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For Clinicians

Exercise and Physical Activity for Hip Osteoarthritis

Understanding how to monitor pain and what exercises to do

Exercise and physical activity are recommended for all people with hip osteoarthritis regardless of age, pain levels, severity of the condition or co-morbidities.

Are exercise and physical activity good for osteoarthritis?

The cartilage in our joints love movement! Exercise can reduce pain and, over time, improve function to make daily tasks easier. It’s also good for your body and mind and can lead to lots of positive things like a strong heart and good overall health.

The benefits of exercise disappear when you stop exercising. To keep the effects of exercise, you have to keep exercising regularly. This is why it’s important to do exercises that you enjoy. This will help make exercise part of your daily routine. Examples of exercises that might work well are: walking, running, aquatic (water) exercises, dancing, cycling, and strength training.

Want to know more about the difference between exercise and physical activity?

Physical Activity

Physical activity is any bodily movement produced by the skeletal muscles that results in burning more energy compared to rest.

Examples of ways to be more physically active might be walking instead of driving, taking the stairs instead of the elevator.

Exercise

Exercise is a specific type of physical activity that is planned, structured, and aims to improve one or more components of fitness (e.g. strength, endurance, flexibility).

Examples of ways to increase your exercise may include going to a muscle strength class.

It is good to become more physically active with hip osteoarthritis (do more of the things you enjoy, such as gardening, shopping, cooking), whilst also supplementing this with regular structured exercise (such as running, walking, strengthening training). Being more physically active by doing things that you enjoy in your free time will keep you happy and improve your overall health. Being active can also help distract from the pain and, if weight is a factor, help you burn off more calories.

The National Guidelines on Physical Activity for Ireland recommend the following for all people – with or without hip osteoarthritis to maximise overall health:

  • At least 2 hours 30 minutes of moderate intensity aerobic physical activity or exercise per week (or broken down as 30 minutes per day across 5 days),
  • A minimum of 2 strength training sessions per week,
  • PLUS limit the amount of time doing sedentary activities like sitting.
Moderate intensity activity can be described as undertaking an activity where you can comfortably continue to talk but would not be able to sing!

Those aged 65 and above are recommended to do balance and strength training on 3 or more days a week, to improve physical function and to prevent falls.

If this seems off-putting, remember that every movement counts! Taking the stairs where you have an option, walking to the shops, gardening, parking a little bit further away from your destination will all help to improve your joint health and overall health.

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Is exercise good for me, even if my hip hurts?

Research has found that exercise and physical activity has a positive effect on pain and function. Everybody reacts to pain differently. Pain is the main reason people with hip osteoarthritis seek treatment. It’s also the main reason people with hip osteoarthritis avoid exercise. People in pain sometimes avoid activity, but being less active can make your pain worse over time.

Inactivity causes muscle weakness, the hip might feel like it is going to “give way”, you can gain weight, and your mood and sleep problems can get worse. All of these things can make you avoid activity even more. It’s a vicious cycle.

It’s normal to feel a bit of pain when you start exercising. You may have a bit of muscle soreness if you haven’t used these muscles regularly or have some joint pain. The muscle soreness will decrease as you get used to exercising. It is important to decide the pain limits that are acceptable to you. These pain limits will be different for everyone and can change over time. Use the two rules in the graphic provided here to help guide your exercise.

It’s important to listen to your body and strike a balance when exercising. Focus on your exercise goals to distract yourself from any pain. Don’t forget to have fun!

Examples of Exercises for Hip Osteoarthritis

The best exercises for osteoarthritis are the ones that you will continue to do as part of your regular routine! In general, medical guidelines suggest that people with hip osteoarthritis should engage in:

Aerobic activity

(for example walking, hiking or cycling) on most days of the week.

Strength training

of the leg and trunk muscles at least twice per week.

Some people will need help or supervision with an exercise programme until they gain some confidence in their joint and their ability. A chartered physiotherapist will be able to provide you with a programme that can be home-based or done in a group setting with other people with osteoarthritis or chronic joint conditions.

