In most studies the participants exercised under the supervision of a physiotherapist. The duration of the interventions ranged from 6 see more to 12 weeks, except in two studies where it was 24 and 52 weeks. Results of the studies to date suggest that treatment effects of exercise are generally small, as presented in Figure 2. A 2009 Cochrane review of land-based exercise for hip osteoarthritis, Libraries combining the results of five clinical trials, demonstrated a small treatment

effect for pain but no benefit in terms of improved self-reported physical function (Fransen et al 2009). The authors concluded that the limited number and small sample sizes of the trials restricts the confidence that can be attributed to these results and that

further clinical trials with larger sample sizes and exercise programs specifically designed for people with symptomatic hip osteoarthritis need to be conducted. Similar conclusions were reached by the authors of another 2009 systematic review where it was stated that there was insufficient evidence to suggest that exercise therapy alone can be an effective short-term management approach with respect to pain, function, and quality of life (McNair et al 2009). Conversely, the results of a 2008 meta-analysis were more favourable in terms of the benefits of exercise for pain relief in hip osteoarthritis but studies using aquatic programs were also included KPT330 in the analysis as well as specific hip data obtained from the authors of the studies (Hernandez-Molina et al 2008). The review concluded that therapeutic exercise, especially with specialised hands-on exercise training and an element of strengthening, is an efficacious treatment for hip osteoarthritis. Since these systematic reviews, four Dipeptidyl peptidase additional high-quality, large, randomised trials of exercise have provided data specific to hip osteoarthritis (Abbott et al 2013, Fernandes et al 2010,

French et al 2013, Juhakoski et al 2011), as presented in Table 1. In general these trials found non-significant mean improvements in pain with various types of exercise that are well short of the benchmark minimum clinically important difference. When combined with the earlier studies in a meta-analysis, an overall treatment effect on pain was significant but small (SMD −0.30, 95% CI −0.51 to −0.09) as presented in Figure 2a. In contrast to pain, exercise appeared to have greater effects on physical function in the recent studies. With all studies combined, the overall treatment effect on function was again significant but small (SMD −0.23, 95% CI −0.45 to −0.002) as presented in Figure 2b. In the study by Abbott et al (2013), a multimodal exercise program with initial physiotherapist-supervised sessions and home exercises thrice weekly led to statistically and clinically significant improvements in physical function at 2 years (p = 0.005), but with suboptimal, non-significant effects on pain.