Implementing exercise therapy for hip and knee osteoarthritis in the clinic: a best practice narrative review

Major guidelines recommend exercise for hip and knee osteoarthritis (OA), yet few provide guidance on how to prescribe it. This narrative review synthesizes high-quality and clinically relevant evidence on exercise therapy for hip or knee OA, prioritizing systematic reviews and randomized controlled trials. Findings were summarized across nine topics, with a focus on translating the evidence into specific guidance for clinicians. Clinicians should consider measuring pain, physical function, quality of life, and global assessment for most patients with hip or knee OA. When educating about OA, clinicians should focus on what patients can do and avoid impairment-based language. Exercise therapy is safe and provides small to moderate improvements in pain and function, although effects appear smaller for hip OA than for knee OA. No exercise type has proven superior, nor has a dose-response relationship been established. Patients with higher baseline pain and poorer function may benefit somewhat more, but effects differ little across other patient characteristics, including comorbidity burden and radiographic severity. Whether increasing adherence leads to greater improvements in pain and function remains unclear, but helping patients start and sustain exercise remains a priority, given its wide-ranging health benefits. In-person, telehealth, and self-directed delivery can all improve pain and function, and they appear to offer benefits of similar magnitude. Overall, exercise is safe, with the most common adverse event being temporary muscle or joint soreness. Clinicians do not need to search for an optimal program but can instead build one around the patient's priorities, preferences, and needs.