The GLA:D Ireland programme (Good Life with osteoArthritis Denmark) is an example of a group exercise and education programme for hip and knee osteoarthritis that is led by physiotherapists and available in healthcare and community settings all around Ireland (and the world). Click here to see where GLA:D is available and how to get referred.

How much exercise and physical activity should I be doing?

If you are starting from 0 minutes of activity a week, it is important to start slowly and gradually increase your time spent being active. A daily 10-minute walk is a good place to start. Try to add a few minutes every time you walk. If you need extra help, a healthcare or exercise professional can help you set some achievable goals to set you on your journey. We have also provided some example exercises below that will help you strengthen the muscles around your joint.

Those aged 65 and above are recommended to do balance and strength training on 3 or more days a week, to improve physical function and to prevent falls.

Hip Osteoarthritis Exercise Programme

Exercises that have been found to be helpful and can be performed at home are explained in the videos below. You can start at Level 1, 2 or 3. Each individual exercise is also described in the table below and accompanied by video links and downloadable files that you can print.

Monitoring your pain

2
3

Remember many people experience an increase in hip discomfort when performing exercises. Review the advice on monitoring hip pain during and after exercise above.

before you start

2
3

Seek advice from a healthcare professional before engaging in these exercises for the first time. Choose a safe and well-lit space to exercise. Hold on to a table or stable surface for balance if needed.

where to start

2
3

If you are new to exercise or your hip pain is very easily irritated, we would suggest starting at Level 1. It can take two or three weeks of repeating these exercises daily to build confidence and strength to progress to Level 2. When you’re comfortable with the exercises on Level 2 and they’ve become easier, you can progress to Level 3. Holding a light weight (2 or 3kg) can increase the challenge as you perform the Level 3 exercises.

how many exercises

2
3

The number of suggested repetitions for each exercise is something to aim for. Everyone will have a different starting point. If your starting point is just a few repetitions of each exercise, that’s fine. You could repeat that more than once a day. When you are able to perform more exercises together, we would suggest performing once a day or every other day.

what if I experience a setback?

2
3

Experiencing a setback or ‘flare up’ of hip pain after starting a new exercise programme or activity can be normal. Stay calm, switch to easier exercises and use ice or pain medication until symptoms improve. If your pain does flare, you have not harmed or damaged your hip.

preparing to exercise

2
3

Warm up by walking or ‘marching on the spot’ for 3 to 4 minutes before you start your exercises. This will help your muscles prepare for the activity by increasing your circulation.

