Resea ch A icle
Exe cise T aining in T ea men and Rehabili a ion o Hip
Os eoa h i is: A 12-Week Pilo T ial
Ki s i Uusi-Rasi,1Radhika Pa il,1Saija Ka inkan a,1Ka i Tokola,1
Pekka Kannus,1,2 and Ha i Sie änen1
1The UKK Ins i u e o Heal h P omo ion Resea ch, Tampe e, Finland
2Depa men o O hopaedics and T auma Su ge y, Tampe e Uni e si y Hospi al and Medical School,
Uni e si y o Tampe e, Tampe e, Finland
Co espondence should be add essed o Ki s i Uusi-Rasi; ki s i.uusi- asi@u a. i
Recei ed 7 July 2016; Accep ed 30 No embe 2016; Published 1 Janua y 2017
Academic Edi o : Me y Jo Ou sle
Copy igh © 2017 Ki s i Uusi-Rasi e al. This is an open access a icle dis ibu ed unde he C ea i e Commons A ibu ion License,
which pe mi s un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal wo k is p ope ly ci ed.
In oduc ion. Os eoa h i is (OA) o he hip is one o he majo causes o pain and disabili y in he olde popula ion. Al hough
exe cise is an e ec i e ea men o knee OA, he e is lack o e idence ega ding hip OA. The aim o his ial was o es he sa e y
and easibili y o a speci ically designed exe cise p og am in elie ing hip pain and imp o ing unc ion in hip OA pa icipan s and o
e alua e a ious me hods o measu e changes in hei physical unc ioning. Ma e ials and Me hods.13womenaged≥65 yea s wi h
hip OA we e ec ui ed in his 12-week pilo s udy. Resul s. Pain declined signi ican ly o e 30% om baseline, and join unc ion
and heal h- ela ed quali y o li e imp o ed sligh ly. Objec i e assessmen o physical unc ioning showed s a is ically signi ican
imp o emen in he maximal isome ic leg ex enso s eng h by 20% and in he hip ex ension ange o mo ion by 30%. Conclusions.
The exe cise p og am was ound o be sa e and easible. The p esen e idence indica es ha he exe cise p og am is e ec i e in he
sho e m. Howe e , adequa e powe ed RCTs a e needed o de e mine e ec s o long- e m exe cise he apy on pain and p og ession
o hip OA.
1. In oduc ion
Os eoa h i is (OA) is a common disease p esen ing wi h
join pain, s i ness, swelling, and ins abili y esul ing in
unc ional impai men in daily ac i i ies. Due o i s high
p e alence in he olde popula ion, OA has a majo impac
on heal hca e cos s globally. Pha macological ea men is no
ecommended as he p ima y ea men o OA [1–3], and
e ec s o a ious physical he apy echniques on elie ing
pain o imp o ing join unc ion ha e emained a he small
[4]. Consequen ly, symp oma ic hip OA o en leads o hip
eplacemen su ge y.
The main ea men goal in OA is o educe join pain
and minimize physical disabili y [5]. E ec i eness o ae obic
and s eng h aining is ecommended as he i s -line conse -
a i e ea men app oach in adul s wi h mild- o-mode a e
knee OA [3]. Despi e cu en na ional and in e na ional
guidelines o he use o exe cise in pa ien s wi h hip OA, e y
ew clinical exe cise ials ha e been conduc ed in pa ien s
wi h hip OA. A Coch ane e iew by F ansen e al. included 10
exe cise ials[6],andonly5 ec ui edsolelypa ien swi hhip
OA [7–10]; one o hese was p esen ed as an abs ac only [11].
Fi e o he included s udies had mixed sample o hip and knee
OA pa ien s wi h he p opo ion o hip OA in hese combined
p og ams being always smalle han he p opo ion wi h knee
OA [12–16]. Howe e , he esul s a e inconsis en .
