Effects of Resistance Training Prior to Total Hip or Knee Replacement on Post-operative Recovery in Functional Performance: A Systematic Review and Meta-Analysis

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Objective: To evaluate the effectiveness of pre-operative resistance training in patients allocated to TJR surgery on selected post-operative outcomes, via a meta-analysis of studies using exercise modalities and loading intensities objectively known to promote gains in muscle size and strength in adults of young-to-old age.

Design: A systematic review and meta-analysis.

Literature Search: Cochrane Central, MEDLINE, EMBASE, and PEDro were searched on August 4th 2021.

Study Selection: Randomized Controlled Trials (RCTs) were included if (i) they compared pre-operative lower-limb-exercises before elective TJR with standard care, (ii) explicitly reported the exercise intensity, and (iii) reported data on functional performance.

Data Synthesis: This systematic review and meta-analysis is reported in accordance with the PRISMA reporting guidelines. A random effects model with an adjustment to the confidence interval was performed for pooling the data.

Results: One thousand studies were identified. After applying exclusion criteria, five RCTs were located including 256 participants (mean age ranged from 61 to 72 years, 54% women). Moderate-to-large improvements in functional performance and maximal knee extensor strength were observed at 3 months after surgery along with small-to-moderate effects 12 months post-operatively. For patient-reported outcomes, small-to-moderate improvements were observed at 3 months post-operatively with no-to-small improvements at 12 months.

Conclusion: Prehabilitation efforts involving progressive resistance training provides an effective means to improve post-operative outcomes related to functional performance, knee extensor strength and patient-reported outcome in patients undergoing TJR. Due to large methodological diversity between studies, an optimal loading intensity remains unknown.

Systematic Review Registration: Prospero ID: CRD42021264796.

Original languageEnglish
Article number924307
JournalFrontiers in Sport and Active Living
Number of pages19
Publication statusPublished - Jul 2022

    Research areas

  • ARTHROPLASTY, BLOOD-FLOW RESTRICTION, EFFICACY, FORCE DEVELOPMENT, GRADE, MUSCLE, OLDER-ADULTS, OUTCOMES, QUADRICEPS STRENGTH, QUALITY, functional performance, muscle strength, orthopedics, patient reported outcomes, prehabilitation

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