Level 1 Hip Osteoarthritis Exercise Programme

Level 2 Hip Osteoarthritis Exercise Programme

Level 3 Hip Osteoarthritis Exercise Programme

Level 1
Exercise Video
Bridging
  • Lying with knees bent and feet apart.
  • Slowly lift your buttocks off the floor.
  • Hold the position for 5 secs.
  • Keep your shoulder blades on the floor.
  • Slowly lower your hips back to the floor “Slowly up, hold, 2, 3, 4, 5, slowly down”
  • Build up to 15 times x 2 sets (total 30)
    • Straight Leg Raise
  • Sitting on the floor/firm bed.
  • With one leg in a bent position, straighten your exercising leg and pull your toes towards your head.
  • Raise your straight leg 6 inches off the floor and hold for 10 secs.
  • Slowly lower and repeat 15 times. Build up to 3 sets (total of 45 reps) for each leg.
    • Chair Stand
  • Stand with arms outstretched, feet parallel and hip distance apart.
  • Sit down with a slow and very controlled movement and return to standing “Down, 2, 3, 4, up, 2, 3, 4”.
  • Keep knees in line with your toes.
  • Repeat 15 times. Build up 3 sets (total of 45 reps).
  • Tip: As you get stronger, during each repetition try to barely touch the seat, before you stand back up.
    • Download Hip OA Level 1 Programme Instructions
    Level 2
    Exercise Video
    Pelvic Lift with Chair / Ball
  • Lying down with heels on a chair, knees at a 90-degree angle.
  • Press your heels into the chair while you roll your bum and hips off of the floor.
  • Hold the lift for a count of 3, then slowly lower back down.
  • Repeat 10 times, build up to 3 sets of 10.
  • Cross your arms over your tummy to increase the challenge.
  • To advance the exercise, you can use an exercise ball instead of a chair.
    • Sliding backwards lunge
  • Rest hands lightly on a chair or use a sturdy broom handle for support
  • Put your weight on the exercising leg
  • Place your other foot lightly on a sliding surface and slide your foot backwards
  • Bend the knee of the front leg until thigh nearly parallel to the floor
  • Return to the starting position by sliding foot forwards
  • Keep your torso upright throughout
  • Repeat 10 times with each leg. Build up to 3 sets of 10 reps
    • Step Ups
  • Place the foot of the exercising leg on a sturdy high step or bench
  • Step up onto the step with a slow controlled movement
  • Lightly touch the other foot to the step, and step back down to the start position
  • Keep body weight on the foot on the step throughout the exercise
  • Ensure the knee is aligned over your foot as you step up
  • Repeat 10 times with the foot of the exercising leg remaining on the step. Build up to 3 sets (total 30)
    • Hip Strengthening with Band (Optional Exercises)
    If you have an exercise resistance band or loop, you can perform these two exercises.
    Band Exercise 1: Hip Abduction
  • Loop the exercise band (secured to table leg) above the ankle of the exercising leg.
  • Hold or keep a hand on the table if you need to.
  • Lift your foot out to the side, until you feel moderate tension in the band. Hold this position for 5 seconds, toes pointing ahead.
  • Slowly return the foot to start position. Avoid leaning forwards or sideways during the movement.
  • Repeat the movement 10 times, then switch sides. Build up to 3 sets of 10 repetitions on each side.
    • Band Exercise 2: Hip Adduction
  • Loop the exercise band (secured to table leg) above the ankle of the exercising leg.
  • Hold or keep a hand on a chair if you need to.
  • This time, pull the exercising leg in towards your standing leg. There should be moderate tension on the band so you may need to re-position your body.
  • Hold this position for 5 seconds, toes pointing ahead, and slowly move leg back to starting position.
  • Repeat the movement 10 times, then switch sides. Build up to 3 sets of 10 repetitions on each side.
    • Download Hip OA Level 2 Programme Instructions
    Level 3
    Exercise Video
    Reverse lunge
  • Stand with feet together, step backwards until the front knee (the exercising leg) is bent to 90°. Keep the front foot in the same position
  • Push through your front heel to return the back leg to the starting position.
  • Repeat 10 times. Build up to 3 sets of 10.
  • Tip: Concentrate on keeping your front knee aligned with your foot
    • Offset or One-legged Squat
  • Stand with feet hip width apart and use broom handle for support
  • Transfer your weight to the exercising leg, leave the toes of opposite leg on floor to provide stability
  • Sit back into a squat position, keep your knee behind your toes at all times
  • Push back up through the exercising leg to the starting position
  • To advance the exercise, remove the support of the stick and the supportive foot and instead do a one-leg squat from a high table
    • Single Leg Bridge
  • Lying down with the exercising leg bent to 90-degrees, raise the other leg into the air.
  • Push down through your heel and slowly lift your hips off the floor.
  • Hold the position for 5 secs.
  • Keep your shoulder blades on the floor.
  • Slowly lower your hips back to the floor “Slowly up, hold, 2, 3, 4, 5, slowly down”.
  • Build up to 15 times x 2 sets (total 30).
    • Crab Walk (Optional Exercise)
  • If you have an exercise resistance band or loop, you can perform this exercise.
  • With an exercise band looped around both ankles, bend at your hips and side-step like a crab, creating some band resistance as you step.
  • Hold your body upright and don’t let your knees drift over your toes as you step to the side.
  • Repeat as many side steps as you can until you run out of space, then sidestep back in the other direction.
  • Repeat 3 times in each direction.
    • Download Hip OA Level 3 Programme Instructions

