Exercise Training in Treatment and Rehabilitation of Hip Osteoarthritis: A 12-Week Pilot Trial

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. 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