P og ams de eloped o OA o he lowe limbs seem o
bene i pa ien s wi h knee OA mo e han hose wi h hip
OA. Juhl e al. ound ha exe cise p og ams o knee OA
should ocus on imp o ing ae obic capaci y, quad iceps mus-
cle s eng h, o lowe ex emi y pe o mance. Fo op imal
esul s, he p og am should be supe ised and ca ied ou 3
imes weekly and comp ise a leas 12 sessions [17].
Exe cise he apy aims a educing pain and disabili y by
imp o ing muscle s eng h, join s abili y, ange o mo ion
(ROM), and ae obic i ness [10]. Whe eas aining ocusing
on imp o ed muscle s eng h and ae obic capaci y is known
o alle ia e OA symp oms, e ec s o exe cise need u he
Hindawi
Jou nal o Os eopo osis
Volume 2017, A icle ID 3905492, 7 pages
h ps://doi.o g/10.1155/2017/3905492
2Jou nal o Os eopo osis
elucida ion [18]. Pa ien s wi h hip OA a e assumed o espond
o exe cise in he same way as pa ien s wi h o he ch onic
lowe limb pain condi ions do. Hip OA pa ien s need speci -
ically de eloped and execu ed exe cise aining o ensu e
adequa e compliance [19].
Thus, mo e e ec i e, easible, and sus ainable exe cise
p o ocols o hip OA a e needed o u he de eloping he a-
peu ic exe cise ecommenda ions o he disease. The p esen
12-week pilo ial aimed o es he sa e y and easibili y o a
speci ically designed exe cise p og am in elie ing hip pain
and imp o ing unc ion in hip OA subjec s and o e alua e
me hods omeasu echangesinphysical unc ioning.
2. Pa icipan s and Me hods
2.1. Pa icipan s. Pa icipan s we e ec ui ed om he wai -
ing lis o he o hopedic ou pa ien clinic o Ha anp¨
a¨
a
and COXA Hospi al (specialized in join eplacemen s) in
Tampe e, Finland. Thi een women aged be ween 65 and
83 yea s, wi h mode a e o se e e es ic ions in mobili y,
debili a ing pain, and di icul ies in walking, s ai climbing, o
pu ing on shoes, olun ee ed o pa icipa e in his pilo ial
and ga e in o med consen . A heal h his o y ques ionnai e
sc eened o sel - epo ed heal h, como bidi ies, medica ion,
andli es yle(physicalac i i y,useo alcohol,andsmoking).
Pa icipan s we e hen in i ed o a baseline examina ion,
which included a physician’s examina ion, ques ionnai es,
and measu emen s o physical unc ioning (s eng h, balance,
and mobili y).
Inclusion c i e ia we e age ≥65 yea s, li ing a home
independen ly, and unila e al o bila e al hip OA wi h pain
in he hip egion (g oin and la e al hip) du ing he p e-
ceding mon h. Exclusion c i e ia we e bila e al o al hip
eplacemen , mode a e- o-se e e knee OA, ac u e du ing
he p eceding 12 mon hs, and ch onic condi ions such as
heuma oid a h i is o majo su gical p ocedu es in he
p eceding 6 mon hs (lowe limb o lowe back). Medica ion
used was no an inclusion o exclusion c i e ion.
This s udy was conduc ed acco ding o he guidelines o
good clinical p ac ice, and he s udy p o ocol was app o ed
by he Pi kanmaa Hospi al Dis ic E hics Commi ee, Tam-
pe e, Finland (R15004).
2.2. An h opome y. Heigh and weigh we e measu ed wi h
s anda d me hods. Body composi ion ( a and lean so
issue mass) and emo al neck bone mine al densi y we e
assessed wi h dual-ene gy X- ay abso p iome y (DXA,
Luna P odigy Ad ance, GE Luna , Madison, WI, USA) [20].
DXA measu emen was pe o med only a baseline. All o he
measu emen s desc ibed below we e done a baseline and a
12 weeks.
