise or joint swelling indicates excessive activity and requires modification. 1

• Modify exercises when joints are inflamed: decrease range of motion or duration of static holds 1
• Never hold breath during exercises 1, 2
• For medically complex patients or those with unstable joints, refer to an experienced physical therapist 1
• Re-evaluate at 4 weeks to assess pain reduction and functional improvement 1

Adjunctive Strategies

Weight Management

If overweight, implement structured weight loss programs targeting 4 kg reduction, which significantly improves outcomes 1, 2

Footwear and Assistive Devices

• Use appropriate comfortable footwear with shock-absorbing properties 1, 2
• Consider a walking cane on the contralateral side to reduce hip joint loading 2

Thermal Modalities

Apply superficial ice or heat before exercises to reduce pain and improve tolerance 1

Evidence Quality and Outcomes

While evidence for hip OA exercise is less robust than for knee OA, available data demonstrates effectiveness. 1

• Pain reduction exceeds 30% from baseline with structured exercise programs 3
• Maximal isometric leg extensor strength improves by 20% and hip extension range of motion by 30% 3
• Both land-based and water-based programs show small to high effect sizes for improving pain, function, quality of life, and stiffness 4

Common Pitfalls to Avoid

• Do not delay exercise initiation due to pain presence: Clinical trials demonstrate patients with OA pain can still achieve improvements 2
• Do not focus solely on the affected hip: Bilateral strengthening is recommended regardless of which hip is symptomatic 2
• Do not prescribe only one exercise type: Comprehensive programs combining strengthening, aerobic, and flexibility components are most effective 1
• Do not overlook the importance of variety: Multiple exercise options prevent joint overuse and exercise boredom 1