Effects of pre- and post-surgery physical activity interventions on physical activity and sedentary behaviour levels following knee and hip arthroplasty: a systematic review and meta-analysis of randomised controlled trials
Date
2025
Authors
d'Unienville, N.
Singh, B.
Gower, B.
Szeto, K.
Badger, H.
Krywanio, M.
Maher, C.
Thewlis, D.
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Journal article
Citation
Osteoarthritis and Cartilage, 2025; 33(9):1066-1081
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Noah d'Unienville, Ben Singh, Bethany Gower, Kimberley Szeto, Heather Badger, Matilda Krywanio, Carol Maher, Dominic Thewlis
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Abstract
Objective To evaluate general exercise and behavioural interventions designed to improve physical activity (PA) or reduce sedentary behaviour in total knee or hip arthroplasty (TKA/THA) patients. Design A systematic review and meta-analysis were conducted on randomised controlled trials reporting PA or sedentary behaviour changes in TKA/THA patients, with effects calculated using standardised mean differences (SMD). Subgroup analyses assessed whether effects differed based on intervention characteristics, arthroplasty timing, outcome type, and follow-up duration. Risk of bias and certainty of evidence were assessed using the PEDro scale and GRADE, respectively. Results Twenty-three trials were included, with meta-analyses including 1265 and 270 participants for PA and sedentary behaviour outcomes, respectively. PA interventions did not decrease sedentary behaviour (SMD=−0.19; 95% CI: −0.66 to 0.29; very low certainty of evidence), but did improve PA (SMD=0.16; 95% CI: 0.01 to 0.30; high certainty of evidence). This included improvements in step count (SMD=0.22; 95% CI: 0.05 to 0.40), but not moderate-to-vigorous PA (SMD=−0.01, 95% CI: −0.33 to 0.30). Interventions were most effective when they integrated wearable activity trackers (e.g., Fitbits; SMD=0.38; 95% CI: 0.18 to 0.57), behaviour change techniques (SMD=0.20, 95% CI: 0.01 to 0.39), and began less than two weeks after surgery (SMD=0.32, 95% CI: 0.14 to 0.50). Conclusion PA interventions, particularly those integrating behavioural strategies and wearable technology, promote PA in arthroplasty patients, but their effects on sedentary behaviour are unclear. These findings suggest that implementing evidence-based PA interventions be considered an essential component of acute arthroplasty care to enhance overall patient health.
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© 2025 The Author(s). Published by Elsevier Ltd on behalf of Osteoarthritis Research Society International. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).