2.3. Pain and Sel -Repo ed Physical Func ion. The p ima y
ou come o he s udy was hip join pain assessed by he
Wes e n On a io and McMas e Uni e si y Os eoa h i is
Index [21] (WOMAC, Finnish e sion [22]). WOMAC p o-
duces h ee subscale sco es (pain, s i ness, and physical
unc ion) and a o al sco e (WOMAC Index) ha e lec s
o e all disabili y. Each i em is assessed on a Visual Analog
Scale, wi h a possible ange o sco es o 0–100 mm. I ems
a e summed o each subscale, pain ( ange = 0–500 mm, 5
i ems), s i ness ( ange = 0–200 mm, 2 i ems), and physical
unc ion ( ange = 0–1700 mm, 17 i ems), and o he o al
WOMAC Index ( ange: 0–2400 mm). Sel - epo ed disease-
speci ic disabili y was assessed using he pain and unc ioning
subscales a baseline and a 12 weeks [23]. Quali y o li e was
assessed by he LEIPAD ques ionnai e [24].
2.4. Hip Join Assessmen and Physical Func ioning. Physical
unc ioning (s eng h, balance, and mobili y) was measu ed
objec i ely. The maximal isome ic leg ex enso muscle
s eng h was measu ed by a leg p ess dynamome e . Timed-
Up and Go (TUG) [25], he Sho Physical Pe o mance
Ba e y (SPPB) (s a ic balance, 4-me e walking speed and
i e- ime chai s and) [26], 9-s ep s ai climb 20 cm [27], and
hip ROM [28] we e assessed. Pos u al balance was assessed
using he o ce pla o m (Good Balance, Me i u , Jy ¨
askyl¨
a,
Finland) [29]. The sys em uses e ical o ce signals om each
co ne o he pla o m o calcula e x(mediola e al, ML) and
y(an e opos e io , AP) coo dina es o he pla o m cen e o
p essu e (COP) when he es pe son s ood on i . Mean ML
and AP eloci y (mm/s) and momen o eloci y (mm2/s)
we e calcula ed. Balance was es ed in he no mal s anding
posi ion in ou es condi ions: eyes open, eyes closed, eyes
open wi h cogni i e ask (men al a i hme ic), and eyes open
whiles andingona oamshee .Pedome e s(Om onWS
III; Om on Heal hca e, Inc., Lake Fo es , IL) we e used
h oughou he 12-week pe iod o objec i e assessmen o
daily s eps aken.
2.5. T aining P og am. T aining was led o implemen ed
as ci cui aining sessions by expe ienced exe cise leade s
(physio he apis s) 3 imes a week o 12 weeks. Fi e sessions
we e o e ed weekly, om which pa icipan s could selec
any h ee. T aining was s a ed wi h a 2-week amilia izing
pe iod o accus om he pa icipan s o he exe cise, ollowed
by5weeksin heexe cisehalland5weeksin hegym.All
sessions las ed 60 minu es and included a 10-minu e wa m-
up as well as s e ching o majo muscle g oups. Exe cise
leade s kep a eco d o pa icipan s’ a endance and possible
ad e se e en s.
T aining was p og essi e and was implemen ed as g oup-
based sessions bu was planned wi h indi idual goals and
limi a ions in mind. Sessions in he exe cise hall ocused
on ange o mo ion, lowe limb muscle s eng h, balance,
agili y, mobili y, and change o di ec ion. P og ession was
achie ed wi h he use o di e en su aces, mul idi ec ional
mo emen pa e ns, and changing he base o suppo . In
addi ion o own body weigh , ankle o es weigh s and s ep-
boa ds o inc easing heigh we e used o inc ease he in ensi y
o aining. Ad anced p og ams we e also ae obic in na u e.
Du ing he gym sessions, esis i e equipmen was used.
All sessions included 8-9 di e en exe cises ocusing on
s eng hening lowe limb muscles (leg ex enso s, hip ex en-
so s, hip abduc o s, hip o a o s, knee ex enso s, and cal
muscles) as well as o he la ge muscle g oups (abdominal,
back, shoulde , and a m muscles). The i s gym pe iod began
wi h 30–60% o one epe i ion maximum (1RM) p og essing
Jou nal o Os eopo osis 3
Table 1: Cha ac e is ics o he pa icipan s (mean (SD)).
