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

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dc.contributor.authord'Unienville, N.
dc.contributor.authorSingh, B.
dc.contributor.authorGower, B.
dc.contributor.authorSzeto, K.
dc.contributor.authorBadger, H.
dc.contributor.authorKrywanio, M.
dc.contributor.authorMaher, C.
dc.contributor.authorThewlis, D.
dc.date.issued2025
dc.description.abstractObjective 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.
dc.description.statementofresponsibilityNoah d'Unienville, Ben Singh, Bethany Gower, Kimberley Szeto, Heather Badger, Matilda Krywanio, Carol Maher, Dominic Thewlis
dc.identifier.citationOsteoarthritis and Cartilage, 2025; 33(9):1066-1081
dc.identifier.doi10.1016/j.joca.2025.07.003
dc.identifier.issn1063-4584
dc.identifier.issn1522-9653
dc.identifier.orcidBadger, H. [0000-0003-0995-361X]
dc.identifier.orcidKrywanio, M. [0000-0001-7010-1358]
dc.identifier.orcidThewlis, D. [0000-0001-6614-8663]
dc.identifier.urihttps://hdl.handle.net/2440/148094
dc.language.isoen
dc.publisherElsevier
dc.relation.grantNHMRC
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/1126229
dc.relation.granthttp://purl.org/au-research/grants/arc/FT230100524
dc.rights© 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/).
dc.source.urihttps://doi.org/10.1016/j.joca.2025.07.003
dc.subjectarthroplasty; physical activity; sedentary behavior; behaviour change; step count; activity trackers
dc.subject.meshExercise Therapy
dc.subject.meshArthroplasty, Replacement, Hip
dc.subject.meshArthroplasty, Replacement, Knee
dc.subject.meshRandomized Controlled Trials as Topic
dc.subject.meshSedentary Behavior
dc.titleEffects 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
dc.typeJournal article
pubs.publication-statusPublished

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