Background Hip osteoarthritis (OA) is a leading cause of pain and functional limitations (1). Current international guidelines recommend exercise as part of the core management for people with Hip OA but the effects of exercise in people with Hip OA are sparsely investigated (2, 3).
Objectives In an observer-blinded, randomized trial to compare the effects of 4 months of supervised strength training (ST), supervised Nordic walking (NW), and unsupervised home based exercise (HBE) on functional performance, muscle function, endurance, hip range of motion and self-reported physical function, pain and health related quality of life in people with Hip OA.
Methods 60+ years old people with clinical Hip OA (ACR criteria (4)) not on a waiting list for hip replacement were recruited through general practitioners and specialists, and advertisements in local newspapers in Greater Copenhagen. 152 individuals (49 men, 103 women, age 70±6 years) were randomized to ST (n=50), NW (n=50) and HBE (n=52) after baseline assessment. Pre and post assessments were conducted. Physical assessments included 30-second chair stand test (primary outcome), timed stair climbing, 8-foot Up & Go, 15-second marching on the spot, 6-minute walk test, maximal isometric hip and thigh muscle strength and leg extensor power and active hip range of motion. Self-reported outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscale physical function and pain, and the hip disability and osteoarthritis outcome score (HOOS) subscale hip related quality of life.
Results 126 participants completed the 4 months of exercise (ST (n=48), NW (n=35) and HBE (n=43)). The 26 participants who dropped out were characterized by more self-reported symptoms (p<0.05) and higher BMI (p=0.04) at baseline. Both per protocol and intension to treat analyses showed that all groups improved in the primary outcome (p<0.01) with no between-group defferences, while the ST-group had a significantly (p=0.001) greater improvement in self-reported physical function and pain compared to the HBE-group. The NW-group improved significantly (p<0.0001) more in walking distance than the ST-group and the HBE-group. Otherwise, there were no significant differences between the groups.
Conclusions All three training modalities resulted in improved chair stand performance. Strength training was superior to home based exercise in improving pain and self-reported physical function while Nordic walking was superior to the other training modalities for improved walking distance in six minutes.
Fautrel et al. Impact of osteoarthritis: results of a nationwide survey of 10,000 patients consulting for OA. Joint Bone Spine 2005; 72: 235-40
Fernandes et al. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. Ann Rheum Dis 2013;72:1125–1135
Fransen et al. Exercise for osteoarthritis of the hip. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD007912
Altman et al. The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum 1991; 34: 505-14
Disclosure of Interest None declared
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