Baseline End poin
Daily walking, mean s eps in 12 wks 5195 (2133) NA
Mini-Men al S a e Examina ion Sco e (0–30)127.8 (2.3) NA
Body a , %142.5 (6.4) NA
Femo al neck 𝑡-sco e1,2 0.01 (0.93) NA
WOMAC
To alindex( ange:0–2400) 796(576) 583(652)
Pain sco e ( ange: 0–500) 202.4 (123.4) 131.9 (143.6)
S i ness sco e ( ange: 0–200) 99.1 (63.5) 76.8 (54.2)
Func ion sco e ( ange: 0–1700) 494.5 (413.9) 375.0 (474.1)
Physical unc ioning
No mal walking speed, m/s 0.9 (0.2) 0.9 (0.2)
Fas walking speed, m/s 1.2 (0.2) 1.75 (1.8)
TUG, s 9.1 (1.5) 10.5 (2.2)
Chai s and ime, s 14.8 (3.3) 14.2 (2.6)
S ai climb, s 11.5 (1.9) 12.2 (2.4)
Isome ic leg ex enso s eng h, N/kg 19.3 (8.0) 23.2 (10.2)
SPPB sco e (0–12) 9.9 (1.2) 9.9 (1.9)
Balance
ML eloci y, eyes open, mm/s 3.7 (2.3) 4.7 (2.5)
AP eloci y, eyes open, mm/s 6.7 (2.8) 8.7 (6.3)
Momen o eloci y, eyes open, mm2/s 8.8 (5.6) 15.1 (13.0)
ROM
Hip abduc ion, a h i ic side 33.2 (11.5) 33.8 (11.2)
Hip abduc ion, heal hy side 42.0 (7.2) 42.6 (6.8)
Hip lexion, a h i ic side 96.2 (10.2) 98.8 (14.2)
Hip lexion, heal hy side 104.0 (10.7) 103.5 (11.4)
Hip ex ension, a h i ic side 12.1 (4.5) 15.8 (5.9)
Hip ex ension, heal hy side 16.8 (5.5) 19.5 (7.0)
1Only baseline measu emen s.
2Femo al neck bone densi y compa ed o e e ence popula ion om Finland (age: 20–40 yea s).
o 60–75% o 1RM o e 5 weeks. Two se s o each exe cise
we e done, wi h each se consis ing o 8–12 epe i ions.
In ensi y o aining was assessed using he a e o pe cei ed
exe ion scale (RPE). The a ge RPE anged om 13 o 18 and
ad anced p og essi ely. Balance aining was included in a
sho wa m-up pe iod. De ailed desc ip ion o he aining
p og am is p esen ed in Table 2.
2.6. S a is ical Analysis . Desc ip i e in o ma ion is p esen ed
as means and s anda d de ia ions (SD). Pai ed - es s we e
used o compa e changes o e ime (12 weeks) in pain and
physical unc ioning. Resul s ela ed o WOMAC sco es,
physical unc ioning, and quali y o li e a e p esen ed as pe -
cen changes wi h 95% con idence in e als (CI). 𝑝 alues less
han 0.05 we e conside ed s a is ically signi ican . Because he
pu pose o his pilo s udy was o es he easibili y and sa e y
o he exe cise p og am, powe calcula ions o ea men
e ec s we e no done.
3. Resul s
Baseline cha ac e is ics a e gi en in Table 1. All pa icipan s
we e nonsmoking women wi h mean age (SD) o 71.6 (6.0)
yea s. Mean heigh was 163.5 (7.0) cm, weigh was 76.5
(12.3) kg, and body mass index (BMI) was 28.5 (3.3) kg/m2.
Weigh emained cons an [mean change: 0.1 (1.9) kg, 𝑝=
NS] du ing he 12-week in e en ion. Th ee women had no
diagnosed illness o he han hip OA, and he mos common
medica ion was o high blood p essu e (𝑛=8). No changes
we e made in OA medica ion du ing he in e en ion. The
mos o en used medica ion was he NSAIDs (nons e oid
an i-in lamma o y d ugs).
