There isn’t one single best exercise for hip osteoarthritis. The most effective approach combines strengthening, low-impact aerobic activity, and flexibility work. Exercise is one of only a few treatments that major rheumatology guidelines strongly recommend for hip OA, and the evidence behind it is robust: structured programs reduce pain by 26 to 33% and improve physical function enough that about half of participants experience clinically meaningful relief.
Why Exercise Works for Hip Arthritis
A hip with osteoarthritis has damaged cartilage, but the muscles, tendons, and ligaments surrounding it still respond to training. Stronger muscles absorb more of the load that would otherwise grind through the joint. Regular movement also pumps fluid through the cartilage that remains, keeping it nourished and more resilient. The American College of Rheumatology strongly recommends exercise as a core treatment for hip OA, placing it alongside weight loss and use of a cane as foundational strategies.
What surprises many people is how consistently exercise outperforms passive treatments. The ACR actually recommends against TENS units for hip and knee OA, and conditionally recommends against massage and manual therapy. Exercise requires more effort, but it changes the joint environment in ways that passive approaches cannot.
Strengthening the Right Muscles
The muscles that matter most for a hip with OA are the ones that stabilize and move the joint through its full range: hip abductors (the outer hip muscles that keep your pelvis level when you walk), hip extensors (the glutes), hip flexors, hip rotators, and the quadriceps. Weakness in any of these groups shifts extra stress onto the joint itself.
Effective strengthening routines typically include these movements:
- Hip abduction: Lying on your side, lifting the top leg straight up. This targets the outer hip muscles that are often the weakest link in people with hip OA.
- Hip extension: Lying face down or standing, pushing one leg straight behind you. This works the glutes, the largest hip stabilizers.
- Hip flexion: Standing or seated, raising the knee toward the chest against resistance. This keeps the front of the hip functional for stairs and getting out of chairs.
- Hip rotation: Seated with a resistance band, rotating the leg inward and outward. Internal and external rotation are often the first movements to become restricted in hip OA.
A pilot trial published in the Journal of Osteoporosis used 8 to 9 exercises per session, targeting not just these hip-specific muscles but also the core, back, and calf muscles. That broader approach matters because your hip doesn’t work in isolation. Weak abdominal and back muscles change the way your pelvis tilts, which changes the angle of force through the hip joint with every step.
Low-Impact Aerobic Activity
Strengthening alone isn’t enough. Aerobic exercise improves cardiovascular fitness, helps with weight management, and reduces the systemic inflammation that worsens OA symptoms. The key is choosing activities that don’t pound the joint.
Walking is the most accessible option for mild to moderate hip OA. It loads the joint enough to stimulate cartilage health without the impact forces of running. Cycling, whether stationary or outdoor, is another strong choice because it moves the hip through a large range of motion with almost no impact. For people with more advanced disease who find land-based exercise too painful, water-based options offer a way forward. The hydrostatic pressure of water reduces swelling, allows greater joint movement, and improves pain levels. Shallow water walking, swimming, and deep-water running all provide enough intensity to improve cardiovascular fitness while dramatically reducing joint stress.
As hip OA progresses, it often becomes difficult to exercise at sufficient intensity on land. That’s the point where shifting to cycling, pool walking, or swimming can keep you active when other options start to feel limiting.
Tai Chi as a Standalone Option
Tai chi deserves its own mention because the ACR gives it a strong recommendation for hip and knee OA, not just a conditional one. It combines slow, controlled movements with balance training, gentle strengthening, and mindfulness. For people who dislike gyms or find structured exercise programs unappealing, tai chi offers a single activity that covers multiple bases: strength, flexibility, balance, and stress reduction. Community classes are widely available and the movements can be modified for different ability levels.
Flexibility and Range of Motion
Stiffness is one of the most frustrating symptoms of hip OA, especially first thing in the morning or after sitting for a long time. Regular stretching won’t reverse cartilage damage, but it can preserve the range of motion you have and slow the loss of flexibility that gradually changes how you walk.
The hip flexor stretch is particularly important because many people with hip OA develop tightness at the front of the hip from unconsciously guarding the joint. To do it: stand in a wide split stance with your hands on something stable in front of you. Bend the front knee and push your hips forward while keeping your back straight. You should feel a stretch in the front of the hip and thigh of the back leg. Hold for 20 to 30 seconds and repeat five times. Similar holds targeting the inner thigh muscles (adductors) and the rotators help maintain the movement patterns you need for everyday tasks like getting in and out of a car or putting on shoes.
How Often and How Long
A meta-analysis of hip OA exercise trials found that programs producing real pain relief typically involved sessions of 30 to 60 minutes, done about three times per week. The median session length across successful trials was roughly 50 minutes. That doesn’t mean shorter sessions are worthless, but it does suggest that a 10-minute routine a few times a week probably won’t move the needle much.
A practical starting point is three sessions per week, each lasting 30 minutes or more, combining some strengthening exercises with a block of aerobic activity. You can split these up: two days focused on strengthening with a short warm-up walk, and one day of longer aerobic work like cycling or pool exercise. The most important variable isn’t the perfect program. It’s consistency over weeks and months.
Structured Programs vs. Exercising on Your Own
The GLA:D program, a structured neuromuscular training protocol developed in Denmark and now used internationally, gives a good picture of what supervised exercise can achieve. Across data from over 28,000 patients in Denmark, Canada, and Australia, participants improved 26 to 33% in pain intensity, 18 to 30% in the ability to stand from a chair, and 12 to 26% in joint-related quality of life. About 43 to 47% of patients experienced pain reductions large enough to be clinically meaningful, and results were similar for hip and knee OA.
That said, you don’t necessarily need ongoing supervision to get results. Research comparing unsupervised home exercise with formal physical therapy found no significant long-term differences in leg strength, self-reported physical function, or quality of life at 12 months. The supervised group may have an advantage early on, particularly in learning proper form and building confidence. But once you know what to do and how to do it safely, a consistent home routine produces comparable outcomes. If you’re new to exercise or unsure about your form, a few sessions with a physical therapist to learn the movements can be a worthwhile investment that you then carry forward independently.
Managing Pain During Exercise
Some discomfort during exercise is normal with hip OA, and it doesn’t mean you’re causing damage. A useful rule of thumb: if your pain increases during exercise but returns to its baseline level within 24 hours, the activity was within a safe range. If pain stays elevated for longer than that, or if you notice increasing swelling, dial back the intensity or duration at your next session.
Starting conservatively matters. People who push too hard in the first week often flare up and quit entirely. Begin with lighter resistance, shorter sessions, and fewer repetitions than you think you need. Increase by small increments every one to two weeks. The goal is to build a sustainable habit over months, not to maximize effort on day one.
Weight Loss Multiplies the Benefits
The ACR strongly recommends weight loss for people with hip OA who are above a healthy weight. Every pound of body weight translates to multiple pounds of force through the hip during walking and stair climbing. Losing even a modest amount of weight reduces the mechanical load on the joint and lowers levels of inflammatory compounds circulating in the body. Exercise combined with weight loss produces better outcomes than either strategy alone, making aerobic activity doubly valuable: it improves joint function directly while also helping create the calorie deficit needed for weight management.