    IRISH RESOURCES FOR EXERCISE AND PHYSICAL ACTIVITY

    • The National Physical Activity and Sedentary Guidelines for Ireland can help people to make choices to increasing their physical activity levels. Remember every move counts towards improving your health!
    • GLA:D Ireland is a physiotherapist-delivered exercise and education programme designed for people with hip and knee osteoarthritis and offered in many clinics and hospitals around Ireland.
    • The Arthritis Ireland Be Active with Arthritis six-week courses are led by chartered physiotherapists and are an adapted exercise programme developed specifically for people with arthritis and related conditions.
    • Age & Opportunity run a free nationwide telephone mentoring service called FitLine, supporting people aged 50+ to be more active. Call 1800 303 545 or 087-6211767 to register your interest.
    • Get Ireland Walking have over 1,800 walking groups registered across the country. Click here to find a national directory of walking groups.
    • Sports Ireland Local Sports Partnerships offer a number of community programmes to suit all levels of physical activity and abilities. To find the website for your Local Sports Partnership and local offerings, click here.
    Read More

    Now you have an understanding of Exercise and Physical Activity, let’s learn more about the second core recommended treatment: Education and Self-Management.

    Next: Lifestyle and Weight Management
    SOURCES OF INFORMATION
    The information in this website page was informed by the following sources/references:

    Scientific Publications

    • Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, Kraus VB, Lohmander LS, Abbott JH, Bhandari M, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthr Cartil. 2019;27:1578–1589. doi: 10.1016/j.joca.2019.06.011.
    • Bieler T, Siersma V, Magnusson SP, Kjaer M, Christensen HE, Beyer N. In hip osteoarthritis, Nordic walking is superior to strength training and home-based exercise for improving function. Scand J Med Sci Sports. 2017;27:873–886. doi: 10.1111/sms.12694.
    • Loureiro A, Mills PM, Barrett RS. Muscle weakness in hip osteoarthritis: a systematic review. Arthritis Care Res. 2013;65:340–352. doi: 10.1002/acr.21806.
    • Moseng T, Dagfinrud H, Smedslund G, Osteras N. The importance of dose in land-based supervised exercise for people with hip osteoarthritis. A systematic review and meta-analysis. Osteoarthr Cartil. 2017;25:1563–1576. doi: 10.1016/j.joca.2017.06.004.
    • Smith BE, Hendrick P, Smith TO, Bateman M, Moffatt F, Rathleff MS, Selfe J, Logan P. Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis. Br J Sports Med. 2017;51:1679–1687. doi: 10.1136/bjsports-2016-097383.
    • Song J, Gilbert AL, Chang RW, Pellegrini CA, Ehrlich-Jones LS, Lee J, Pinto D, Semanik PA, Sharma L, Kwoh CK, et al. Do inactive older adults who increase physical activity experience less disability: evidence from the osteoarthritis initiative. J Clin Rheumatol. 2017;23(1):26–32. doi: 10.1097/RHU.0000000000000473.
    • Ton J, Perry D, Thomas B, Allan GM, Lindblad AJ, McCormack J, Kolber MR, Garrison S, Moe S, Craig R, Dugré N, Chan K, Finley CR, Ting R, Korownyk CS. PEER umbrella systematic review of systematic reviews: Management of osteoarthritis in primary care. Can Fam Physician. 2020 Mar;66(3):e89-e98.

    Patient Websites/Resources

    Clinical Guidelines

    • National Clinical Guideline Centre (UK). National Institute for Health and Clinical Excellence: Guidance. Osteoarthritis in over 16s: diagnosis and management. NICE guideline [NG226]. Published: 19 October 2022. https://www.nice.org.uk/guidance/ng226

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    If you are someone with a joint condition using this website for the first time, we need your help to evaluate the website!

    Click here to find out more.