3.1. Sa e y and Feasibili y o he P og am. Exe cise compli-
ance measu ed as a endance a all o e ed sessions was 90%
( ange: 42% o 100%), and all pa icipan s a ended he end
poin measu emen s. In gene al, he aining p og am was
4Jou nal o Os eopo osis
Table 2: De ailed desc ip ion o he aining p og am.
Pe iod Desc ip ion Mo emen s and Execu ion
In oduc ion
o exe cise
hall, 2 weeks
G oup aining, weeks 1 and 2
(i) 10 min wa m-up
(ii) 20 min balance and agili y exe cises
(iii) 20 min muscle s eng h, lexibili y, and mobili y exe cises
(i ) 10 min s e ching
Wa m-up and balance aining in s anding posi ion
S eng h and mobili y while aining pa ly while si ing on a chai
S e ching while si ing on a chai
I pe iod:
exe cise hall,
5weeks
G oup aining, weeks 3, 5, and 7
(i) 10 min wa m-up
(ii) 20 min balance and agili y exe cises
(iii) 20 min muscle s eng h, lexibili y, and mobili y exe cises
(i ) 10 min s e ching
Ci cui aining, weeks 4 and 6:
8 mo emen s, 1 min wo k, 1 min es , 2 ounds
(i) 10 min wa m-up
(ii) 40 min balance, agili y, mobili y, and muscle s eng hening
(iii) 10 min s e ching
Balance and mobili y:
(i) Reducing base o suppo using di e en oo posi ions in s anding
(ii) Swaying, eaching ou in di e en di ec ions
(iii) Changing di ec ions and speed du ing walking, mul idi ec ional s epping pa e ns
(i ) S epping o e obs acles and using di e en su aces o walking and s epping
Muscle s eng h:
(i) Knee ex ension in si ing posi ion and lexion in s anding posi ion
(ii) Hip abduc ion, lexion, and ex ension in s anding posi ion
(iii) Si o s and, squa s, and heel aises (wi h o wi hou suppo o a chai )
(i ) S ep boa d exe cises wi h a ying heigh
( ) T unk lexion and ex ension in si ing posi ion
( i) Body weigh , esis ance bands, o ankle weigh s o esis ance
Flexibili y and join mobili y:
(i) Hip a ea, spine, uppe limbs, and shoulde -neck egion
In oduc ion
o gym II
pe iod: in he
gym, 4 weeks
In oduc ion, week 8
Ci cui aining in pai s, weeks 9–12
(i) 10–15 min wa m-up emphasizing balance and mobili y exe cises
(ii) 40 min aining especially o he lowe limbs
(iii) 5–10 min s e ching
(i ) 6–8 exe cises, 10–12 epe i ions, 2 se s wi h 2 min es
( ) Fi s 4 weeks, p og ession om he le el 30% 1RM o 60% 1RM:
a ge 60–65% 1RM
( i) Weekly 5–10% inc ease in esis ance, accompanied by
educ ion in he numbe o epe i ions
Flexibili y and join mobili y:
(i) Leg p ess
(ii) Hip abduc ion
(iii) S anding up om he chai (using a weigh es )
(i ) Hip ex ension
( ) Hip lexion
( i) Hip o a ion
( ii) Heel ise wi h a weigh es
( iii) Back ex ension
(ix) One limb ches p ess wi h body o a ion
(x) Rowing, sawing
(xi) Squa ing wi h pulley weigh s
Jou nal o Os eopo osis 5
−40 −20 0 20406080
Quali y o li e
No mal walking
Fas walking
TUG
Chai s and
S ai climb
Leg ex enso s eng h
Abduc ion
Flexion
Ex ension
S i ness
Func ion
Pain
Fa o s aining (%)
Changes (%)
WOMAC
ROM
Physical unc ioning
Figu e 1: Mean changes (95% CI) in he main ou come a iables in 12 weeks.
