You’ve been told your hip arthritis needs exercise, and now you have to pick a lane: heavy lifting to build the muscle around the joint, or slower control and balance work to move better. A large 2024 trial put those two head to head, and the answer is more freeing than you’d expect.
The study, briefly
Kjeldsen and colleagues ran a multicentre, cluster randomised, assessor blinded superiority trial across hospitals and physiotherapy clinics in Denmark, published in Annals of Internal Medicine. They enrolled 160 adults with clinically diagnosed hip osteoarthritis between January 2021 and April 2023, and assigned them to one of two 12 week programs (Kjeldsen et al., Annals of Internal Medicine, 2024;177(5):573-582).
- Progressive resistance training (82 participants): five high intensity resistance exercises targeting the muscles around the hip and knee.
- Neuromuscular exercise (78 participants): ten exercises emphasising sensorimotor control and functional stability, which in plain terms means training the timing, balance and joint control side of movement rather than maximum load.
Both groups got exactly the same dose: two supervised 60 minute group sessions per week for 12 weeks, so 24 supervised sessions in total. The primary outcome was the 30 second chair stand test, a simple count of how many times you can get out of a chair in half a minute. It is one of the better real world measures of lower body function, because getting up off a couch is the thing people with hip arthritis actually complain about. Key secondary outcomes were the pain and hip related quality of life subscales of the Hip Disability and Osteoarthritis Outcome Score, or HOOS.
The word “superiority” in the study design matters. The researchers set out expecting heavy strength training to win.
What they found
It didn’t. The two groups were, functionally, a tie.
- Chair stands improved identically. Both groups gained 1.5 extra chair stands in 30 seconds (95% CI 0.9 to 2.1 in each arm). The between-group difference was 0.0 stands, with a confidence interval of negative 0.8 to 0.8 (Kjeldsen et al., 2024). That is about as clean a null result as this kind of trial produces.
- Pain improved in both, by a similar amount. HOOS pain rose 8.6 points with resistance training (95% CI 5.3 to 11.8) and 9.3 points with neuromuscular exercise (95% CI 5.9 to 12.6). The difference between them was negative 0.7 points (95% CI negative 5.3 to 4.0).
- Quality of life also moved together. Hip related quality of life improved 8.0 points with resistance training and 5.7 points with neuromuscular exercise, a difference of 2.3 points (95% CI negative 3.0 to 7.6). The interval spans zero, so there is no meaningful separation.
- Both worked. This is the part that gets lost when a study reports “no difference.” Both groups genuinely improved from baseline on all three measures, and every one of those improvements had a confidence interval sitting clear of zero.
The catch
Two limitations shape how much weight I put on this.
First, participants and the treating physiotherapists were not blinded, which the authors list as their stated limitation. Nobody in a supervised exercise trial can be, realistically. You know whether you are squatting under load or doing single-leg control drills. That matters most for the self reported outcomes, pain and quality of life, because expectation shapes how people rate their own symptoms. It matters much less for the chair stand test, which is somebody counting how many times you stand up. And the chair stand result was the tightest tie of the three, so the objective measure is the one I trust most here.
Second, and more practically: follow-up stopped at 12 weeks. This study tells you nothing about what these two approaches look like at six months or two years. That is a real gap, because hip osteoarthritis is a decades-long condition and 12 weeks is a snapshot. It is entirely possible that heavy resistance training builds a reserve of strength that pays off later, or that the control-focused work is easier to stick with long term. The trial cannot tell you either way.
One more honest note: this was a superiority trial, not an equivalence trial. It was designed to detect resistance training being better, and it failed to. Strictly speaking, “we did not find a difference” is not the same statement as “we proved they are the same,” though with a between-group difference of exactly 0.0 stands and a narrow interval, the practical read is clear enough.
What this means for you
Pick the one you will actually keep doing. This is the whole message. If you like lifting, lift. If barbells intimidate you, or your knees complain, or you’d rather work on balance and step control, that route got the same results. The variable that both groups shared was 24 supervised sessions in 12 weeks. The consistency was the active ingredient, not the philosophy.
Set realistic targets. Here is a concrete three month goal you can hold yourself to, drawn straight from the numbers: about 1.5 more chair stands in 30 seconds, and roughly a 9 point improvement on a 100 point hip pain score. That is not a cure and it is not dramatic. It is meaningful, measurable progress in something you do dozens of times a day. Test yourself now with a stopwatch and a dining chair, write the number down, and retest in 12 weeks.
Twice a week, supervised, was the dose. Not daily. Not five days a week. Two sessions of about an hour, with someone watching your form and pushing the progression. If you are trying to do this alone from a printed handout, the thing you are most likely missing is progression, meaning the exercises getting harder as you get stronger. That is why I build a written, progressing plan rather than a static sheet. If you want that structure without ongoing visits, a home exercise program is designed for exactly this.
Do not stop moving in between. Neither arm of this trial was a walking program, but general activity remains the backdrop for joint health. I’ve written before about whether walking is enough to build strength, and the short version applies here: walking is excellent for the joint and for your health, but it will not add chair stands. You need resistance or control work on top of it, and this trial says you get to choose which.
Reassess before you assume surgery is next. Twelve weeks of the right dose of exercise changed pain and function measurably in both arms. If you have not had a real, progressed, supervised trial of exercise, that is worth doing before you make decisions about the joint itself.
Where to start
If your hip has been limiting what you do and you are not sure which of these two paths fits you, that is a good problem to solve in person. In an hour together I can test your strength, your control, and your chair stand baseline, then hand you the version of this that matches how you actually like to train. You can reach out here to get started. If you would rather run your care through insurance, CACC Physical Therapy is the insurance-based option.
References
- Kjeldsen T, Skou ST, Dalgas U, Tonning LU, Ingwersen KG, Birch S, Holm PM, Frydendal T, Garval M, Varnum C, Bibby BM, Mechlenburg I. Progressive Resistance Training or Neuromuscular Exercise for Hip Osteoarthritis: A Multicenter Cluster Randomized Controlled Trial. Annals of Internal Medicine. 2024;177(5):573-582. doi:10.7326/M23-3225. PMID 38588540. https://pubmed.ncbi.nlm.nih.gov/38588540/
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