Baseline
Pain
0
50
100
150
200
250
300
350
400
450
500
(mm)
12 weeks
Figu e 2: Indi idual changes in he WOMAC pain sco e in 12 weeks.
The mean (SD) pain sco e a he baseline and 12-week ime poin is
ma ked wi h a do being 202 (123) mm and a 12-week ime poin 131
(143) mm, espec i ely ( educ ion 35%, 𝑝 = 0.002).
well ole a ed and no one consul ed he a ending physician
(PK), al hough one pa icipan wi hd ew om he aining
due o back pain (addi ional diagnosis o p olapsus disci
in e e eb alis was done du ing he in e en ion).
3.2. E ec s on Pain, S i ness, and Func ion. Mean changes
(95% CI) in he ou comes o in e es a e shown in Table 1
and Figu e 1. Mean educ ion in he WOMAC pain sco e was
35% (8% o 62%), wi h la ge indi idual a ia ions; decline
was seen in 9 o 13 pa icipan s (Figu e 2). Reduc ion in he
s i ness o unc ion sco es was also seen bu did no each
s a is ical signi icance. The o al WOMAC Index educed by
27% (−4% o 57%, 𝑝 = 0.079).
3.3. E ec s on Physical Func ioning. Mean SPPB sco e was
9.9 (1.2) a baseline, wi h no change a 12 weeks. Also,
he e we e no signi ican changes in walking speed, chai
s and, o s ep climbing imes. Mean (95% CI) isome ic leg
ex enso s eng h inc eased by 3.8 (1.1 o 6.6) N/body weigh .
Unexpec edly, mean TUG ime was 1.4 s (0.6 o 2.2 s) slowe
a 12 weeks compa ed o baseline (Figu e 1). Pos u al sway
wi h eyes open showed a end o small 6.3 (−0.3 o 12.9,
𝑝 = 0.06)mm
2/s inc ease in momen o eloci y. Closing
eyes, adding a cogni i e ask, and s anding on oam inc eased
sway and eloci y compa ed wi h he eyes open es , wi h
no s a is ically signi ican changes ( esul s no shown). Hip
ex ension ROM inc eased signi ican ly, wi h he mean change
being 30% (7% o 54%), bu no signi ican changes we e
oundinhipabduc iono lexion.The ewasa end o
imp o emen in quali y o li e, wi h mean change o 13.8%
(−2.4 o 29.9%, 𝑝 = 0.09).
4. Discussion
The signi ican 30% educ ion ound in pain is la ge enough
o be conside ed clinically ele an [9, 12]. Thus, he esul s
o his pilo ial suppo and u he de elop he speci ic
exe cise p og am o ehabili a ion o hip OA.
Besides pain, he pu pose o he aining was o imp o e
join unc ion which was also la gely achie ed. Impo an ly,
isome ic leg ex enso muscle s eng h imp o ed s a is ically
signi ican ly by 20% and hip ex ension ROM by 30%. How-
e e , no imp o emen s in ROM o he hip lexion o abduc-
ion we e seen, possibly because bo h s eng hening and
ROM exe cises we e mainly a ge ed owa ds imp o ing hip
ex ension. O he ou comes o physical unc ioning emained
unchanged o only showed a end o imp o emen . Su p is-
ingly, he TUG es e en showed 15% wo sening in spi e o
educed pain and imp o ed leg s eng h and hip ROM.
Hip OA may educe pos u al s abili y, inc easing he
isk o alling. In ou s udy, pos u al sway wi h eyes open

6Jou nal o Os eopo osis
inc eased sligh ly, as did hip ex ension ROM. This may indi-
ca e ha he pa icipan s ha e be e con idence in main ain-
ing s abili y as a esul o aining, no necessa ily declined
balance [30]. Simila ly, Nagy e al. showed g ea e sway in
olde adul s a e 8-week balance, s eng h, lexibili y, and
ae obic aining in spi e o imp o ed unc ional pe o mance.
This migh ha e been due o imp o ed balance con idence
ela ed o ainees’ be e abili y o con ol he mo ion o hei
hip and lowe limbs [31]. I has also been shown ha ime o
day e ec in pos u al sway measu emen s is high especially
in olde adul s [32]. In his s udy, he baseline and end poin
measu emen s we e done a he same ime o he day.
Wide indi idual a ia ion in aining esponses and he
small s udy sample possibly con ounded some o he indings.
OA is a disease wi h in e mi en symp oms agg a a ed by
a ious ac o s such as ac i i y le els, li es yle, and e en ime
o day [33]. These may a ec pe o mance in mobili y es s,
such as he TUG and s ai climbing. The e o e, in addi ion o
ala ge s udyg oup,alonge ollow-uppe iodwi hacon ol
g oup wi h mo e han wo measu emen poin s is needed o
e alua e he e ec s o exe cise.
The ecen Coch ane e iew by F ansen e al. demon-
s a ed a signi ican imp o emen wi h exe cise in sel -
epo ed pain and physical unc ion among he small subse
o pa icipan s wi h hip OA only, bu he pain educ ion was
a he small [6]. Physical unc ioning was assessed objec i ely
in only wo s udies [8, 9], and no be ween-g oup di e ences
we e obse ed. Resul s om mo e ecen me a-analysis o
land-based exe cise o hip OA emain consis en wi h he
Coch ane e iew. Simila ly, wa e -based exe cise he apy
showed sligh pain elie in pa ien s wi h hip OA in he
sho e m [34]. Howe e , wa e -based exe cise he apy is no
always easible. Also, no bene i s o physical he apy ei he
combined wi h exe cise o alone ha e been ound, bo h in
e ms o sel - epo ed pain o unc ion and in objec i ely
measu ed changes in physical unc ioning [4, 34].
Whe eas pain elie is he mos impo an ou come,
physical unc ioning ough o be e alua ed objec i ely as well,
because i is di icul o a ain long- e m bene i s wi hou clin-
ically meaning ul imp o emen s in unc ion. Twel e weeks is
a sho ime o e ec i e p og ession in aining. P og essing
oo apidly could wo sen pain, likely discou aging pa ien s
o con inue aining. On he o he hand, oo ligh exe cise
may emain ine ec i e. In spi e o he sho du a ion, ou
esul s we e encou aging. Mos o he exe cise ials in hip
OA pa ien s ha e also been o sho du a ion, mainly be ween
6 and 12 weeks, wi h some bene i s epo ed immedia ely
a he end o he in e en ion. Only wo s udies e alua ed
sus ained bene i s o physical unc ion [7, 9], wi h nei he
demons a ing a signi ican educ ion in pain. One eason
o hismaybe he ac ha hepa icipan shad ela i ely
low WOMAC pain sco es, wi h less oom o imp o emen .
This sugges s ha he equency o in ensi y o exe cise
was oolowo du a ionwas oosho oimp o ephysical
unc ioning.
E ec i e exe cise in hip OA also equi es mo i a ed
pa icipan s. Ou aining was s a ed a low in ensi y and
le el o di icul y. Since g oup sizes we e small, he leade s
we e able o pay indi idual a en ion o op imal join loading
and pe o mance echniques o a oid agg a a ion o join
symp oms. This esul ed in excellen aining compliance
o e 12 weeks. Compliance may be mo e di icul o main ain
o e a longe du a ion.
5. Conclusions
Exe cise p og ams ocusing on imp o ing ae obic capaci y,
quad iceps muscle s eng h, o lowe ex emi y pe o mance
ca ied ou 3 imes weekly comp ising a leas 12 sessions
ha e been conside ed op imal ea men o knee OA. These
p inciples we e ollowed in planning he exe cise p og am o
hip OA. The aining p og am was ound o be easible and
sa e, hough i was o a sho du a ion. This s udy suppo s
he use o exe cise aining in educing hip OA pain. Fu he
con olled s udies wi h la ge g oup sizes a e needed o
de e mine he long- e m bene i s o exe cise and i s e ec s
on he p og ession o he disease.
Compe ing In e es s
The au ho s decla e ha hey ha e no compe ing in e es s.
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